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Objectives/Goals: We describe the prevalence of individuals with household exposure to SARS-CoV-2, who subsequently report symptoms consistent with COVID-19, while having PCR results persistently negative for SARS-CoV-2 (S[+]/P[-]). We assess whether paired serology can assist in identifying the true infection status of such individuals. Methods/Study Population: In a multicenter household transmission study, index patients with SARS-CoV-2 were identified and enrolled together with their household contacts within 1 week of index’s illness onset. For 10 consecutive days, enrolled individuals provided daily symptom diaries and nasal specimens for polymerase chain reaction (PCR). Contacts were categorized into 4 groups based on presence of symptoms (S[+/-]) and PCR positivity (P[+/-]). Acute and convalescent blood specimens from these individuals (30 days apart) were subjected to quantitative serologic analysis for SARS-CoV-2 anti-nucleocapsid, spike, and receptor-binding domain antibodies. The antibody change in S[+]/P[-] individuals was assessed by thresholds derived from receiver operating characteristic (ROC) analysis of S[+]/P[+] (infected) versusS[-]/P[-] (uninfected). Results/Anticipated Results: Among 1,433 contacts, 67% had ≥1 SARS-CoV-2 PCR[+] result, while 33% remained PCR[-]. Among the latter, 55% (n = 263) reported symptoms for at least 1 day, most commonly congestion (63%), fatigue (63%), headache (62%), cough (59%), and sore throat (50%). A history of both previous infection and vaccination was present in 37% of S[+]/P[-] individuals, 38% of S[-]/P[-], and 21% of S[+]/P[+] (P<0.05). Vaccination alone was present in 37%, 41%, and 52%, respectively. ROC analyses of paired serologic testing of S[+]/P[+] (n = 354) vs. S[-]/P[-] (n = 103) individuals found anti-nucleocapsid data had the highest area under the curve (0.87). Based on the 30-day antibody change, 6.9% of S[+]/P[-] individuals demonstrated an increased convalescent antibody signal, although a similar seroresponse in 7.8% of the S[-]/P[-] group was observed. Discussion/Significance of Impact: Reporting respiratory symptoms was common among household contacts with persistent PCR[-] results. Paired serology analyses found similar seroresponses between S[+]/P[-] and S[-]/P[-] individuals. The symptomatic-but-PCR-negative phenomenon, while frequent, is unlikely attributable to true SARS-CoV-2 infections that go missed by PCR.
Social anhedonia, indicating reduced pleasure from social interaction, is heightened in autistic youth and associated with increased internalizing symptoms transdiagnostically. The stability of social anhedonia over time and its longitudinal impact on internalizing symptoms in autism have never been examined.
Methods
Participants were 276 autistic children (Mage = 8.60, SDage = 1.65; 211 male) with IQ ≥ 60 (MIQ = 96.74, SDIQ = 18.19). Autism severity was measured using the Autism Diagnostic Observation Schedule, Second Edition. Caregivers completed the Child and Adolescent Symptom Inventory, Fifth Edition (CASI-5) at baseline, 6 weeks, and 6 months. The CASI-5 includes a social anhedonia subscale derived from relevant items across domains. ICC (Intraclass Correlation Coefficient) analysis assessed stability, while cross-lagged panel models examined associations among social anhedonia, depression, and social anxiety across time.
Results
At baseline, social anhedonia correlated with autism severity, as well as parent-reported social anxiety and depression. Social anhedonia showed relative stability (ICC = 0.763) over 6 months, with a significant decline between baseline and 6 weeks (β = −0.52, p < .001). Cross-lagged models revealed a bidirectional relationship between social anhedonia and depression over time, while social anxiety displayed concurrent, but not predictive, associations across time.
