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On July 28, 2022, eastern Kentucky experienced the state’s deadliest flood in recorded history. In response to ongoing mental health concerns from community members who survived the flood, local health department directors in affected communities requested technical assistance from the Kentucky Department for Public Health and the Centers for Disease Control and Prevention.
Methods
Two simultaneous Community Assessments for Public Health Emergency Response (CASPERs) were conducted 6 weeks after the flood. Four counties were assessed in each CASPER. EpiInfo7 was used to calculate the unweighted and weighted frequencies and percentages to estimate the number and percentage of households with a particular response in each CASPER.
Results
Approximately a third (30.5%) of households in CASPER 1 and approximately 40% of households in CASPER 2 reported experiencing ≥1 mental health problems. Individual-level mental health questions from a modified 3-stage CASPER found approximately 15% of persons in both CASPERs reported a Patient Health Questionnaire-2 (PHQ-2) score ≥3 and approximately 20% of persons in both CASPERs reported Generalized Anxiety Disorder-2 (GAD-2) score ≥3.
Conclusions
These findings indicated households experienced mental health problems after the flood. Depression and anxiety were prevalent among persons living in flood-affected areas. If ever needed, households preferred to receive mental health services in-person and locally.
Recent reports suggest the ON and OFF pathways are differentially susceptible to selective vision loss in glaucoma. Thus, perimetric assessment of ON- and OFF-pathway function may serve as a useful diagnostic. However, this necessitates a developed understanding of normal ON/OFF pathway function around the visual field and as a function of input intensity. Here, using electroencephalography, we measured ON- and OFF-pathway biased contrast response functions in the upper and lower visual fields. Using the steady-state visually evoked potential paradigm, we flickered achromatic luminance probes according to a saw-tooth waveform, the fast phase of which biased responses towards the ON or OFF pathways. Neural responses from the upper and lower visual fields were simultaneously measured using frequency tagging - probes in the upper visual field modulated at 3.75 Hz, while those in the lower visual field modulated at 3 Hz. We find that responses to OFF/decrements are larger than ON/increments, especially in the lower visual field. In the lower visual field, both ON and OFF responses were well described by a sigmoidal non-linearity. In the upper visual field, the ON pathway function was very similar to that of the lower, but the OFF pathway function showed reduced saturation and more cross-subject variability. Overall, this demonstrates that the relationship between the ON and OFF pathways depends on the visual field location and contrast level, potentially reflective of natural scene statistics.
On July 28, 2022, floods in eastern Kentucky displaced over 600 individuals. With the goal of understanding mental health needs of affected families, we surveyed households living in flood evacuation shelters after the 2022 Kentucky floods.
Methods
Families experiencing displacement from the 2022 Kentucky floods currently living in three different temporary shelter locations were surveyed via convenience sampling. A rapid community needs assessment involving in-person interviews using modified two stage cluster methodology (CASPER) was conducted between September 6-9, 2022.
Results
Teams conducted 61 household interviews. Since the flood, 27.7% reported that their household received services from behavioral health and 19.6% received grief counseling. Experiencing agitation (36.7%), difficulty concentrating (47.5%), nightmares (62.3%), or suicidal thoughts/self-harm (6.6%) were reported by households surveyed. Over one-fourth (27.0%) of individuals surveyed reported being depressed nearly every day. Over 20% reported anhedonia (inability to feel pleasure) nearly every day. Over 75% of individuals surveyed reported being anxious several days or more over the last two weeks. Over one-third of individuals (34.0%) reported being unable to stop worrying nearly every day. Of those individuals surveyed, 36.1% reported barriers to mental health services.
Conclusions
Symptoms of depressed mood, anhedonia, anxiety, and nightmares were prevalent in displaced families six weeks after the 2022 Kentucky floods. Providing and encouraging access to mental health services are important priorities during disaster recovery.
