Previous observational studies suggested that vitamin D may control absorption of iron by inhibition of hepcidin, but the causal relevance of these associations is uncertain. Using placebo-controlled randomization, we assessed the effects of supplementation with vitamin D on biochemical markers of iron status and erythropoiesis in community-dwelling older people living in the United Kingdom (UK). The BEST-D trial, designed to establish the optimum dose of vitamin D3 for future trials, had 305 participants, aged 65 years or older, randomly allocated to 4000 IU vitamin D3 (n=102), 2000 IU vitamin D3 (n=102), or matching placebo (n=101). We estimated the effect of vitamin D allocation on plasma levels of hepcidin, soluble transferrin receptor (sTfR), ferritin, iron, transferrin, saturated transferrin (TSAT%), and the sTfR-ferritin index. Despite increases in 25-hydroxy-vitamin D, neither dose had significant effects on biochemical markers of iron status or erythropoiesis. Geometric mean concentrations were similar in vitamin D3 arms vs placebo for hepcidin (20.7 [SE 0.90] vs 20.5 [1.21] ng/mL), sTfR (0.69 [0.010] vs 0.70 [0.015] µg/mL), ferritin (97.1 [2.81] vs 97.8 [4.10] µg/L) and sTfR-ferritin ratio (0.36 [0.006] vs 0.36 [0.009]), respectively, while arithmetic mean levels were similar for iron (16.7 [0.38] vs 17.3 [0.54] µmol/L), transferrin (2.56 [0.014] vs 2.60 [0.021] g/dL), and TSAT% (26.5 [0.60] vs 27.5 [0.85]). The proportions of participants with ferritin <15 µg/L and TSAT<16% were unaltered by vitamin D3 suggesting that 12 months of daily supplementation with moderately high doses of vitamin D3 are unlikely to alter the iron status of older adults.

We describe an outbreak of Legionnaires’ disease linked to an exclusive cold-water source in a private residential setting in Yorkshire. The cold-water source was identified following microbiological testing of clinical and environmental samples. Legionella pneumophila was only detected in the cold-water system. Three cases were identified over the course of the outbreak: two confirmed and one probable. Conditions favourable to bacterial growth included system ‘dead legs’ and significant heat transfer to the cold-water system. We describe challenges in implementing control measures at the venue and highlight the importance of using enforcement powers, where necessary, to reduce risk.

Ichthyosauria, Plesiosauria, and Metriorhynchidae were apex predators in Mesozoic oceanic trophic networks. Previous stable oxygen isotope studies suggested that several taxa belonging to these groups were endothermic and that some of them were homeothermic organisms. However, these conclusions remain contentious owing to the associated uncertainties regarding the δ18O value and oxygen isotope fractionation relative to environmental seawater. Here, we present new bioapatite phosphate δ18O values (δ18Op) of Ichthyosauria, Plesiosauria, and Metriorhynchidae (Middle Jurassic to Early Cretaceous) recovered from mid- to high paleolatitudes to better constrain their thermophysiology and investigate the presence of regional heterothermies. The intraskeletal δ18Op variability failed to reveal distinct heterothermic patterns within any of the specimens, indicating either intrabody temperature homogeneity or an overriding diagenetic overprint of the original biological δ18Op bone record. Body temperature estimates have been reassessed from new and published δ18Op values of well-preserved isolated teeth, recently revised Mesozoic latitudinal δ18O oceanic gradients, and 18O-enrichment factors of fully aquatic air-breathing vertebrates. Our results confirm that Ichthyosauria were homeothermic endotherms (31°C to 41°C), while Plesiosauria were likely poikilothermic endotherms (27°C to 34°C). The new body temperature estimates of the Metriorhynchidae (25°C to 32°C) closely follow ambient temperatures and point to poikilothermic strategy with no or little endothermic ability. These results improve our understanding of Mesozoic marine reptile thermoregulation and indicate that due to their limited body temperature variations, the δ18Op values from Ichthyosauria fossil remains could be used as valuable archives of Mesozoic oceans δ18Osw values that may help improve paleoenvironmental and paleoclimatic reconstructions.

The conventional method of measuring ability, which is based on items with assumed true parameter values obtained from a pretest, is compared to a Bayesian method that deals with the uncertainties of such items. Computational expressions are presented for approximating the posterior mean and variance of ability under the three-parameter logistic (3PL) model. A 1987 American College Testing Program (ACT) math test is used to demonstrate that the standard practice of using maximum likelihood or empirical Bayes techniques may seriously underestimate the uncertainty in estimated ability when the pretest sample is only moderately large.