Conclusions
Social anhedonia demonstrated stability over 6 months, suggesting that it may be a relatively stable characteristic in autistic children. Concurrent relationships were observed between social anhedonia and depression, as well as social anxiety and attention-deficit/hyperactivity disorder. Only depression demonstrated a bidirectional longitudinal association with social anhedonia. This bidirectional relationship aligns with developmental models linking early negative social experiences to subsequent internalizing symptoms in autistic children, underscoring the clinical significance of social anhedonia assessment in this population.
National policy in England recommends that young people be admitted to mental health wards that are age-appropriate. Despite this, young people continue to be admitted to adult wards.
Aims
To explore the impact of young people’s admissions to adult wards, from the perspectives of young people, parents/carers and mental health professionals working in adult services.
Method
Semi-structured interviews were conducted with 29 participants to explore experiences of receiving and delivering care in adult mental health wards. Participants were four young people (aged 16–17 years), four parents/carers and 21 mental health professionals from adult mental health services in England. Data were analysed using framework analysis.
Results
Young people’s admissions to adult wards tend to occur out of hours, at a time of crisis and when no suitable adolescent bed is available. Admissions were conceptualised as a short-term safety measure rather than for any therapeutic input. Concerns were raised about safeguarding, limited treatment options and a lack of education provision for young people on adult wards. However, exceptionally, for older adolescents, an adult ward might be clinically or socially appropriate. Recommendations to reduce adult ward admissions included better integration of adolescent and adult services, having more flexible policies and increasing community provision.
Conclusions
Our findings emphasise the importance of young people being admitted to age-appropriate in-patient facilities. Earlier intervention and increased provision of specialist care in the community could prevent young people’s admissions to adult wards.
The influence of grammatical gender on conceptual representations of gender has proven to be a controversial topic in the linguistic relativity literature, with empirical evidence in support of the Linguistic Relativity Hypothesis being highly task and context-dependent, as well as being modulated by the type of items being investigated (animates/inanimates). In this paper, we take a megastudy approach in order to investigate differences in results based on explicit and implicit paradigms that modulate the role of language and gender in their design. We present analyses of three experiments focussing on participants (total N = 4,621) with a grammatically gendered L1 (Czech), a non-grammatically gendered L1 (English) and L1-Czech in L2-English, and on three distinct semantic categories – people, animals and inanimates (total Nitems = 1,208). Our results indicate that the most reliable effects of grammatical gender influencing conceptual gender (outside of the domain of people) are observed for items representing animals, with Czech participants showing congruency effects in both explicit and implicit paradigms, even in their L2. The evidence for effects on inanimates is substantially weaker and is highly restrained to explicit tasks. We discuss these results in relation to the Linguistic Relativity Hypothesis and highlight important methodological considerations for future research.
Peripheral inflammatory markers, including serum interleukin 6 (IL-6), are associated with depression, but less is known about how these markers associate with depression at different stages of the life course.
Methods
We examined the associations between serum IL-6 levels at baseline and subsequent depression symptom trajectories in two longitudinal cohorts: ALSPAC (age 10–28 years; N = 4,835) and UK Biobank (39–86 years; N = 39,613) using multilevel growth curve modeling. Models were adjusted for sex, BMI, and socioeconomic factors. Depressive symptoms were measured using the Short Moods and Feelings Questionnaire in ALSPAC (max time points = 11) and the Patient Health Questionnaire-2 in UK Biobank (max time points = 8).
Results
Higher baseline IL-6 was associated with worse depression symptom trajectories in both cohorts (largest effect size: 0.046 [ALSPAC, age 16 years]). These associations were stronger in the younger ALSPAC cohort, where additionally higher IL-6 levels at age 9 years was associated with worse depression symptoms trajectories in females compared to males. Weaker sex differences were observed in the older cohort, UK Biobank. However, statistically significant associations (pFDR <0.05) were of smaller effect sizes, typical of large cohort studies.
Conclusions
These findings suggest that systemic inflammation may influence the severity and course of depressive symptoms across the life course, which is apparent regardless of age and differences in measures and number of time points between these large, population-based cohorts.