Background: Residence or recent stay in a long-term care facility (LTCF) is one of the most important risk factors for multidrug-resistant organism (MDRO) carriage and infection, making reliable identification of LTCF-exposed inpatients a critical priority for infection control day-to-day practice and research. However, because most hospital electronic health records (EHRs) do not include a dedicated field for documenting LTCF exposure, absent manual review of patient charts, identifying LTCF-exposed inpatients is challenging. We aimed to develop an automated, natural language processing (NLP)-based classifier for identifying LTCF exposure from clinical notes. Methods: We randomly sampled 1020 adult admissions from 2016-2021 across the 12-hospital University of Maryland Medical System and manually reviewed each admission’s history & physical (H&P) note for mention of LTCF exposure (Figure 1). After H&P pre-processing, we calculated feature representations for documents based on term frequencies and visually explored between-group (LTCF-exposed vs. LTCF-unexposed) feature differences. To predict LTCF status from the H&P notes, we trained and tuned a LASSO regression-based classifier on 70% of the data with 3-fold cross-validation and 1:1 up-sampling to address class imbalance. The final classifier was evaluated on the 30% held-out sample (not up-sampled), with calculation of the C-statistic (area-under-the-curve, AUC) with bootstrapped 95% confidence intervals, and construction of receiver-operating-characteristic and variable importance plots (R Version 4.3.2). Results: 7% (n=76 cases) of H&P notes documented LTCF exposure. In our visual analysis, the H&P words and phrases that were over-represented among LTCF patients had high face validity (Figure 2). The final LASSO-regression-based classifier achieved a C-statistic of 0.89 (95% CI: 0.80–0.98) on the held-out data for identifying LTCF exposure from the H&P notes (Figure 3). The most important model predictors (i.e., words) for distinguishing LTCF-exposed from LTCF-unexposed patients are reflected in Figure 4. The most important predictor-words of LTCF-exposure were “rehab,” “place,” “status,” “egd,” and “dementia.” Conclusion: In this multi-center study, even a simple NLP classifier demonstrated very strong discrimination for identifying LTCF exposure status from H&P notes, which could substantially reduce the manual review time required to identify LTCF-exposed inpatients. If automated in the electronic health record, it could also inform real-time MDRO screening decisions. Future research is planned to build more sophisticated classifiers using machine learning best practices, to build classifiers for additional MDRO risk factors, and to externally validate NLP classifiers on notes from an external healthcare system.
Identifying long-term care facility (LTCF)-exposed inpatients is important for infection control research and practice, but ascertaining LTCF exposure is challenging. Across a large validation study, electronic health record data fields identified 76% of LTCF-exposed patients compared to manual chart review.
Sedentary occupation of the southern Levantine coast spans from the Pre-Pottery Neolithic C to the Early Bronze Age Ib phase (c. 7000–3100 BC). Sites dating to the Early Pottery Neolithic (c. 6400–5500 BC) are scarce, however, potentially reflecting the effects of the 8.2ka climatic event. Here, the authors present the investigations at the submerged site of Habonim North off the Carmel Coast. Typological and radiocarbon dating indicate an Early Pottery Neolithic occupation and evidence for continuity of subsistence and economic strategies with both earlier and later Neolithic cultures. The results indicate the resilience of coastal communities in the face of significant climatic uncertainty and contribute to understanding human responses to environmental change.
Passive-microwave sea ice concentration (SIC) algorithms employ different frequencies and polarisations in their operational implementations. Commonly, these algorithms utilise combinations such as 19/37 GHz, yielding reduced measurement uncertainties but at a coarse spatial resolution. Alternatively, these algorithms can solely use 89 GHz, producing a higher spatial resolution but with increased measurement uncertainties. This study evaluates the application of a resolution-enhancing SIC algorithm (reSICCI3LF), initially developed for the coarser Special Sensor Microwave Imager / Sounder, on the Advanced Microwave Scanning Radiometer. By applying reSICCI3LF, we aim to produce a 5 km SIC for 2013–2020 in the Fram Strait and the Barents and Kara Sea region that gains the benefits of both types of algorithms, high spatial resolution and low measurement uncertainty.
We present the algorithm tuning, spectral analysis of spatial resolutions, and validation against the Round Robin Data Package of 0% and 100% SIC points and SIC derived from Landsat-8. The findings demonstrate that the reSICCI3LF algorithm produces a SIC field with fine details, achieving a balance between high spatial resolution and lower measurement uncertainties compared to a 89 GHz based SIC. Consequently, this resolution-enhanced SIC technique can potentially initialise higher-resolution coupled ocean and sea ice forecasting systems through data assimilation.
