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The global population and status of Snowy Owls Bubo scandiacus are particularly challenging to assess because individuals are irruptive and nomadic, and the breeding range is restricted to the remote circumpolar Arctic tundra. The International Union for Conservation of Nature (IUCN) uplisted the Snowy Owl to “Vulnerable” in 2017 because the suggested population estimates appeared considerably lower than historical estimates, and it recommended actions to clarify the population size, structure, and trends. Here we present a broad review and status assessment, an effort led by the International Snowy Owl Working Group (ISOWG) and researchers from around the world, to estimate population trends and the current global status of the Snowy Owl. We use long-term breeding data, genetic studies, satellite-GPS tracking, and survival estimates to assess current population trends at several monitoring sites in the Arctic and we review the ecology and threats throughout the Snowy Owl range. An assessment of the available data suggests that current estimates of a worldwide population of 14,000–28,000 breeding adults are plausible. Our assessment of population trends at five long-term monitoring sites suggests that breeding populations of Snowy Owls in the Arctic have decreased by more than 30% over the past three generations and the species should continue to be categorised as Vulnerable under the IUCN Red List Criterion A2. We offer research recommendations to improve our understanding of Snowy Owl biology and future population assessments in a changing world.
Organic sweetpotato growers have limited effective weed management options, and most rely on in-season between-row cultivation and hand weeding, which are time consuming, are costly, and deteriorate soil quality. Studies were conducted at the Samuel G. Meigs Horticulture Research Farm, Lafayette, IN, and at the Southwest Purdue Agricultural Center, Vincennes, IN, in 2022 and 2023 to determine the effects of in-row plant spacing and cultivar selection on weed suppression and organic sweetpotato yield. The experiment was a split-split plot design, with in-row spacings of 20, 30, and 40 cm as the main plot factor, weeding frequency (critical weed-free period and weed-free) as the subplot factor, and sweetpotato cultivar (‘Covington’ and ‘Monaco’) as the sub-subplot factor. However, in 2022, we evaluated only in-row spacing and weeding frequency because of the poor establishment of ‘Monaco’. In 2023, sweetpotato canopy at 5 wk after transplanting (WAP) decreased as in-row spacing increased from 20 to 40 cm, and sweetpotato canopy cover of ‘Monaco’ (62%) was greater than that of ‘Covington’ (44%). In-row spacing did not affect weed density at 4, 5, and 6 WAP. As in-row spacing increased from 20 to 40 cm, total sweetpotato yield pooled across both locations in 2023 decreased from 30,223 to 21,209 kg ha−1 for ‘Covington’ and from 24,370 to 20,848 kg ha−1 for ‘Monaco’; however, jumbo yield increased for both cultivars. Findings from this study suggest that an in-row spacing of 20 cm may provide greater yield than the standard spacing of 30 cm for both ‘Monaco’ and ‘Covington’.
Fructose-containing sugars can exaggerate postprandial lipaemia and stimulate hepatic de novo lipogenesis (DNL) when compared to glucose-based carbohydrates(1). Galactose has recently been shown to increase postprandial lipaemia compared to glucose(2), but mechanisms remain uncharacterised. The aim of this study was to assess the effect and mechanisms of lactose-induced lipaemia.
Twenty-four non-obese adults (12 male and 12 female) completed three trials in a randomised, crossover design (28 ± 7-day washout). During trials, participants consumed test drinks containing 50 g fat with 100 g of carbohydrate. The control carbohydrate was a glucose polymer (maltodextrin), the experimental carbohydrate was galactose-containing carbohydrate (lactose) and the active comparator was fructose-containing carbohydrate (sucrose). Hepatic DNL was assessed by the 2H2O method and [U-13C]-palmitate was added to the test drink to trace the fate of the ingested fat. Blood and breath samples were taken to determine plasma metabolite and hormone concentrations, in addition to plasma and breath 2H and 13C enrichments. Data were converted into incremental under the curve (iAUC) and were checked for normality by visual inspection of residuals. Differences between trials were assessed by one-way ANOVA. Where a main effect of trial was detected, post- hoc t-tests were performed to determine which trials differed from lactose according to the principle of closed-loop testing.