With wide-field phased array feed technology, the Australian Square Kilometre Array Pathfinder (ASKAP) is ideally suited to search for seemingly rare radio transient sources that are difficult to discover previous-generation narrow-field telescopes. The Commensal Real-time ASKAP Fast Transient (CRAFT) Survey Science Project has developed instrumentation to continuously search for fast radio transients (duration $\lesssim$ 1 s) with ASKAP, with a particular focus on finding and localising fast radio bursts (FRBs). Since 2018, the CRAFT survey has been searching for FRBs and other fast transients by incoherently adding the intensities received by individual ASKAP antennas, and then correcting for the impact of frequency dispersion on these short-duration signals in the resultant incoherent sum (ICS) in real time. This low-latency detection enables the triggering of voltage buffers, which facilitates the localisation of the transient source and the study of spectro-polarimetric properties at high time resolution. Here we report the sample of 43 FRBs discovered in this CRAFT/ICS survey to date. This includes 22 FRBs that had not previously been reported: 16 FRBs localised by ASKAP to $\lesssim 1$ arcsec and 6 FRBs localised to $\sim 10$ arcmin. Of the new arcsecond-localised FRBs, we have identified and characterised host galaxies (and measured redshifts) for 11. The median of all 30 measured host redshifts from the survey to date is $z=0.23$. We summarise results from the searches, in particular those contributing to our understanding of the burst progenitors and emission mechanisms, and on the use of bursts as probes of intervening media. We conclude by foreshadowing future FRB surveys with ASKAP using a coherent detection system that is currently being commissioned. This will increase the burst detection rate by a factor of approximately ten and also the distance to which ASKAP can localise FRBs.
If being asked to give to charity stimulates an emotional response, like empathy, that makes giving difficult to resist, a natural self-control mechanism might be to avoid being asked in the first place. We replicate a result from a field experiment that points to the role of empathy in giving. We conduct an experiment in a large superstore in which we solicit donations to charity and randomly allow shoppers the opportunity to avoid solicitation by using the other door. We find the rate of avoidance by store entrants to be 8.9 %. However, we also find that the avoidance effect disappears in very cold weather, suggesting that avoidance behavior is sensitive to its cost.
We examine the energy distribution of the fast radio burst (FRB) population using a well-defined sample of 63 FRBs from the Australian Square Kilometre Array Pathfinder (ASKAP) radio telescope, 28 of which are localised to a host galaxy. We apply the luminosity-volume ($V/V_{\mathrm{max}}$) test to examine the distribution of these transient sources, accounting for cosmological and instrumental effects, and determine the energy distribution for the sampled population over the redshift range $0.01 \lesssim z \lesssim 1.02$. We find the distribution between $10^{23}$ and $10^{26}$ J Hz$^{-1}$ to be consistent with both a pure power-law with differential slope $\gamma=-1.96 \pm 0.15$, and a Schechter function with $\gamma = -1.82 \pm 0.12$ and downturn energy $E_\mathrm{max} \sim 6.3 \, \times 10^{25}$ J Hz$^{-1}$. We identify systematic effects which currently limit our ability to probe the luminosity function outside this range and give a prescription for their treatment. Finally, we find that with the current dataset, we are unable to distinguish between the evolutionary and spectral models considered in this work.