Chronic Kidney Disease (CKD) is a condition that leads to end-stage renal disease (ESRD), characterized by a gradual loss of kidney function. In 2021, the healthcare system expenditure of CKD in Australia was estimated to be over AUD2.3 billion (USD1.5 billion), largely attributed to Kidney Replacement Therapy (KRT, dialysis or kidney transplantation). This exploratory analysis aims to calculate the cost-benefit to the Australian healthcare system should KRT be delayed.
Methods
The prevalence of ESRD with and without KRT between 2016 and 2021 was estimated, and a simple linear regression model was created to estimate the prevalence of ESRD with KRT between 2022 and 2026. The projected cost of KRT management in 2022 was calculated, enabling an approximate cost benefit presented as the number of patients needed to reduce expenditure by AUD1 million (USD0.7 million).
Results
In 2021, it was calculated that 34,554 patients live with ESRD in Australia, of which 28,542 patients are on KRT. The number of new patients on KRT increases linearly by an average of 943 patients per year and provided a model with a strong goodness-of-fit (R2 = 0.99); predicting that the prevalence of patients on KRT is estimated to increase to 33,417 patients by 2026. Dialysis accounts for the highest cost associated with ESRD management, estimated to be AUD87,975/year/patient (USD58,253), and accounts for over AUD1.3 billion (USD0.9 billion) in annual expenditure. When considering the proportion of patients receiving KRT undergoing dialysis (52.6%), first-year renal transplant (3.4%), and post-kidney transplantation (43.9%), in 2022, the average annual cost per patient receiving KRT is estimated to be AUD57,565 (USD38,109). The prevention of KRT in 17.4 patients in 2022, decreasing to 15.4 patients in 2026, has the potential to save AUD1 million/year (USD0.7 million).
Conclusions
The prevalence of ESRD in Australia increases linearly and contributes to a significant cost to the Australian healthcare system. In 2022, preventing KRT in 17.4 patients (0.06%) can equate to a saving of AUD1 million/year (USD0.7 million), further decreasing to 15.4 patients (0.05%) in 2026.
The next generation of high-power lasers enables repetition of experiments at orders of magnitude higher frequency than what was possible using the prior generation. Facilities requiring human intervention between laser repetitions need to adapt in order to keep pace with the new laser technology. A distributed networked control system can enable laboratory-wide automation and feedback control loops. These higher-repetition-rate experiments will create enormous quantities of data. A consistent approach to managing data can increase data accessibility, reduce repetitive data-software development and mitigate poorly organized metadata. An opportunity arises to share knowledge of improvements to control and data infrastructure currently being undertaken. We compare platforms and approaches to state-of-the-art control systems and data management at high-power laser facilities, and we illustrate these topics with case studies from our community.
On February 24, 2022, Russia invaded Ukraine, resulting in Europe’s largest refugee crisis since World War II. More than six million Ukrainians fled the country—half of these to Poland—and one-third of the population was internally displaced.
Border points became bottlenecks where fatalities were reported—people risked their lives in long queues and subzero temperatures.
Method:
This presentation focuses on experiential information obtained during a 17-week deployment of EMT Type 1 both at border points (fixed) and in northwestern Ukraine (mobile). Quantitative and qualitative data were obtained after deployment by online survey with 75 medical, logistical and interpreter volunteers.
Results:
Initial teams experienced extremely fluid demands and numerous challenges with security, team adherence to COVID-19 protocols, behavioral issues with less experienced volunteers, and collaboration with novel governmental and non-governmental partners to achieve objectives.
Conclusion:
1. Deployment to a conflict setting requires adherence to the Incident Command System, with daily security briefings and structured handover between teams at the beginning of each deployment.
2. Strict adherence to well-defined protocols for the prevention and management of emerging infectious risks such as COVID-19 is necessary, along with contingency plans to isolate infected team members.
3. There is a need for standardized pre-deployment vetting, training and orientation of all volunteers—particularly team leaders.
4. Identification of international partners should start pre-deployment and remain a continuous process during deployment.
This chapter discusses responses to Thucydides’ History in the thousand-year period between the foundation of Constantinople in 330 CE and the appearance of the first translations of Thucydides in the late 14th century. The chapter describes the processes by which the text was preserved and transmitted and how it was read and understood in this period. It also explores the question of why the Byzantines were interested in Thucydides and the creative ways in which some Byzantine authors adapted or redeployed Thucydides’ work in their own writing.