The plasma triacylglycerol iAUC (mean ± SD) in response to maltodextrin was 51 ± 68 mmol/L*360 min. Following lactose ingestion, plasma triacylglycerol iAUC increased to 98 ± 88 mmol/L*360 min (p<0.001 vs maltodextrin), which was comparable to sucrose [90 ± 95 mmol/L*360 min (p=0.41 vs lactose)]. Hepatic DNL in response to maltodextrin was 6.6 ± 3.0%. Following ingestion of lactose, hepatic DNL increased to 12.4 ± 6.9% (p=0.02 vs maltodextrin), which was comparable to sucrose [12.2 ± 6.9% (p=0.96 vs lactose)]. Exhaled 13CO2 in response to maltodextrin was 10.4 ± 4.1 mmol/kgFFM*360 min. Following ingestion of lactose, exhaled 13CO2 was 8.8 ± 4.9 mmol/kgFFM*360 min (p=0.09 vs maltodextrin), which was lower than sucrose [11.1 ± 3.9 mmol/kgFFM*360 min (p=0.01 vs lactose)].
These data are consistent with the hypothesis that hepatic de novo lipogenesis contributes to both lactose and sucrose-induced lipaemia and provide a rationale to investigate the longer-term effects of lactose and sucrose on metabolism.
Medical researchers are increasingly prioritizing the inclusion of underserved communities in clinical studies. However, mere inclusion is not enough. People from underserved communities frequently experience chronic stress that may lead to accelerated biological aging and early morbidity and mortality. It is our hope and intent that the medical community come together to engineer improved health outcomes for vulnerable populations. Here, we introduce Health Equity Engineering (HEE), a comprehensive scientific framework to guide research on the development of tools to identify individuals at risk of poor health outcomes due to chronic stress, the integration of these tools within existing healthcare system infrastructures, and a robust assessment of their effectiveness and sustainability. HEE is anchored in the premise that strategic intervention at the individual level, tailored to the needs of the most at-risk people, can pave the way for achieving equitable health standards at a broader population level. HEE provides a scientific framework guiding health equity research to equip the medical community with a robust set of tools to enhance health equity for current and future generations.
This study examines the grazing management plans (GMPs) adoption and prioritization of environmental and economic objectives among U.S. cow-calf and stocker operations, utilizing 2020–2021 survey data and logistic regression analysis. Findings reveal regional adoption differences, with higher rates in the Midwest. Operations with succession plans, larger grazing lands, and stocker activities are more likely to adopt GMPs. Operations with more privately owned land and smaller herd sizes prefer environmental goals, while those with less grazing land prioritize economic outcomes due to resource concerns. The study provides insights for policies promoting GMP adoption and sustainability in the U.S. beef sector.
High-quality evidence is lacking for the impact on healthcare utilisation of short-stay alternatives to psychiatric inpatient services for people experiencing acute and/or complex mental health crises (known in England as psychiatric decision units [PDUs]). We assessed the extent to which changes in psychiatric hospital and emergency department (ED) activity were explained by implementation of PDUs in England using a quasi-experimental approach.
Methods
We conducted an interrupted time series (ITS) analysis of weekly aggregated data pre- and post-PDU implementation in one rural and two urban sites using segmented regression, adjusting for temporal and seasonal trends. Primary outcomes were changes in the number of voluntary inpatient admissions to (acute) adult psychiatric wards and number of ED adult mental health-related attendances in the 24 months post-PDU implementation compared to that in the 24 months pre-PDU implementation.
