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The global food system puts enormous pressure on the environment. Managing these pressures requires understanding not only where they occur (i.e., where food is produced), but also who drives them (i.e., where food is consumed). However, the size and complexity of global supply chains make it difficult to trace food production to consumption. Here, we provide the most comprehensive dataset of bilateral trade flows of environmental pressures stemming from food production from producing to consuming nations. The dataset provides environmental pressures for greenhouse gas emissions, water use, nitrogen and phosphorus pollution, and the area of land/water occupancy of food production for crops and animals from land, freshwater, and ocean systems. To produce these data, we improved upon reported food trade and production data to identify producing and consuming nations for each food item, allowing us to match food flows with appropriate environmental pressure data. These data provide a resource for research on sustainable global food consumption and the drivers of environmental impact.
During the COVID-19 pandemic, the United States Centers for Disease Control and Prevention provided strategies, such as extended use and reuse, to preserve N95 filtering facepiece respirators (FFR). We aimed to assess the prevalence of N95 FFR contamination with SARS-CoV-2 among healthcare personnel (HCP) in the Emergency Department (ED).
Design:
Real-world, prospective, multicenter cohort study. N95 FFR contamination (primary outcome) was measured by real-time quantitative polymerase chain reaction. Multiple logistic regression was used to assess factors associated with contamination.
Setting:
Six academic medical centers.
Participants:
ED HCP who practiced N95 FFR reuse and extended use during the COVID-19 pandemic between April 2021 and July 2022.
Primary exposure:
Total number of COVID-19-positive patients treated.
Results:
Two-hundred forty-five N95 FFRs were tested. Forty-four N95 FFRs (18.0%, 95% CI 13.4, 23.3) were contaminated with SARS-CoV-2 RNA. The number of patients seen with COVID-19 was associated with N95 FFR contamination (adjusted odds ratio, 2.3 [95% CI 1.5, 3.6]). Wearing either surgical masks or face shields over FFRs was not associated with FFR contamination, and FFR contamination prevalence was high when using these adjuncts [face shields: 25% (16/64), surgical masks: 22% (23/107)].
Conclusions:
Exposure to patients with known COVID-19 was independently associated with N95 FFR contamination. Face shields and overlying surgical masks were not associated with N95 FFR contamination. N95 FFR reuse and extended use should be avoided due to the increased risk of contact exposure from contaminated FFRs.
Multicenter clinical trials are essential for evaluating interventions but often face significant challenges in study design, site coordination, participant recruitment, and regulatory compliance. To address these issues, the National Institutes of Health’s National Center for Advancing Translational Sciences established the Trial Innovation Network (TIN). The TIN offers a scientific consultation process, providing access to clinical trial and disease experts who provide input and recommendations throughout the trial’s duration, at no cost to investigators. This approach aims to improve trial design, accelerate implementation, foster interdisciplinary teamwork, and spur innovations that enhance multicenter trial quality and efficiency. The TIN leverages resources of the Clinical and Translational Science Awards (CTSA) program, complementing local capabilities at the investigator’s institution. The Initial Consultation process focuses on the study’s scientific premise, design, site development, recruitment and retention strategies, funding feasibility, and other support areas. As of 6/1/2024, the TIN has provided 431 Initial Consultations to increase efficiency and accelerate trial implementation by delivering customized support and tailored recommendations. Across a range of clinical trials, the TIN has developed standardized, streamlined, and adaptable processes. We describe these processes, provide operational metrics, and include a set of lessons learned for consideration by other trial support and innovation networks.
