Low vitamin D associated with high parathyroid hormone (PTH) is commonly reported in the context of HIV infection. We determined the association between total 25-hydroxyvitamin-D [25(OH)D] and PTH in adolescents living with HIV, in Zambia and Zimbabwe. Adolescents (11-19 years) perinatally-infected with HIV and established on antiretroviral therapy (ART) for ≥6 months were recruited into a cross-sectional study. Socio-demographic and clinical characteristics were recorded, anthropometry measured, and fasted serum concentrations of 1,25-dihydroxyvitamin-D (1,25(OH)2D), total 25(OH)D and intact PTH measured. The association between total 25(OH)D and PTH was examined using natural cubic spline regression modelling. 842 participants (female: 53.2%) with median age 15.5 (IQR:13.2-17.9) years were enrolled. Median ART duration was 9.8 [IQR:6.3-12.3] years and 165/841 (19.6%) had an HIV viral load >60copies/ml. Stunting (HAZ score<-2) and underweight (WAZ score<-2) were observed in 29.9% and 30.0% respectively. Three quarters (n=639) reported daily calcium intakes <150mg/day. The mean (SD) concentrations of total 25(OH)D and 1,25(OH)2D were 66.1(16.5) nmol/L and 210.6(70.4) pmol/L respectively, and median PTH level was 4.3 (IQR:3.3-5.5) pmol/L. There was an inverse non-linear relationship between total 25(OH)D and PTH, 25(OH)D levelling-off at 74.6nmol/L (95%CI: 74.5-75.2). Results were consistent in those taking tenofovir disoproxil fumarate (81.7%) and in those who were virally unsuppressed. In this population with extremely low habitual calcium intakes, the lack of association between 25(OH)D and PTH when 25(OH)D exceeded 75nmol/L, potentially suggests levels of 25(OH)D >75nmol/l may need to be achieved to improve bone health; investigation is needed in future research studies.

Mental health disorders are the leading cause of ill-health and disability, with depression and anxiety being among the most prevalent(1). There is a growing body of evidence to indicate that optimal nutrition can help to promote better mental health, while suboptimal dietary patterns or status of specific nutrients have been associated with a greater risk of depression and anxiety, but the evidence is conflicting(2,3,4,5). Therefore, the aim was to conduct a systematic review with metaanalyses to investigate the effect of interventions with specific nutrients or dietary patterns on mental health outcomes in adults.

Searches were conducted using the electronic bibliographic databases: MEDLINE, EMBASE and PsycINFO. The inclusion criteria were randomised controlled trials or controlled dietary interventions; study duration ≥ 12 weeks; participants aged ≥ 18 years old; outcome measures of depression or anxiety. The meta-analysis was conducted using Cochrane Review Manager Software (RevMan), version 5.4. The Risk of Bias and Quality of Evidence were assessed utilising the Cochrane Risk of Bias 2 tool and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework, respectively.

A total of 68 studies met the inclusion criteria: 5 investigated dietary patterns, while 63 were nutrient interventions, involving omega-3 (n = 22), vitamin D (n = 18), B-vitamins (n = 10), zinc (n = 7), iron (n = 1), vitamin D combined with calcium (n = 4), and omega-3 combined with vitamin D (n = 1). Insufficient studies were available to conduct a meta-analysis for any nutrient in relation to anxiety; all results relate to depression. Meta-analysis results showed that zinc intervention significantly reduced depression (standardised mean difference (SMD) in depression scores was −0.67; 95% Confidence Interval (95% CI) −0.96, −0.37); 4 studies, GRADE: moderate certainty). No significant effects on depression were reported in response to intervention with omega-3 fatty acids [SMD 0.26 (95% CI −0.64, 0.12); 10 studies, GRADE: moderate certainty] or vitamin D [SMD 0.07 (95% CI 0.34, 0.47); 10 studies, GRADE: moderate certainty], while there were insufficient studies to perform a meta-analysis for B-vitamins and depression. There was also no significant effect of the Mediterranean Diet on depression [SMD −0.95 (95% CI -1.90, 0.01); 3 studies, GRADE: high certainty], and insufficient studies for analysis of the Dietary Approaches to Stop Hypertension (DASH) diet.