Results
The two PDUs (one urban and one rural) with longer (average) stays and high staff-to-patient ratios observed post-PDU decreases in the pattern of weekly voluntary psychiatric admissions relative to pre-PDU trend (Rural: −0.45%/week, 95% confidence interval [CI] = −0.78%, −0.12%; Urban: −0.49%/week, 95% CI = −0.73%, −0.25%); PDU implementation in each was associated with an estimated 35–38% reduction in total voluntary admissions in the post-PDU period. The (urban) PDU with the highest throughput, lowest staff-to-patient ratio and shortest average stay observed a 20% (−20.4%, CI = −29.7%, −10.0%) level reduction in mental health-related ED attendances post-PDU, although there was little impact on long-term trend. Pooled analyses across sites indicated a significant reduction in the number of voluntary admissions following PDU implementation (−16.6%, 95% CI = −23.9%, −8.5%) but no significant (long-term) trend change (−0.20%/week, 95% CI = −0.74%, 0.34%) and no short- (−2.8%, 95% CI = −19.3%, 17.0%) or long-term (0.08%/week, 95% CI = −0.13, 0.28%) effects on mental health-related ED attendances. Findings were largely unchanged in secondary (ITS) analyses that considered the introduction of other service initiatives in the study period.
Conclusions
The introduction of PDUs was associated with an immediate reduction of voluntary psychiatric inpatient admissions. The extent to which PDUs change long-term trends of voluntary psychiatric admissions or impact on psychiatric presentations at ED may be linked to their configuration. PDUs with a large capacity, short length of stay and low staff-to-patient ratio can positively impact ED mental health presentations, while PDUs with longer length of stay and higher staff-to-patient ratios have potential to reduce voluntary psychiatric admissions over an extended period. Taken as a whole, our analyses suggest that when establishing a PDU, consideration of the primary crisis-care need that underlies the creation of the unit is key.
Recent measurements of inertial particles in isotropic turbulence (Hammond & Meng, J. Fluid Mech., vol. 921, 2021, A16) revealed surprising extreme clustering of particles at near-contact separations $(r)$, whereby the radial distribution function, $g(r)$, grows from $O(10)$ to $O(10^3)$ with a $(r/a)^{-6}$ scaling (where $a$ is the particle radius), and a surprising upturn of the mean inward particle-pair relative velocity (MIRV). Hydrodynamic interactions (HIs) were proposed to explain the extreme clustering, but despite predicting the correct scaling $(r/a)^{-6}$, the HI theory underpredicted $g(r)$ by at least two orders of magnitude (Bragg et al., J. Fluid Mech., vol. 933, 2022, A31). To further understand the extreme clustering phenomenon and the relevance of HI, we characterize $g(r)$ and particle-pair kinematics for Stokes numbers $0.07 \leq St \leq 3.68$ in a homogeneous isotropic turbulence chamber using three-dimensional (3-D) particle tracking resolved to near–contact. A drift–diffusion equation governing $g(r)$ is presented to investigate the kinematic mechanisms of particle pairs. Measurements in all 24 conditions show that when $r/a\lessapprox 20$, extreme clustering consistently occurs, scaling as $g(r) \sim (r/a)^{-k}$ with $4.5 \leq k \leq 7.6$, which increases with $St$. Here $g(r)$ varies with $St$, particle size, density and polydispersity in ways that HI cannot explain. The extreme clustering region features an inward drift contributed by particle-pair turbophoresis and an inward radial relative acceleration. The latter indicates an interparticle attractive force at these separations that HI also cannot explain. The MIRV turns upward when approaching the extreme clustering region, opposite to direct numerical simulation predictions. These observations further support our previous assessment that extreme clustering arises from particle–particle interactions, but HI is not the main mechanism.
