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The increase in severe acute respiratory coronavirus virus 2 (SARS-CoV-2) cases due to the omicron strain led to reduced acute care hospital beds at the Veterans Administration (VA) Hospital, North Texas; veterans with non-severe coronavirus disease 2019 (COVID-19) disease were managed at a community living center (CLC), a VA nursing home. The management of non-severe COVID-19 in VA nursing homes has not been extensively described.
Methods:
We describe resident characteristics and outcomes, and infection control practices implemented during 2 COVID-19 outbreak periods (January 12–February 15, 2022, June 28–July 14, 2023). Serial testing of all CLC residents was conducted, and residents with polymerase chain reaction-confirmed SARS-CoV-2 (COVID-19) infection were included in the analysis. Resident data were ascertained from the COVID-19 facility dashboard and medical record system.
Results:
From January 12 to February 15, 2022, and June 28–July 14, 2023, 62 adults residing at the CLC were diagnosed with COVID-19. Overall, the median age was 75 years [interquartile range, 71–80], and 57 (91.9%) were men. Residents were cohorted by COVID-19 test results. A multidisciplinary team was convened, and staff were fit tested for appropriate personal protective equipment (PPE) and received refresher training on hand hygiene, donning, and doffing of PPE. Thirty-seven (59.7%) residents were symptomatic. Overall, 55 (88.7%) residents were documented to have received the SARS-CoV-2 primary vaccination series. Most residents were managed at the CLC, while 12 (19.3%) were hospitalized in acute care.
Conclusions:
It is feasible to manage high-risk residents with non-severe COVID-19 disease in a CLC utilizing a multidisciplinary approach and implementing Infection Prevention and Control strategies.
This study conceptually replicates Cepeda, Coburn, Rohrer, Wixted, Mozer, & Pashler’s (2009, Experiment 1) study on the effects of distributed practice on second language (L2) vocabulary learning to examine its generalizability to a new context and population sample. The secondary focus of the paper is to examine the challenges and affordances of online data collection and participant recruitment sites. Both the original and our study examined the effects of distributed practice on two study sessions to learn L2 vocabulary assessed on a 10-day delayed posttest. Our results showed that the spaced conditions significantly outperformed the massed condition, mirroring the original study’s findings. However, Cepeda et al.’s (2009) participants outscored our participants by 10–20% (in each experimental group) on the posttest. While these findings highlight the benefits of spacing towards learning and memory, they also underscore the challenges researchers may face when conducting experimental research in online environments.
OBJECTIVES/GOALS: Prematurity and perinatal brain injury are known risk factors for strabismus. In this study, we sought to understand the link between neonatal neuroimaging measures in very preterm infants and the emergence of strabismus later in life. Study findings may inform if neonatal brain MRI could serve as a prognostic tool for this visual disorder. METHODS/STUDY POPULATION: This study draws from a longitudinal cohort of very preterm infants (VPT, < 30 weeks gestation, range 23 – 29 weeks) who underwent an MRI scan at 36 to 43 weeks postmenstrual age (PMA). Anatomic and diffusion MRI data were collected for each child . A subset of thirty-three patients in this cohort had records of an eye exam, which were reviewed for a history of strabismus. Patients with MRI scans demonstrating cystic periventricular leukomalacia or grade III/IV intraventricular hemorrhage were classified as having brain injury. Clinical variables with a known association to strabismus or diffusion metrics were included in a multivariable logistic regression model. Diffusion tractography metrics were screened for association with strabismus on univariable analysis prior to inclusion in the regression model. RESULTS/ANTICIPATED RESULTS: A total of 17/33 (51.5%) patients developed strabismus. A logistic regression model including gestational age, PMA at MRI, retinopathy of prematurity (ROP) stage, brain injury, and fractional anisotropy of the right optic radiation was significant at the .001 level according to the chi-square statistic. The model predicted 88% of responses correctly. Each decrease of 0.01 in the fractional anisotropy of the right optic radiation increased the odds of strabismus by a factor of 1.5 (95% CI 1.03 – 2.06; p = .03). Patients with brain injury had 15.8 times higher odds of strabismus (95% CI 1.1 – 216.5; p = .04). Gestational age (OR 1.7; 95% CI 0.9 – 3.3; p = .1) and stage of ROP (OR 0.6; 95% CI 0.2 – 2.0; p = .4) were not significant predictors of strabismus in the multivariable model. DISCUSSION/SIGNIFICANCE: Our findings suggest that strabismus in VPT patients may be related to specific changes in brain structure in the neonatal period. The identified association between neonatal optic radiation microstructure and strabismus supports the possibility of using brain MRI in very preterm infants to prognosticate visual and ocular morbidity.