Vitamin A deficiency (VAD) poses significant health risks and is prevalent in children and adolescents in India. This study aimed to determine the effect of seasonal variation and availability of vitamin A-rich (VA-rich) foods on serum retinol in adolescents. Data on serum retinol levels from adolescents (n 2297, mean age 14 years) from the Comprehensive National Nutrition Survey (2016–2018) in India were analysed, with VAD defined as serum retinol < 0·7 µmol/L. Five states were selected based on a comparable under-five mortality rate and the seasonal spread of the data collection period. Dietary data from adolescents and children ≤ 4 years old were used to assess VA-rich food consumption. A linear mixed model framework was employed to analyse the relationship between serum retinol, month of the year and VA-rich food consumption, with a priori ranking to control for multiple hypothesis testing. Consumption of VA-rich foods, particularly fruits and vegetables/roots and tubers, showed seasonal patterns, with higher consumption during summer and monsoon months. Significant associations were found between serum retinol concentrations and age, month of sampling, consumption of VA-rich foods and fish. VAD prevalence was lowest in August, coinciding with higher consumption of VA-rich fruits and foods. Findings highlight the importance of considering seasonality in assessing VAD prevalence and careful interpretation of survey findings. Intentional design, analysis and reporting of surveys to capture seasonal variation is crucial for accurate assessment and interpretation of VAD prevalence, including during monitoring and evaluation of programmes, and to ensure that public health strategies are appropriately informed.
The First Large Absorption Survey in H i (FLASH) is a large-area radio survey for neutral hydrogen in and around galaxies in the intermediate redshift range $0.4\lt z\lt1.0$, using the 21-cm H i absorption line as a probe of cold neutral gas. The survey uses the ASKAP radio telescope and will cover 24,000 deg$^2$ of sky over the next five years. FLASH breaks new ground in two ways – it is the first large H i absorption survey to be carried out without any optical preselection of targets, and we use an automated Bayesian line-finding tool to search through large datasets and assign a statistical significance to potential line detections. Two Pilot Surveys, covering around 3000 deg$^2$ of sky, were carried out in 2019-22 to test and verify the strategy for the full FLASH survey. The processed data products from these Pilot Surveys (spectral-line cubes, continuum images, and catalogues) are public and available online. In this paper, we describe the FLASH spectral-line and continuum data products and discuss the quality of the H i spectra and the completeness of our automated line search. Finally, we present a set of 30 new H i absorption lines that were robustly detected in the Pilot Surveys, almost doubling the number of known H i absorption systems at $0.4\lt z\lt1$. The detected lines span a wide range in H i optical depth, including three lines with a peak optical depth $\tau\gt1$, and appear to be a mixture of intervening and associated systems. Interestingly, around two-thirds of the lines found in this untargeted sample are detected against sources with a peaked-spectrum radio continuum, which are only a minor (5–20%) fraction of the overall radio-source population. The detection rate for H i absorption lines in the Pilot Surveys (0.3 to 0.5 lines per 40 deg$^2$ ASKAP field) is a factor of two below the expected value. One possible reason for this is the presence of a range of spectral-line artefacts in the Pilot Survey data that have now been mitigated and are not expected to recur in the full FLASH survey. A future paper in this series will discuss the host galaxies of the H i absorption systems identified here.
Prior reports of healthcare-associated respiratory syncytial virus (RSV) have been limited to cases diagnosed after the third day of hospitalization. The omission of other healthcare settings where RSV transmission may occur underestimates the true incidence of healthcare-associated RSV.
Design:
Retrospective cross-sectional study.
Setting:
United States RSV Hospitalization Surveillance Network (RSV-NET) during 2016–2017 through 2018–2019 seasons.
Patients:
Laboratory-confirmed RSV-related hospitalizations in an eight-county catchment area in Tennessee.
Methods:
Surveillance data from RSV-NET were used to evaluate the population-level burden of healthcare-associated RSV. The incidence of healthcare-associated RSV was determined using the traditional definition (i.e., positive RSV test after hospital day 3) in addition to often under-recognized cases associated with recent post-acute care facility admission or a recent acute care hospitalization for a non-RSV illness in the preceding 7 days.