Sweetpotato [Ipomoea batatas (L.) Lam.] is a staple crop that provides nutritional benefits to humans globally, but it is subject to yield loss when competing with weeds, especially during the early stage of establishment. Yield loss can vary widely based on the cultivar, production environment, weed species, and management techniques. To address this challenge, we conducted field research at the Samuel G. Meigs Horticulture Research Farm, Lafayette, IN, and at the Southwest Purdue Agricultural Center, Vincennes, IN, in 2022 to determine the effect of sweetpotato cultivar on the critical weed-free period. The experiment was a split-plot design, with weed-free interval treatments as the main plot factor and cultivar as the subplot factor. The three cultivars used were ‘Covington’, ‘Monaco’, and ‘Murasaki’. Weeds were removed by hand and allowed to establish and compete with the crop beginning at 0, 14, 21, 28, 35, or 42 d after transplanting (DAP). As the weed-free interval increased from 0 to 42 DAP, predicted total yield increased from 19 kg ha−1 to 20,540 kg ha−1 for Covington, 3 kg ha−1 to 11,407 kg ha−1 for Monaco, and 125 kg ha−1 to 13,460 kg ha−1 for Murasaki at the Lafayette location. At Vincennes, as the weed-free interval increased from 0 to 42 DAP, predicted total yield increased from 14,664 kg ha−1 to 33,905 kg ha−1 for Covington, 4,817 kg ha−1 to 18,059 kg ha−1 for Monaco, and 12,735 kg ha−1 to 21,105 kg ha−1 for Murasaki. A threshold of ≤10% total yield reduction was achieved by maintaining sweetpotatoes weed-free 24 DAP for Covington, 20 DAP for Murasaki, and 33 DAP for Monaco.
Transient acquisition of methicillin-resistant Staphylococcus aureus (MRSA) on healthcare personnel (HCP) gloves and gowns following patient care has been examined. However, the potential for transmission to the subsequent patient has not been studied. We explored the frequency of MRSA transmission from patient to HCP, and then in separate encounters from contaminated HCP gloves and gowns to a subsequent simulated patient as well as the factors associated with these 2 transmission pathways.
Methods:
We conducted a prospective cohort study with 2 parts. In objective 1, we studied MRSA transmission from random MRSA-positive patients to HCP gloves and gowns after specific routine patient care activities. In objective 2, we simulated subsequent transmission from random HCP gloves and gowns without hand hygiene to the next patient using a manikin proxy.
Results:
For the first objective, among 98 MRSA-positive patients with 333 randomly selected individual patient–HCP interactions, HCP gloves or gowns were contaminated in 54 interactions (16.2%). In a multivariable analysis, performing endotracheal tube care had the greatest odds of glove or gown contamination (OR, 4.06; 95% CI, 1.3–12.6 relative to physical examination). For the second objective, after 147 simulated HCP–patient interactions, the subsequent transmission of MRSA to the manikin proxy occurred 15 times (10.2%).
Conclusion:
After caring for a patient with MRSA, contamination of HCP gloves and gown and transmission to subsequent patients following HCP-patient interactions occurs frequently if contact precautions are not used. Proper infection control practices, including the use of gloves and gown, can prevent this potential subsequent transmission.
COVID-19 misinformation proliferating online has led to adverse health and societal consequences. Older adults are a particularly vulnerable population due to increased risk for both COVID-19 related complications and susceptibility to, as well as sharing of, misinformation on social networking sites. The present study aimed to: 1) investigate differences in COVID-19 headline accuracy discernment and online sharing of COVID-19 misinformation in older and younger adults; and 2) examine individual differences in global cognition, health literacy and verbal IQ in online sharing of COVID-19 misinformation.
Participants and Methods:
Fifty-two younger (age 18 to 35 years) and fifty older adults (age 50 and older) completed a telephone neurocognitive battery, health literacy and numeracy measures and self-report questionnaires. Participants also completed a social media headline-sharing experiment (Pennycook et al.,2020) in which they were presented true and false COVID-19 headlines and asked to indicate: 1) the likelihood that they would share the story on social media; and 2) the factual accuracy of the story.
Results:
A repeated measures multivariate analysis of variance controlling for gender and race/ethnicity showed no effects of age (p=.099), but a significant interaction between actual COVID-19 headline accuracy and likelihood of sharing (p<.001), such that accuracy is more strongly related to sharing false headlines (r=-.64) versus true headlines (r=-.43). Moreover, higher likelihood of sharing false COVID-19 headlines was associated with lower verbal IQ and numeracy skills in older adults (rs=-.51--.40; ps<.01) and with lower verbal IQ, numeracy, and global cognition in younger adults (rs=-.66--.60; ps<.01).