Fast radio burst (FRB) science primarily revolves around two facets: the origin of these bursts and their use in cosmological studies. This work follows from previous redshift–dispersion measure (z–DM) analyses in which we model instrumental biases and simultaneously fit population parameters and cosmological parameters to the observed population of FRBs. This sheds light on both the progenitors of FRBs and cosmological questions. Previously, we have completed similar analyses with data from the Australian Square Kilometer Array Pathfinder (ASKAP) and the Murriyang (Parkes) Multibeam system. In this manuscript, we use 119 FRBs with 29 associated redshifts by additionally modelling the Deep Synoptic Array (DSA) and the Five-hundred-metre Aperture Spherical radio Telescope (FAST). We also invoke a Markov chain Monte Carlo (MCMC) sampler and implement uncertainty in the Galactic DM contributions. The latter leads to larger uncertainties in derived model parameters than previous estimates despite the additional data and indicate that precise measurements of DM$_\textrm{ISM}$ will be important in the future. We provide refined constraints on FRB population parameters and derive a new constraint on the minimum FRB energy of log $E_{\mathrm{min}}$(erg)=39.47$^{+0.54}_{-1.28}$ which is significantly higher than bursts detected from strong repeaters. This result likely indicates a low-energy turnover in the luminosity function or may alternatively suggest that strong repeaters have a different luminosity function to single bursts. We also predict that FAST will detect 25–41% of their FRBs at $z \gtrsim 2$ and DSA will detect 2–12% of their FRBs at $z \gtrsim 1$.
Fast radio bursts (FRBs) are short-duration radio transients that occur at random times in host galaxies distributed all over the sky. Large field of view instruments can play a critical role in the blind search for rare FRBs. We present a concept for an all-sky FRB monitor using a compact all-sky phased array (CASPA), which can efficiently achieve an extremely large field of view of $\sim10^4$ square degrees. Such a system would allow us to conduct a continuous, blind FRB search covering the entire southern sky. Using the measured FRB luminosity function, we investigate the detection rate for this all-sky phased array and compare the result to a number of other proposed large field-of-view instruments. We predict a rate of a few FRB detections per week and determine the dispersion measure and redshift distributions of these detectable FRBs. This instrument is optimal for detecting FRBs in the nearby Universe and for extending the high-end of the FRB luminosity function through finding ultraluminous events. Additionally, this instrument can be used to shadow the new gravitational-wave observing runs, detect high-energy events triggered from Galactic magnetars and search for other bright, but currently unknown transient signals.
A collaborative evaluation of remote consultations in mental health services was undertaken by mental health service providers, experts by experience, academic institutions and a Health Innovation Network in south London, UK. ‘Learning healthcare systems’ thinking was applied. Workstream 1 reviewed international published evidence; workstream 2 synthesised findings from three health provider surveys of the perceptions and experiences of staff, patients and carers; and workstream 3 comprised an electronic survey on local projects.
Results
Remote consultations can be acceptable to patients and staff. They improve access for some while restricting access for others, with digital exclusion being a key concern. Providing tailored choice is key.
Clinical implications
The collaboration generated learning to inform choices by healthcare providers to embed or adapt remote delivery. A key output was freely downloadable survey questions for assessing the quantity and quality of appointments undertaken by phone or video or face to face.
Recruiting and retaining research participants is challenging because it often requires overcoming structural barriers and addressing how histories of mistrust and individuals’ lived experiences affect their research engagement. We describe a pilot workshop designed to educate clinical research professionals on using empathy skills to recognize and mitigate bias to improve recruitment and retention. In a post-workshop survey (22/31 participants completed), 94% agreed the workshop helped them practice perspective-taking, recognize implicit bias, and identify opportunities for empathy. Participants reported increased confidence in key recruitment and retention skills (p < 0.05). Future studies will evaluate whether this translates into improved recruitment.
In response to the COVID-19 pandemic, we rapidly implemented a plasma coordination center, within two months, to support transfusion for two outpatient randomized controlled trials. The center design was based on an investigational drug services model and a Food and Drug Administration-compliant database to manage blood product inventory and trial safety.
Methods:
A core investigational team adapted a cloud-based platform to randomize patient assignments and track inventory distribution of control plasma and high-titer COVID-19 convalescent plasma of different blood groups from 29 donor collection centers directly to blood banks serving 26 transfusion sites.