The depth distribution of illite/smectite (I/S) compositions was investigated for a well drilled to a depth of 3462 m on Barbados Island, the only subaerial exposure of the Barbados accretionary complex. The classical pattern of increasing percentage of illite interlayers in the mixed-layer clay with increasing burial depth was not observed. Rather, the data describe an irregular, zig-zag trend with depth. This trend is probably the result of reverse faulting in the section. I/S data were also used to infer several kilometers of uplift and subsequent erosion of the section. This study shows that irregular patterns of clay diagenesis with depth can be anticipated for sequences that have undergone complicated tectonism and deformation. Combined with other geologic information, these patterns can help to determine the tectonic history of the sedimentary sequence.

The California Department of Public Health (CDPH) reviewed 109 cases of healthcare personnel (HCP) with laboratory-confirmed mpox to understand transmission risk in healthcare settings. Overall, 90% of HCP with mpox had nonoccupational exposure risk factors. One occupationally acquired case was associated with sharps injury while unroofing a patient’s lesion for diagnostic testing.

We show that many graphs with bounded treewidth can be described as subgraphs of the strong product of a graph with smaller treewidth and a bounded-size complete graph. To this end, define the underlying treewidth of a graph class $\mathcal{G}$ to be the minimum non-negative integer $c$ such that, for some function $f$, for every graph $G \in \mathcal{G}$ there is a graph $H$ with $\textrm{tw}(H) \leqslant c$ such that $G$ is isomorphic to a subgraph of $H \boxtimes K_{f(\textrm{tw}(G))}$. We introduce disjointed coverings of graphs and show they determine the underlying treewidth of any graph class. Using this result, we prove that the class of planar graphs has underlying treewidth $3$; the class of $K_{s,t}$-minor-free graphs has underlying treewidth $s$ (for $t \geqslant \max \{s,3\}$); and the class of $K_t$-minor-free graphs has underlying treewidth $t-2$. In general, we prove that a monotone class has bounded underlying treewidth if and only if it excludes some fixed topological minor. We also study the underlying treewidth of graph classes defined by an excluded subgraph or excluded induced subgraph. We show that the class of graphs with no $H$ subgraph has bounded underlying treewidth if and only if every component of $H$ is a subdivided star, and that the class of graphs with no induced $H$ subgraph has bounded underlying treewidth if and only if every component of $H$ is a star.

Objectives: Few reports have been published about the transmission of mpox in healthcare settings. During the 2022 multinational outbreak, the California Department of Public Health (CDPH) conducted a systematic review of healthcare personnel (HCP) with mpox, including their community and occupational exposures, to understand the transmission risk in healthcare settings. We also sought to inform return-to-work protocols by describing the frequency of HCP working while symptomatic for mpox and identifying occurrences of secondary transmission from infected HCP to patients. Methods: We analyzed surveillance data for laboratory-confirmed mpox cases in California with symptom onset from May 17 to September 30, 2022, collected by investigators at local health departments and reported to the CDPH. The reported data were supplemented by review of free-text variables, interview notes, and other files uploaded to state and county disease surveillance data registries. We identified HCP as all persons working in healthcare settings with potential for direct or indirect exposure to patients or infectious materials, including clinical and nonclinical staff but excluding remote workers. Results: The CDPH received reports of 3,176 mpox cases during the study period: 109 were HCP. Of the 109 HCP identified from 19 counties, 78 (72%) were aged 30–49 years, 102 (94%) were male, and 43 (39%) were Hispanic or Latino. Also, 29 HCP (27%) had received at least 1 dose of the JYNNEOS vaccine. Occupations requiring frequent physical interactions with patients were reported for 66 individuals (61%). During interviews with local health department investigators, nearly all HCP (n = 98, 90%) reported potential or confirmed sources of community exposure; 1 had confirmed occupational exposure with symptom onset 9 days after a sharps injury acquired during collection of an mpox specimen for testing. Of the 60 HCP who provided information about the days they worked, 35 (58%) worked while symptomatic, for a mean of 3.14 days (median, 2; IQR, 3). Also, 2 HCP worked for 12 days after symptom onset. No secondary cases of mpox were associated with HCP reported to the CDPH. Conclusions: This analysis suggests that HCP are more likely to be exposed to mpox in community settings than healthcare settings. The findings support recommendations against sharps use for mpox specimen collection. Although transmission between symptomatic HCP and patients was not reported, HCP can decrease opportunities for mpox transmission by closely monitoring themselves for symptoms after potential exposures and staying home from work if symptoms develop.