Northern Arizona University, Flagstaff, Arizona, USA, recently installed a MIni CArbon DAting System (MICADAS) with a gas interface system (GIS) for determining the 14C content of CO2 gas released by the acid dissolution of biogenic carbonates. We compare 48 paired graphite, GIS, and direct carbonate 14C determinations of individual mollusk shells and echinoid tests. GIS sample sizes ranged between 0.5 and 1.5 mg and span 0.1 to 45.1 ka BP (n = 42). A reduced major axis regression shows a strong relationship between GIS and graphite percent Modern Carbon (pMC) values (m = 1.011; 95% CI [0.997–1.023], R2 = 0.999) that is superior to the relationship between the direct carbonate and graphite values (m = 0.978; 95% CI [0.959-0.999], R2 = 0.997). Sixty percent of GIS pMC values are within ±0.5 pMC of their graphite counterparts, compared to 26% of direct carbonate pMC values. The precision of GIS analyses is approximately ±70 14C yrs to 6.5 ka BP and decreases to approximately ±130 14C yrs at 12.5 ka BP. This precision is on par with direct carbonate and is approximately five times larger than for graphite. Six Plio-Pleistocene mollusk and echinoid samples yield finite ages when analyzed as direct carbonate but yield non-finite ages when analyzed as graphite or as GIS. Our results show that GIS 14C dating of biogenic carbonates is preferable to direct carbonate 14C dating and is an efficient alternative to standard graphite 14C dating when the precision of graphite 14C dating is not required.
The electrochemical properties of kaolinite before and after modification with chlorodimethyl-octadecylsilane have been studied by electrophoretic mobility, surface charge titration, and extrapolated yield stress measurements as a function of pH and ionic strength. A heteropolar model of kaolinite, which views the particles as having a pH-independent permanent negative charge on the basal planes and a pH-dependent charge on the edges, has been used to model the data. The zeta potential and surface charge titration experimental data have been used simultaneously to calculate acid and ion complexation equilibrium constants using a surface complex model of the oxide-solution interface. The experimental data were modeled following subtraction of the basal plane constant negative charge, describing only the edge electrical double layer properties. Extrapolated yield stress measurements along with the electrochemical data were used to determine the edge isoelectric points for both the unmodified and modified kaolinite and were found to occur at pH values of 5.25 and 6.75, respectively. Acidity and ion complexation constants were calculated for both sets of data before and after surface modification. The acidity constants, pKa1 = 5.0 and pKa2 = 6.0, calculated for unmodified kaolinite, correlate closely with acidity constants determined by oxide studies for acidic sites on alumina and silica, respectively, and were, therefore, assigned to pH-dependent specific chemical surface hydroxyl groups on the edges of kaolinite. The parameters calculated for the modified kaolinite indicate that the silane has reacted with these pH-dependent hydroxyl groups causing both a change in their acidity and a concomitant decrease in their ionization capacity. Infrared data show that the long chain hydrocarbon silane is held by strong bonding to the kaolinite surface as it remains attached after washing with cyclohexane, heating, and dispersion in an aqueous environment.
The twenty-first volume of the Journal of Medieval Military History begins with three studies examining aspects of warfare in the Latin East: an archaeological report on the defenses of Jerusalem by Shimon Gibson and Rafael Y. Lewis; a study of how military victories and defeats (viewed through the lens of carefully shaped reporting) affected the reputation, and the flow of funds and recruits to, the Military Orders, by Nicolas Morton; and an exploration of how the Kingdom of Jerusalem quickly recovered its military strength after the disaster of Hattin by Stephen Donnachie. Turning to the other side of the Mediterranean, Donald J. Kagay analyzes how Jaime I of Aragon worked to control violence within his realms by limiting both castle construction and the use of mechanical artillery. Guilhem Pépin also addresses the limitation of violence, using new documents to show that the Black Prince's sack of Limoges in 1370 was not the unrestrained bloodbath described by Froissart. The remaining three contributions deal with aspects of open battle. Michael John Harbinson offers a large-scale study of when and why late-medieval men-at-arms chose to dismount and fight on foot instead of acting tactically as cavalry. Laurence W. Marvin reconsiders the Battle of Bouvines, concluding that it was far from being a ritualized mass duel. Finally, Michael Livingston elucidates some principles for understanding medieval battles in general, and the battle of Agincourt in particular.