A national survey characterized training and career development for translational researchers through Clinical and Translational Science Award (CTSA) T32/TL1 programs. This report summarizes program goals, trainee characteristics, and mentorship practices.
Methods:
A web link to a voluntary survey was emailed to 51 active TL1 program directors and administrators. Descriptive analyses were performed on aggregate data. Qualitative data analysis used open coding of text followed by an axial coding strategy based on the grounded theory approach.
Results:
Fifty out of 51 (98%) invited CTSA hubs responded. Training program goals were aligned with the CTSA mission. The trainee population consisted of predoctoral students (50%), postdoctoral fellows (30%), and health professional students in short-term (11%) or year-out (9%) research training. Forty percent of TL1 programs support both predoctoral and postdoctoral trainees. Trainees are diverse by academic affiliation, mostly from medicine, engineering, public health, non-health sciences, pharmacy, and nursing. Mentor training is offered by most programs, but mandatory at less than one-third of them. Most mentoring teams consist of two or more mentors.
Conclusions:
CTSA TL1 programs are distinct from other NIH-funded training programs in their focus on clinical and translational research, cross-disciplinary approaches, emphasis on team science, and integration of multiple trainee types. Trainees in nearly all TL1 programs were engaged in all phases of translational research (preclinical, clinical, implementation, public health), suggesting that the CTSA TL1 program is meeting the mandate of NCATS to provide training to develop the clinical and translational research workforce.
Evidence supporting collection of follow-up blood cultures for Gram-negative bacteremia is mixed. We sought to understand why providers order follow-up blood cultures when managing P. aeruginosa bacteremia and whether follow-up blood cultures in this context are associated with short- and long-term survival.
Methods:
We conducted a retrospective cohort study of adult inpatients with P. aeruginosa bacteremia at the University of Maryland Medical Center in 2015–2020. Kaplan-Meier survival curves and Cox regression with time-varying covariates were used to evaluate the association between follow-up blood cultures and time to mortality within 30 days of first positive blood culture. Provider justifications for follow-up blood cultures were identified through chart review.
Results:
Of 159 eligible patients, 127 (80%) had follow-up blood cultures, including 9 (7%) that were positive for P. aeruginosa and 10 (8%) that were positive for other organisms. Follow-up blood cultures were typically collected “to ensure clearance” or “to guide antibiotic therapy.” Overall, 30-day mortality was 25.2%. After risk adjustment for patient characteristics, follow-up blood cultures were associated with a nonsignificant reduction in mortality risk (hazard ratio, 0.43; 95% confidence interval, 1.08; P = .071). In exploratory analyses, the potential mortality reduction from follow-up blood cultures was driven by their use in patients with Pitt bacteremia scores >0.
Conclusions:
Follow-up blood cultures are commonly collected for P. aeruginosa bacteremia but infrequently identify persistent bacteremia. Targeted use of follow-up blood cultures based on severity of illness may reduce unnecessary culturing.
The regionalization of the Canadian party system is a topic that has occupied Canadian scholars for decades. While there have undoubtedly been periods of significant regionalization (for example, the 1990s) and while these periods have been well documented, there has been very little systematic study of regionalization/nationalization in the Canadian party system. We address this gap by exploring nationalization of the Canadian party system from 1867 to 2015. To do so, we apply two measures. First, we consider how nationalized party competition is by exploring the extent to which parties compete in districts across the entire country. Second, we compliment this approach by applying the Gini coefficient to vote shares, revealing the extent to which Canadian parties have (un)even electoral support from province to province. In doing so, we explore not only the system as a whole but individual parties as well.
Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.
Methods
We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
Results
16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).