Results:
We performed 1,351 transfusions in 16 months. The transparency of the digital inventory at each site was critical to facilitate qualification, randomization, and overnight shipments of blood group-compatible plasma for transfusions into trial participants. While inventory challenges were heightened with COVID-19 convalescent plasma, the cloud-based system, and the flexible approach of the plasma coordination center staff across the blood bank network enabled decentralized procurement and distribution of investigational products to maintain inventory thresholds and overcome local supply chain restraints at the sites.
Conclusion:
The rapid creation of a plasma coordination center for outpatient transfusions is infrequent in the academic setting. Distributing more than 3,100 plasma units to blood banks charged with managing investigational inventory across the U.S. in a decentralized manner posed operational and regulatory challenges while providing opportunities for the plasma coordination center to contribute to research of global importance. This program can serve as a template in subsequent public health emergencies.
Migrants and refugees face elevated risks for mental health problems but have limited access to services. This study compared two strategies for training and supervising nonspecialists to deliver a scalable psychological intervention, Group Problem Management Plus (gPM+), in northern Colombia. Adult women who reported elevated psychological distress and functional impairment were randomized to receive gPM+ delivered by nonspecialists who received training and supervision by: 1) a psychologist (specialized technical support); or 2) a nonspecialist who had been trained as a trainer/supervisor (nonspecialized technical support). We examined effectiveness and implementation outcomes using a mixed-methods approach. Thirteen nonspecialists were trained as gPM+ facilitators and three were trained-as-trainers. We enrolled 128 women to participate in gPM+ across the two conditions. Intervention attendance was higher in the specialized technical support condition. The nonspecialized technical support condition demonstrated higher fidelity to gPM+ and lower cost of implementation. Other indicators of effectiveness, adoption and implementation were comparable between the two implementation strategies. These results suggest it is feasible to implement mental health interventions, like gPM+, using lower-resource, community-embedded task sharing models, while maintaining safety and fidelity. Further evidence from fully powered trials is needed to make definitive conclusions about the relative cost of these implementation strategies.
To quantify the proportion of referrals sent to Crumlin Cardiology Department for cardiac screening prior to commencement or modifying attention deficit hyperactivity disorder medication and assess the number detected with a clinically significant abnormality.
Methods:
A prospective audit was performed over a 6-month period, from November 2021 to April 2022 inclusive. Referrals sent via outpatient department triage letters, electrocardiogram dept. email, and walk-in electrocardiogram service were screened for those pertaining to commencing or modifying medication for children with attention deficit hyperactivity disorder. Each referral was coded against National Institute for Health and Care Excellence guidelines to determine the degree of clinical details given. Reported abnormalities, recommended management, and correspondence were recorded.
Results:
Ninety-one referrals were received during the 6-month audit period. More than half lacked a clinical indication for referral (53/91, 58.2%), with fewer than one third (26/91, 28.5%) meeting National Institute for Health and Care Excellence criteria for referral for cardiology. Eighty (80/91) referrals had clinical outcomes available for review (missing outpatient department information and age outside of service range accounted for eleven referrals with unavailable clinical outcomes). Of the eighty clinically reviewed referrals, seventy-two (72/80, 90%) were reported as normal with no cardiology follow up required. Eight referrals (8/80, 10%) were reviewed in the Cardiology Outpatient Department prior to commencement or modifying attention deficit hyperactivity disorder medication. Of these, only one (1/80 1%) had a clinically significant abnormality which was a potential contraindication to attention deficit hyperactivity disorder medication use, and this referral was appropriate as per National Institute for Health and Care Excellence guidelines.
Conclusion:
Routine screening prior to attention deficit hyperactivity disorder medication prescription in the absence of clinical indications (as per National Institute for Health and Care Excellence) contributed to delays in medication initiation among young people with attention deficit hyperactivity disorder. Unnecessary referrals have resource implications for cardiology clinical team. Improved adherence to National Institute for Health and Care Excellence guidelines would provide benefits for patients and clinicians.