The enhanced spatial and spectral resolution provided by the Compact Reconnaissance Imaging Spectrometer for Mars (CRISM) on the Mars Reconnaissance Orbiter (MRO) has led to the discovery of numerous hydrated silicate minerals on Mars, particularly in the ancient, cratered crust comprising the southern highlands. Phases recently identified using visible/near-infrared spectra include: smectite, chlorite, prehnite, high-charge phyllosilicates (illite or muscovite), the zeolite analcime, opaline silica, and serpentine. Some mineral assemblages represent the products of aqueous alteration at elevated temperatures. Geologic occurrences of these mineral assemblages are described using examples from west of the Isidis basin near the Nili Fossae and with reference to differences in implied temperature, fluid composition, and starting materials during alteration. The alteration minerals are not distributed homogeneously. Rather, certain craters host distinctive alteration assemblages: (1) prehnite-chloritesilica, (2) analcime-silica-Fe,Mg-smectite-chlorite, (3) chlorite-illite (muscovite), and (4) serpentine, which furthermore has been found in bedrock units. These assemblages contrast with the prevalence of solely Fe,Mg-smectites in most phyllosilicate-bearing terrains on Mars, and they represent materials altered at depth then exposed by cratering. Of the minerals found to date, prehnite provides the clearest evidence for subsurface, hydrothermal/metamorphic alteration, as it forms only under highly restricted conditions (T = 200–400°C). Multiple mechanisms exist for forming the other individual minerals; however, the most likely formation mechanisms for the characteristic mineralogic assemblages observed are, for (1) and (2), low-grade metamorphism or hydrothermal (<400°C) circulation of fluids in basalt; for (3), transformation of trioctahedral smectites to chlorite and dioctahedral smectites to illite during diagenesis; and for (4), low-grade metamorphism or hydrothermal (<400°C) circulation of fluids in ultramafic rocks. Evidence for high-grade metamorphism at elevated pressures or temperatures >400°C has not been found.
Liquid immiscibility has become the preferred mode of genesis for the carbonatite rocks, which commonly, but not exclusively, accompany silicate rocks in alkaline-rock complexes. This concept has been universally based on the presumption that nephelinitic and phonolitic magmas can evolve to a stage where two conjugate immiscible liquids separate. It is assumed that these two liquids separate quickly, or even instantaneously, into discrete bodies of magma capable of being intruded or extruded with subsequent independent crystallization. Supporting evidence generally given is: alleged consanguinity as discrete occurrence of the two rock types; similarity of radiogenic isotope ratios; trace element contents similar to those predicted from experimentally derived partition coefficients. We do not accept that a general case for liquid immiscibility has been demonstrated; although we do accept that silicate and carbonate liquids are inherently immiscible, we maintain that they are not conjugate in a petrogenetic context. We have reviewed and critically examined the experimental data purporting to establish liquid immiscibility and find that when applied to natural rocks, they are based on inappropriate experimental designs, which are not relevant to the genesis of calcite or dolomite carbonatites, although they might have some relevance to Oldoinyo Lengai nyerereite–gregoryite lavas. The design of these experiments guarantees immiscibility and ensures that the carbonate liquids formed will be calcitic or sodium-rich. We dispute the validity of comparing the trace element contents of natural rocks, which in many instances do not represent liquid compositions, to experimentally determine partition coefficients. We consider that experimental design inadequacies, principally assuming but not proving, that the liquids involved are conjugate, indicate that these coefficients are merely an expression of the preference of certain elements for particular liquids, regardless of how the liquids formed. Proof of consanguinity in alkaline complexes requires more accurate age determinations on the relevant rock types than has generally been the case, and in most complexes, consanguinity can be discounted. We dispute the contention that melt inclusions represent parental melts, although they might elucidate the character of magmas undergoing fractional crystallization from magmatic to carbothermal stages. Radiogenic isotope data are shown to be too widely variable to support a case for liquid immiscibility. We address the contention that calcite cannot crystallize from a dolomitic liquid formed by direct mantle melting, and must therefore have crystallized from a calcite carbonate liquid generated by liquid immiscibility, and demonstrate that it is an unsupported hypothesis as calcite can readily crystallize from dolomitic liquids. We observe that, because immiscible dolomite liquids have never been produced experimentally, the liquid immiscibility proposition could at best be applied only to calcite carbonatites, thus leaving unexplained the large number of dolomite carbonatites and those of either type, which are not accompanied by alkaline silicate rocks. The assumed bimodality of alkaline-rock carbonatite complexes is considered to be fallacious and no actual geological or petrographic evidence for immiscibility processes is evident in these complexes. Several examples of alkaline rock carbonatite complexes for which immiscibility has been proposed are evaluated critically and shown to fail in attempts to establish them as exemplifying immiscibility. We conclude that no actual geological or experimental data exist to establish liquid immiscibility being involved in the genesis of calcite or dolomite carbonatite-forming magmas.