Conclusions:
Findings indicate that headline accuracy judgements are an important predictor of sharing COVID-19 misinformation in both older and younger adults. Further, individual differences in cognition, IQ, and numeracy may predict the likelihood of misinformation sharing in younger adults, while IQ and numeracy skills may act as important antecedents of misinformation sharing in older adults. Future work might leverage modern, neuropsychologically-based psychoeducation approaches to improving health and science literacy related to COVID-19.
The gold standard for hand hygiene (HH) while wearing gloves requires removing gloves, performing HH, and donning new gloves between WHO moments. The novel strategy of applying alcohol-based hand rub (ABHR) directly to gloved hands might be effective and efficient.
Design:
A mixed-method, multicenter, 3-arm, randomized trial.
Setting:
Adult and pediatric medical-surgical, intermediate, and intensive care units at 4 hospitals.
Participants:
Healthcare personnel (HCP).
Interventions:
HCP were randomized to 3 groups: ABHR applied directly to gloved hands, the current standard, or usual care.
Methods:
Gloved hands were sampled via direct imprint. Gold-standard and usual-care arms were compared with the ABHR intervention.
Results:
Bacteria were identified on gloved hands after 432 (67.4%) of 641 observations in the gold-standard arm versus 548 (82.8%) of 662 observations in the intervention arm (P < .01). HH required a mean of 14 seconds in the intervention and a mean of 28.7 seconds in the gold-standard arm (P < .01). Bacteria were identified on gloved hands after 133 (98.5%) of 135 observations in the usual-care arm versus 173 (76.6%) of 226 observations in the intervention arm (P < .01). Of 331 gloves tested 6 (1.8%) were found to have microperforations; all were identified in the intervention arm [6 (2.9%) of 205].
Conclusions:
Compared with usual care, contamination of gloved hands was significantly reduced by applying ABHR directly to gloved hands but statistically higher than the gold standard. Given time savings and microbiological benefit over usual care and lack of feasibility of adhering to the gold standard, the Centers for Disease Control and Prevention and the World Health Organization should consider advising HCP to decontaminate gloved hands with ABHR when HH moments arise during single-patient encounters.
Background: To clarify the landscape of molecular diagnoses (MDs) in early-onset epilepsy individuals, we determined the prevalent MDs stratified by age at seizure onset (SO) and the time to MD in children with SO <36 months of life. Methods: A panel of up to 302 genes associated with epilepsy was utilized and ordering physicians provided the age of SO. Diagnostic yield analyses were performed for SO ages including <1 mo, 1-2 mo, 3-5 mo, 6-11 mo, 12-23 mo, and 24-35 mo. The time to MD (MD age - SO age) was determined for the top 10 genes in each SO category. Results: 15,074 individuals with SO <36 months of life were tested. Predominant MD findings are as follows: KCNQ2 in neonates with SO at <1mo, KCNQ2 and CDKL5 for SO between 1-2 mo, PRRT2 and SCN1A for SO between 3-11 mo, and SCN1A for SO between 12-36 months. The median time to MD varied by gene. For example, there was no delay in the median time to MD for the GLDC, KCNQ2, and SCN2A genes while the median delay for MECP2, SLC2A1, and other genes was ≥ 12 months. Conclusions: These data highlight the importance of comprehensive early testing in children with early-onset epilepsy.
Multiplex polymerase chain reaction (PCR) respiratory panels are rapid, highly sensitive tests for viral and bacterial pathogens that cause respiratory infections. In this study, we (1) described best practices in the implementation of respiratory panels based on expert perspectives and (2) identified tools for diagnostic stewardship to enhance the usefulness of testing.
Methods:
We conducted a survey of the Society for Healthcare Epidemiology of America Research Network to explore current and future approaches to diagnostic stewardship of multiplex PCR respiratory panels.