The accelerated rate of product development and design complexities offered by Additive Manufacturing (AM) has allowed for innovation in the space industry. However, the surface roughness of parts poses a challenge, as it impacts performance and is tied to design choices. Design tools for traditional manufacturing methods fall short in AM contexts, prompting the need for alternative design processes. This work proposes an experimental approach to design for AM investigation using design artefacts to explore a process-structure-property-performance relationship.
Empowering the Participant Voice (EPV) is an NCATS-funded six-CTSA collaboration to develop, demonstrate, and disseminate a low-cost infrastructure for collecting timely feedback from research participants, fostering trust, and providing data for improving clinical translational research. EPV leverages the validated Research Participant Perception Survey (RPPS) and the popular REDCap electronic data-capture platform. This report describes the development of infrastructure designed to overcome identified institutional barriers to routinely collecting participant feedback using RPPS and demonstration use cases. Sites engaged local stakeholders iteratively, incorporating feedback about anticipated value and potential concerns into project design. The team defined common standards and operations, developed software, and produced a detailed planning and implementation Guide. By May 2023, 2,575 participants diverse in age, race, ethnicity, and sex had responded to approximately 13,850 survey invitations (18.6%); 29% of responses included free-text comments. EPV infrastructure enabled sites to routinely access local and multi-site research participant experience data on an interactive analytics dashboard. The EPV learning collaborative continues to test initiatives to improve survey reach and optimize infrastructure and process. Broad uptake of EPV will expand the evidence base, enable hypothesis generation, and drive research-on-research locally and nationally to enhance the clinical research enterprise.
CHD is a significant risk factor for the development of necrotising enterocolitis. Existing literature does not differentiate between term and preterm populations. Long-term outcomes of these patients are not well understood. The aim was to investigate the baseline characteristics and outcomes of term normal birth weight infants with CHD who developed necrotising enterocolitis.
Methods:
A retrospective review was performed of infants from a single tertiary centre with CHD who developed necrotising enterocolitis of Bell’s Stage 1–3, over a ten-year period. Inclusion criteria was those born greater than 36 weeks’ gestation and birth weight over 2500g. Exclusion criteria included congenital gastro-intestinal abnormalities. Sub-group analysis was performed using Fisher’s exact test.
Results:
Twenty-five patients were identified, with a median gestational age of 38 weeks. Patients with univentricular physiology accounted for 32% (n = 8) and 52% of patients (n = 13) had a duct-dependent lesion. Atrioventricular septal defect was the most common cardiac diagnosis (n = 6, 24%). Patients with trisomy 21 accounted for 20% of cases. Mortality within 30 days of necrotising enterocolitis was 20%. Long-term mortality was 40%, which increased with increasing Bell’s Stage. In total, 36% (n = 9) required surgical management of necrotising enterocolitis, the rate of which was significantly higher in trisomy 21 cases (p < 0.05).
Conclusion:
Not previously described in term infants is the high rate of trisomy 21 and atrioventricular septal defect. This may reflect higher baseline incidence in our population. Infants with trisomy 21 were more likely to develop surgical necrotising enterocolitis. Mortality at long-term follow-up was high in patients with Bell’s Stage 2–3.
This paper integrates concepts from philosophy and Zen Buddhism in order to define the implications of an American Zen Master’s sermon about the 2009 financial crisis. It interprets three aspects of his sermon: his critique of modernity, his reflection on the experience of Zen meditation (shikan-taza), and his version of Buddhist ontology (tathāgata-garbha). The paper shows that his sermon is an innovative problematization of what it is to be a modern subject or, still more generally, what it is to exist historically. Each of its three aspects indicates a different, perhaps even opposed, response to this problem. Yet they all suggest new configurations of temporality, historicity, and Being. The paper argues that it is precisely this mobile adjacency to the dominant modernist perspective which makes the Zen Master’s sermon both ethically and intellectually effective. Recruiting him into a Nietzschean lineage, it concludes with a programmatic statement of how work in the human sciences could develop his insights.