Results:
Among the 900 laboratory-confirmed RSV-related hospitalizations, 41 (4.6%) had traditionally defined healthcare-associated RSV. Including patients with a positive RSV test obtained in the first 3 days of hospitalization and who were either transferred to the hospital directly from a post-acute care facility or who were recently discharged from an acute care facility for a non-RSV illness in the preceding 7 days identified an additional 95 cases (10.6% of all RSV-related hospitalizations).
Conclusions:
RSV is an often under-recognized healthcare-associated infection. Capturing other healthcare exposures that may serve as the initial site of viral transmission may provide more comprehensive estimates of the burden of healthcare-associated RSV and inform improved infection prevention strategies and vaccination efforts.
Aerosol-cloud interactions contribute significant uncertainty to modern climate model predictions. Analysis of complex observed aerosol-cloud parameter relationships is a crucial piece of reducing this uncertainty. Here, we apply two machine learning methods to explore variability in in-situ observations from the NASA ACTIVATE mission. These observations consist of flights over the Western North Atlantic Ocean, providing a large repository of data including aerosol, meteorological, and microphysical conditions in and out of clouds. We investigate this dataset using principal component analysis (PCA), a linear dimensionality reduction technique, and an autoencoder, a deep learning non-linear dimensionality reduction technique. We find that we can reduce the dimensionality of the parameter space by more than a factor of 2 and verify that the deep learning method outperforms a PCA baseline by two orders of magnitude. Analysis in the low dimensional space of both these techniques reveals two consistent physically interpretable regimes—a low pollution regime and an in-cloud regime. Through this work, we show that unsupervised machine learning techniques can learn useful information from in-situ atmospheric observations and provide interpretable results of low-dimensional variability.
We explore the role of targeted echocardiography as a screening tool for bicuspid aortic valve and left ventricular hypertrophy, specifically assessing the risk of missing significant cardiac findings that would otherwise be identified by comprehensive echocardiograms.
Method:
Children < 18 years at initial echocardiogram for indications of “family history of bicuspid aortic valve” and “left ventricular hypertrophy on electrocardiogram” were queried. Cardiology clinic notes and complete echocardiogram reports were reviewed for additional background histories and incidental findings. Follow-up clinic visits, if any, and management for those with incidental findings were reviewed.
Results:
Bicuspid aortic valve group included 138 patients, 71 (51%) males and mean age at comprehensive echo was 8.4 ± 4.8 years. Bicuspid aortic valve was found in 3.6%, incidental findings were found in 15 (11%), and follow-up was recommended in 4 (2.8%). Left ventricular hypertrophy group included 70 patients, 58 (83%) males and mean age at echo 10.9 ± 4.7 years. Left ventricular hypertrophy was found in 2.8%, incidental findings were found in 9 (13%), and follow-up was recommended in 2 (2.8%).
None of the follow-up group developed symptoms or required cardiac medications, exercise restrictions, or catheter or surgical-based interventions, except for one case of mild aortic root dilation who was restricted from heavy weightlifting.
Conclusion:
The risk of missing clinically important findings with targeted echocardiography that would have been identified with comprehensive echocardiography is extremely low for screening indications of isolated left ventricular hypertrophy on electrocardiogram or family history of bicuspid aortic valve, suggesting that targeted echocardiography could be an effective screening tool.
Gravity currents are a ubiquitous density-driven flow occurring in both the natural environment and in industry. They include: seafloor turbidity currents, primary vectors of sediment, nutrient and pollutant transport; cold fronts; and hazardous gas spills. However, while the energetics are critical for their evolution and particle suspension, they are included in system-scale models only crudely, so we cannot yet predict and explain the dynamics and run-out of such real-world flows. Herein, a novel depth-averaged framework is developed to capture the evolution of volume, concentration, momentum and turbulent kinetic energy from direct integrals of the full governing equations. For the first time, we show the connection between the vertical profiles, the evolution of the depth-averaged flow and the energetics. The viscous dissipation of mean-flow energy near the bed makes a leading-order contribution, and an energetic approach to entrainment captures detrainment of fluid through particle settling. These observations allow a reconsideration of particle suspension, advancing over 50 years of research. We find that the new formulation can describe the full evolution of a shallow dilute current, with the accuracy depending primarily on closures for the profiles and source terms. Critically, this enables accurate and computationally efficient hazard risk analysis and earth surface modelling.