Results:
In total, 41 sites completed the survey (response rate, 50%). Multiplex PCR respiratory panels were perceived as supporting accurate diagnoses at 35 sites (85%), supporting more efficient patient care at 33 sites (80%), and improving patient outcomes at 23 sites (56%). Thirteen sites (32%) reported that testing may support diagnosis or patient care without improving patient outcomes. Furthermore, 24 sites (58%) had implemented diagnostic stewardship, with a median of 3 interventions (interquartile range, 1–4) per site. The interventions most frequently reported as effective were structured order sets to guide test ordering (4 sites), restrictions on test ordering based on clinician or patient characteristics (3 sites), and structured communication of results (2 sites). Education was reported as “helpful” but with limitations (3 sites).
Conclusions:
Many hospital epidemiologists and experts in infectious diseases perceive multiplex PCR respiratory panels as useful tests that can improve diagnosis, patient care, and patient outcomes. However, institutions frequently employ diagnostic stewardship to enhance the usefulness of testing, including most commonly clinical decision support to guide test ordering.
Hospital readmission is unsettling to patients and caregivers, costly to the healthcare system, and may leave patients at additional risk for hospital-acquired infections and other complications. We evaluated the association between comorbidities present during index coronavirus disease 2019 (COVID-19) hospitalization and the risk of 30-day readmission.
Design, setting, and participants:
We used the Premier Healthcare database to perform a retrospective cohort study of COVID-19 hospitalized patients discharged between April 2020 and March 2021 who were followed for 30 days after discharge to capture readmission to the same hospital.
Results:
Among the 331,136 unique patients in the index cohort, 36,827 (11.1%) had at least 1 all-cause readmission within 30 days. Of the readmitted patients, 11,382 (3.4%) were readmitted with COVID-19 as the primary diagnosis. In the multivariable model adjusted for demographics, hospital characteristics, coexisting comorbidities, and COVID-19 severity, each additional comorbidity category was associated with an 18% increase in the odds of all-cause readmission (adjusted odds ratio [aOR], 1.18; 95% confidence interval [CI], 1.17–1.19) and a 10% increase in the odds of readmission with COVID-19 as the primary readmission diagnosis (aOR, 1.10; 95% CI, 1.09–1.11). Lymphoma (aOR, 1.86; 95% CI, 1.58–2.19), renal failure (aOR, 1.32; 95% CI, 1.25–1.40), and chronic lung disease (aOR, 1.29; 95% CI, 1.24–1.34) were most associated with readmission for COVID-19.
Conclusions:
Readmission within 30 days was common among COVID-19 survivors. A better understanding of comorbidities associated with readmission will aid hospital care teams in improving postdischarge care. Additionally, it will assist hospital epidemiologists and quality administrators in planning resources, allocating staff, and managing bed-flow issues to improve patient care and safety.
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.
Cover crops can be utilized to suppress weeds via direct competition for sunlight, water, and soil nutrients. Research was conducted to determine if cover crops can be used in label-mandated buffer areas in 2,4-D-resistant soybean cropping systems. Delaying termination of cover crops containing cereal rye to at or after soybean planting resulted in a 25 to more than 200 percentage point increase in cover crop biomass compared to a control treatment. Cover crops generally improved horseweed control when 2,4-D was not used. Cover crops reduced grass densities up to 54% at four of six site-years when termination was delayed to after soybean planting. Cover crops did not reduce giant ragweed densities. Cover crops reduced waterhemp densities by up to 45%. Cover crops terminated at or after planting were beneficial within buffer areas for control of grasses and waterhemp, but not giant ragweed. Yield reductions of 14% to 41% occurred when cover crop termination was delayed to after soybean planting at three of six site-years. Terminating the cover crops at planting time provided suppression of grasses and waterhemp within buffer areas and had similar yield to the highest-yielding treatment in five out of six site-years.
Virtual platforms can provide a socially distanced mechanism by which to promote ongoing research progress in the coronavirus disease 2019 (COVID-19) era and may change our approach to online research in the future. Understanding how to best utilise online research represents an important task for our field.