The results indicate that zinc supplementation has beneficial effects on depression, but there were no significant effects of intervention with the Mediterranean Diet, omega-3 fatty acids or vitamin D. These meta-analyses are however based on a limited number of intervention studies and therefore no firm conclusions can be reached. Further intervention trials are required to fully investigate the effects of specific nutritional factors on mental health.

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.

The authors report on their development of a National Advisory Board (NAB) to guide a funded project: Two in One: HIV + COVID-19 Screening and Testing Model. This project aimed to improve primary care practitioners’ capacity to routinize HIV, PrEP/PEP, and COVID-19 vaccine screenings for all their patients while relying on culturally responsive communication with their minoritized patients. To approach their monumental research and education tasks, they created a NAB, drawing from the literature on advisory boards to (a) promote board member engagement and (b) progress successfully through the six stages suggested for successful advisory boards. A midpoint survey and final focus groups with NAB members indicated mixed levels of engagement, a sense of time and work being valued, and pride in the media and academic reach of the project. The authors offer considerations for others considering forming a NAB to guide primary care research and interventions.

Cosmological simulations fail to reproduce realistic galaxy populations without energy injection from active galactic nuclei (AGN) into the interstellar medium (ISM) and circumgalactic medium (CGM); a process called ‘AGN feedback’. Consequently, observational work searches for evidence that luminous AGN impact their host galaxies. Here, we review some of this work. Multi-phase AGN outflows are common, some with potential for significant impact. Additionally, multiple feedback channels can be observed simultaneously; e.g., radio jets from ‘radio quiet’ quasars can inject turbulence on ISM scales, and displace CGM-scale molecular gas. However, caution must be taken comparing outflows to simulations (e.g., kinetic coupling efficiencies) to infer feedback potential, due to a lack of comparable predictions. Furthermore, some work claims limited evidence for feedback because AGN live in gas-rich, star-forming galaxies. However, simulations do not predict instantaneous, global impact on molecular gas or star formation. The impact is expected to be cumulative, over multiple episodes.

Objective. The efficacy of individualized, community-based physical activity as an adjunctive smoking cessation treatment to enhance long-term smoking cessation rates was evaluated for the Lifestyle Enhancement Program (LEAP). Methods. The study was a two-arm, parallel-group, randomized controlled trial. All participants (n = 392) received cessation counseling and a nicotine patch and were randomized to physical activity (n = 199; YMCA membership and personalized exercise programming from a health coach) or an equal contact frequency wellness curriculum (n = 193). Physical activity treatment was individualized and flexible (with each participant selecting types of activities and intensity levels and being encouraged to exercise at the YMCA and at home, as well as to use “lifestyle” activity). The primary outcome (biochemically verified prolonged abstinence at 7-weeks (end of treatment) and 6- and 12-months postcessation) and secondary outcomes (7-day point prevalent tobacco abstinence (PPA), total minutes per week of leisure time physical activity and strength training) were assessed at baseline, 7 weeks, 6 months, and 12 months. Results. Prolonged abstinence in the physical activity and wellness groups was 19.6% and 25.4%, respectively, at 7-weeks, 15.1% and 16.6% at 6-months, and 14.1% and 17.1% at 12 months (all between-group P values >0.18). Similarly, PPA rates did not differ significantly between groups at any follow-up. Change from baseline leisure-time activity plus strength training increased significantly in the physical activity group at 7 weeks (P = 0.04). Across treatment groups, an increase in the number of minutes per week in strength training from baseline to 7 weeks predicted prolonged abstinence at 12 months (P ≤ 0.001). Further analyses revealed that social support, fewer years smoked, and less temptation to smoke were associated with prolonged abstinence over 12 months in both groups. Conclusions. Community-based physical activity programming, delivered as adjunctive treatment with behavioral/pharmacological cessation treatment, did not improve long-term quit rates compared to adjunctive wellness counseling plus behavioral/pharmacological cessation treatment. This trial is registered with https://beta.clinicaltrials.gov/study/NCT00403312, registration no. NCT00403312.

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.

We evaluated povidone-iodine (PVI) decolonization among 51 fracture-fixation surgery patients. PVI was applied twice on the day of surgery. Patients were tested for S. aureus nasal colonization and surveyed. Mean S. aureus concentrations decreased from 3.13 to 1.15 CFU/mL (P = .03). Also, 86% of patients stated that they felt neutral or positive about their PVI experience.

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.