Disclosures: None

Supraglacial ponds and ice cliffs can dramatically enhance ablation rates on debris-covered glaciers. Supraglacial ponds can also coalesce, forming moraine-dammed lakes at risk of glacial lake outburst flood (GLOF). Given Bhutanese glaciers have some of the highest ice loss rates in the Himalaya and GLOF vulnerability is high, we seek to advance our understanding of the spatial distribution and evolution of supraglacial ponds and ice cliffs. Here, we use high-resolution (3 m) Planet Labs satellite imagery to provide the first short-term, high-resolution dataset of supraglacial pond and ice cliff evolution for three glaciers along the Bhutan–Tibet border from 2016 to 2018. A total of 5754 ponds and 2088 ice cliffs were identified. Large intra-annual changes were observed, with ponded area changes and drainage events coinciding with the seasonality of the Indian Summer Monsoon. On average, ~19% of the total number of ponds had a coincident ice cliff. Pond spatial distribution was driven by ice-surface velocities, with higher numbers of ponds found in areas of low velocity (<8 m a−1). Our study provides the first detailed, quantitative investigation of supraglacial ponds and ice cliffs in Bhutan, providing a framework for further monitoring in this understudied, yet important, region of the Himalaya.

Prospective longitudinal studies of idiopathic autism spectrum disorder (ASD) have provided insights into early symptoms and predictors of ASD during infancy, well before ASD can be diagnosed at age 2–3 years. However, research on the emergence of ASD in disorders with a known genetic etiology, contextualized in a developmental framework, is currently lacking. Using a biobehavioral multimethod approach, we (a) determined the rate of ASD in N = 51 preschoolers with fragile X syndrome (FXS) using a clinical best estimate (CBE) procedure with differential diagnoses of comorbid psychiatric disorders and (b) investigated trajectories of ASD symptoms and physiological arousal across infancy as predictors of ASD in preschoolers with FXS. ASD was not diagnosed if intellectual ability or psychiatric disorders better accounted for the symptoms. Our results determined that 60.7% of preschoolers with FXS met the Diagnostic and Statistical Manual of Mental Disorders (fifth edition) (DSM-5) criteria for ASD using the CBE procedure. In addition, 92% of these preschoolers presented with developmental delay and 45.4% also met criteria for psychiatric disorders, either anxiety, ADHD, or both. ASD diagnoses in preschoolers with FXS were predicted by elevated scores on traditional ASD screeners in addition to elevated autonomic arousal and avoidant eye contact from infancy.

The scarcity of Romano-British human remains from north-west England has hindered understanding of burial practice in this region. Here, we report on the excavation of human and non-human animal remains1 and material culture from Dog Hole Cave, Haverbrack. Foetal and neonatal infants had been interred alongside a horse burial and puppies, lambs, calves and piglets in the very latest Iron Age to early Romano-British period, while the mid- to late Roman period is characterised by burials of older individuals with copper-alloy jewellery and beads. This material culture is more characteristic of urban sites, while isotope analysis indicates that the later individuals were largely from the local area. We discuss these results in terms of burial ritual in Cumbria and rural acculturation. Supplementary material is available online (https://doi.org/10.1017/S0068113X20000136), and contains further information about the site and excavations, small finds, zooarchaeology, human osteology, site taphonomy, the palaeoenvironment, isotope methods and analysis, and finds listed in Benson and Bland 1963.

Behavioral and psychological symptoms of dementia (BPSD), constitute a major clinical component of Alzheimer’s disease (AD). There is a growing interest in BPSD as they are responsible for a large share of the suffering of patients and caregivers, and they strongly determine the patient’s lifestyle and management. Better detection and understanding of these symptoms is essential to provide appropriate management. This article is a consensus produced by the behavioral group of the European Alzheimer’s Disease Consortium (EADC). The aim of this article is to present clinical description and biological correlates of the major behavioral and psychological symptomatology in AD. BPSD is not a unitary concept. Instead, it should be divided into several symptoms or more likely: groups of symptoms, each possibly reflecting a different prevalence, course over time, biological correlate and psychosocial determinants. There is some clinical evidence for clusters within groups of BPSD. Biological studies indicate that patients with AD and BPSD are associated with variations in the pathological features (atrophy, brain perfusion/metabolism, histopathology) when compared to people with AD without BPSD. An individually tailored approach taking all these aspects into account is warranted as it may offer more, and better, pharmacological and non-pharmacological treatment opportunities.