Conclusions
PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
The CakeML compiler is, to the best of our knowledge, the most realistic verified compiler for a functional programming language to date. The architecture of the compiler, a sequence of intermediate languages through which high-level features are compiled away incrementally, enables verification of each compilation pass at an appropriate level of semantic detail. Parts of the compiler’s implementation resemble mainstream (unverified) compilers for strict functional languages, and it supports several important features and optimisations. These include efficient curried multi-argument functions, configurable data representations, efficient exceptions, register allocation, and more. The compiler produces machine code for five architectures: x86-64, ARMv6, ARMv8, MIPS-64, and RISC-V. The generated machine code contains the verified runtime system which includes a verified generational copying garbage collector and a verified arbitrary precision arithmetic (bignum) library. In this paper, we present the overall design of the compiler backend, including its 12 intermediate languages. We explain how the semantics and proofs fit together and provide detail on how the compiler has been bootstrapped inside the logic of a theorem prover. The entire development has been carried out within the HOL4 theorem prover.
Despite the lack of another Flagship-class mission such as Cassini–Huygens, prospects for the future exploration of Saturn are nevertheless encouraging. Both NASA and the European Space Agency (ESA) are exploring the possibilities of focused interplanetary missions (1) to drop one or more in situ atmospheric entry probes into Saturn and (2) to explore the satellites Titan and Enceladus, which would provide opportunities for both in situ investigations of Saturn’s magnetosphere and detailed remote-sensing observations of Saturn’s atmosphere. Additionally, a new generation of powerful Earth-based and near-Earth telescopes with advanced instrumentation spanning the ultraviolet to the far-infrared promise to provide systematic observations of Saturn’s seasonally changing composition and thermal structure, cloud structures and wind fields. Finally, new advances in amateur telescopic observations brought on largely by the availability of low-cost, powerful computers, low-noise, large-format cameras, and attendant sophisticated software promise to provide regular, longterm observations of Saturn in remarkable detail.
Different diagnostic interviews are used as reference standards for major depression classification in research. Semi-structured interviews involve clinical judgement, whereas fully structured interviews are completely scripted. The Mini International Neuropsychiatric Interview (MINI), a brief fully structured interview, is also sometimes used. It is not known whether interview method is associated with probability of major depression classification.
Aims
To evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics.
Method
Data collected for an individual participant data meta-analysis of Patient Health Questionnaire-9 (PHQ-9) diagnostic accuracy were analysed and binomial generalised linear mixed models were fit.
Results
A total of 17 158 participants (2287 with major depression) from 57 primary studies were analysed. Among fully structured interviews, odds of major depression were higher for the MINI compared with the Composite International Diagnostic Interview (CIDI) (odds ratio (OR) = 2.10; 95% CI = 1.15–3.87). Compared with semi-structured interviews, fully structured interviews (MINI excluded) were non-significantly more likely to classify participants with low-level depressive symptoms (PHQ-9 scores ≤6) as having major depression (OR = 3.13; 95% CI = 0.98–10.00), similarly likely for moderate-level symptoms (PHQ-9 scores 7–15) (OR = 0.96; 95% CI = 0.56–1.66) and significantly less likely for high-level symptoms (PHQ-9 scores ≥16) (OR = 0.50; 95% CI = 0.26–0.97).
Conclusions
The MINI may identify more people as depressed than the CIDI, and semi-structured and fully structured interviews may not be interchangeable methods, but these results should be replicated.
Declaration of interest
Drs Jetté and Patten declare that they received a grant, outside the submitted work, from the Hotchkiss Brain Institute, which was jointly funded by the Institute and Pfizer. Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain. Dr Chan is a steering committee member or consultant of Astra Zeneca, Bayer, Lilly, MSD and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr Hegerl declares that within the past 3 years, he was an advisory board member for Lundbeck, Servier and Otsuka Pharma; a consultant for Bayer Pharma; and a speaker for Medice Arzneimittel, Novartis, and Roche Pharma, all outside the submitted work. Dr Inagaki declares that he has received grants from Novartis Pharma, lecture fees from Pfizer, Mochida, Shionogi, Sumitomo Dainippon Pharma, Daiichi-Sankyo, Meiji Seika and Takeda, and royalties from Nippon Hyoron Sha, Nanzando, Seiwa Shoten, Igaku-shoin and Technomics, all outside of the submitted work. Dr Yamada reports personal fees from Meiji Seika Pharma Co., Ltd., MSD K.K., Asahi Kasei Pharma Corporation, Seishin Shobo, Seiwa Shoten Co., Ltd., Igaku-shoin Ltd., Chugai Igakusha and Sentan Igakusha, all outside the submitted work. All other authors declare no competing interests. No funder had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.