Surfactant transport is central to a diverse range of natural phenomena with numerous practical applications in physics and engineering. Surprisingly, this process remains relatively poorly understood at the molecular scale. Here, we use non-equilibrium molecular dynamics (NEMD) simulations to study the spreading of sodium dodecyl sulphate on a thin film of liquid water. The molecular form of the control volume is extended to a coordinate system moving with the liquid–vapour interface to track surfactant spreading. We use this to compare the NEMD results to the continuum description of surfactant transport on an interface. By including the molecular details in the continuum model, we establish that the transport equation preserves substantial accuracy in capturing the underlying physics. Moreover, the relative importance of the different mechanisms involved in the transport process is identified. Consequently, we derive a novel exact molecular equation for surfactant transport along a deforming surface. Close agreement between the two conceptually different approaches, i.e. NEMD simulations and the numerical solution of the continuum equation, is found as measured by the surfactant concentration profiles, and the time dependence of the so-called spreading length. The current study focuses on a relatively simple specific solvent–surfactant system, and the observed agreement with the continuum model may not arise for more complicated industrially relevant surfactants and anti-foaming agents. In such cases, the continuum approach may fail to predict accompanying phase transitions, which can still be captured through the NEMD framework.
Inflammation and infections such as malaria affect concentrations of many micronutrient biomarkers and hence estimates of nutritional status. We aimed to assess the relationship between malaria infection and micronutrient biomarker concentrations in pre-school children (PSC), school-age children (SAC) and women of reproductive age (WRA) in Malawi and examine the potential role of malarial immunity on the relationship between malaria and micronutrient biomarkers. Data from the 2015/2016 Malawi micronutrient survey were used. The associations between current or recent malaria infection, detected by rapid diagnostic test and concentration of serum ferritin, soluble transferrin receptor (sTfR), zinc, serum folate, red blood cell folate and vitamin B12 were estimated using multivariable linear regression. Factors related to malarial immunity including age, altitude and presence of hemoglobinopathies were examined as effect modifiers. Serum ferritin, sTfR and zinc were adjusted for inflammation using the BRINDA method. Malaria infection was associated with 68 % (95 % CI 51, 86), 28 % (18, 40) and 34 % (13, 45) greater inflammation-adjusted ferritin in PSC, SAC and WRA, respectively (P < 0·001 for each). In PSC, the positive association was stronger in younger children, high altitude and children who were not carriers of the sickle cell trait. In PSC and SAC, sTfR was elevated (+ 25 % (16, 29) and + 15 % (9, 22) respectively, P < 0·001). Serum folate and erythrocyte folate were elevated in WRA with malaria (+ 18 % (3, 35) and + 11 % (1, 23), P = 0·01 and P = 0·003 respectively). Malaria affects the interpretation of micronutrient biomarker concentrations, and examining factors related to malarial immunity may be informative.
Objectives/Goals: Manual skin assessment in chronic graft-versus-host disease (cGVHD) can be time consuming and inconsistent (>20% affected area) even for experts. Building on previous work we explore methods to use unmarked photos to train artificial intelligence (AI) models, aiming to improve performance by expanding and diversifying the training data without additional burden on experts. Methods/Study Population: Common to many medical imaging projects, we have a small number of expert-marked patient photos (N = 36, n = 360), and many unmarked photos (N = 337, n = 25,842). Dark skin (Fitzpatrick type 4+) is underrepresented in both sets; 11% of patients in the marked set and 9% in the unmarked set. In addition, a set of 20 expert-marked photos from 20 patients were withheld from training to assess model performance, with 20% dark skin type. Our gold standard markings were manual contours around affected skin by a trained expert. Three AI training methods were tested. Our established baseline uses only the small number of marked photos (supervised method). The semi-supervised method uses a mix of marked and unmarked photos with human feedback. The self-supervised method uses only unmarked photos without any human feedback. Results/Anticipated Results: We evaluated performance by comparing predicted skin areas with expert markings. The error was given by the absolute difference between the percentage areas marked by the AI model and expert, where lower is better. Across all test patients, the median error was 19% (interquartile range 6 – 34) for the supervised method and 10% (5 – 23) for the semi-supervised method, which incorporated unmarked photos from 83 patients. On dark skin types, the median error was 36% (18 – 62) for supervised and 28% (14 – 52) for semi-supervised, compared to a median error on light skin of 18% (5 – 26) for supervised and 7% (4 – 17) for semi-supervised. Self-supervised, using all 337 unmarked patients, is expected to further improve performance and consistency due to increased data diversity. Full results will be presented at the meeting. Discussion/Significance of Impact: By automating skin assessment for cGVHD, AI could improve accuracy and consistency compared to manual methods. If translated to clinical use, this would ease clinical burden and scale to large patient cohorts. Future work will focus on ensuring equitable performance across all skin types, providing fair and accurate assessments for every patient.
Are you or someone you know struggling with hoarding disorder, feeling ashamed or guilty about your belongings, and afraid to let them go? It's more common than you might think, affecting up to 6% of the general population. But despite its prevalence, seeking help can be challenging. This new book provides a clear description of hoarding, exploring it as a symptom of other issues as well as a condition in its own right. You'll learn about different treatment options and find step-by-step guidance and tools for recovery in the self-help section. Personal narratives and case studies make this guide accessible and relatable for those affected by hoarding, as well as their loved ones and health professionals. Don't let hoarding disorder control your life - take the first step towards recovery today with this invaluable resource.
In this chapter we examine the idea of Hoarding Disorder. This relatively new diagnosis was first described in the American Psychiatric Association’s Diagnostic and Statistical Manual which was published in 2013. Hoarding Disorder is used to describe hoarding which is associated with an extreme attachment to items which are hoarded. Although people with Hoarding Disorder may suffer from other problems such as depression and anxiety, in Hoarding Disorder it is thought that the hoarding is not due to another diagnosis or problem. However, how Hoarding Disorder can present with other diagnoses, as well as the concept of conditions with increased risk taking and impulsivity and how they can be linked, even in the same person with increased compulsivity and avoidance of risk. Because the concept of Hoarding Disorder has only been described relatively recently, there is a lack of research in this area. Whereas Hoarding Disorder is often described in the elderly or late middle-aged, it is thought to have its roots in childhood. In this chapter we will examine the presentation of Hoarding Disorder in all age groups.
As well as examining the description and diagnosis of Hoarding Disorder, in this chapter we will also look at the risks inherent in the hoarding itself as well as the risk of suicide. Theories and research about the possible causes of Hoarding Disorder will be discussed.
In this chapter we will examine the substantial overlap, similarities, and also connections between people with Hoarding Disorder, Obsessive Compulsive Personality, Attention Deficit Hyperactivity Disorder, and Autism. The importance of ADHD in many people with hoarding will be examined along with a discussion about how the increasing recognition of a link between the two conditions has led to research into new ways of treating Hoarding Disorder. It is also recognised that autism interacts with hoarding as well as ADHD in a number of ways. Some people with autism are unable to tolerate any clutter at all whilst others hoard huge numbers of items due difficulty in decision-making. In addition, a substantial proportion of people with autism also have a diagnosis of OCD. As has already been discussed (Chapter 5), OCD may present with hoarding symptoms due to the nature of obsessive thoughts as well as Hoarding Disorder also.