The U.S. Department of Agriculture–Agricultural Research Service (USDA-ARS) has been a leader in weed science research covering topics ranging from the development and use of integrated weed management (IWM) tactics to basic mechanistic studies, including biotic resistance of desirable plant communities and herbicide resistance. ARS weed scientists have worked in agricultural and natural ecosystems, including agronomic and horticultural crops, pastures, forests, wild lands, aquatic habitats, wetlands, and riparian areas. Through strong partnerships with academia, state agencies, private industry, and numerous federal programs, ARS weed scientists have made contributions to discoveries in the newest fields of robotics and genetics, as well as the traditional and fundamental subjects of weed–crop competition and physiology and integration of weed control tactics and practices. Weed science at ARS is often overshadowed by other research topics; thus, few are aware of the long history of ARS weed science and its important contributions. This review is the result of a symposium held at the Weed Science Society of America’s 62nd Annual Meeting in 2022 that included 10 separate presentations in a virtual Weed Science Webinar Series. The overarching themes of management tactics (IWM, biological control, and automation), basic mechanisms (competition, invasive plant genetics, and herbicide resistance), and ecosystem impacts (invasive plant spread, climate change, conservation, and restoration) represent core ARS weed science research that is dynamic and efficacious and has been a significant component of the agency’s national and international efforts. This review highlights current studies and future directions that exemplify the science and collaborative relationships both within and outside ARS. Given the constraints of weeds and invasive plants on all aspects of food, feed, and fiber systems, there is an acknowledged need to face new challenges, including agriculture and natural resources sustainability, economic resilience and reliability, and societal health and well-being.
We present the third data release from the Parkes Pulsar Timing Array (PPTA) project. The release contains observations of 32 pulsars obtained using the 64-m Parkes ‘Murriyang’ radio telescope. The data span is up to 18 yr with a typical cadence of 3 weeks. This data release is formed by combining an updated version of our second data release with $\sim$3 yr of more recent data primarily obtained using an ultra-wide-bandwidth receiver system that operates between 704 and 4032 MHz. We provide calibrated pulse profiles, flux density dynamic spectra, pulse times of arrival, and initial pulsar timing models. We describe methods for processing such wide-bandwidth observations and compare this data release with our previous release.
In patients with bipolar disorder, depression symptoms are associated with greater reduction in function and quality of life than hypomania/mania symptoms. Lumateperone (LUMA), is an FDA-approved antipsychotic to treat schizophrenia and depressive episodes associated with bipolar I or bipolar II disorder.
In a recent phase 3 clinical trial (Study 404, NCT03249376) in people with bipolar depression, LUMA 42 mg monotherapy significantly improved symptoms of depression compared with placebo (PBO). This analysis of Study 404 investigated the effects of LUMA on functional disability and quality of life as measured using the secondary outcome measure, the Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF).
Methods
Patients (18–75 years) with bipolar I or bipolar II disorder experiencing a major depressive episode (Montgomery-Åsberg Depression Rating Scale [MADRS] Total score ≥20 and Clinical Global Impression Scale-Bipolar Version-Severity [CGI-BP-S] score ≥4) were randomized to LUMA 42 mg or PBO orally, once daily in the evening for 6 weeks. The primary endpoint was the change from baseline to Day 43 in MADRS Total score, analyzed using a mixed-effects model for repeated measures (MMRM) approach in the intent-to-treat population (ITT). This post hoc analysis evaluated the mean change from baseline to Day 43 in the Q-LES-Q-SF individual item scores using an analysis of covariance with last observation carried forward (ANCOVA-LOCF) in the ITT. Categorical shifts in individual items were also analyzed.
Results
The ITT comprised 376 patients (LUMA 42 mg, 188; PBO, 188). Patients in the LUMA 42 mg group had significantly greater improvement on MADRS Total score change from baseline to Day 43 compared with PBO (least squares mean difference vs PBO [LSMD], −4.585; 95% CI, −6.344 to −2.826; effect size vs PBO [ES], −0.56; P<.0001). LUMA 42 mg treatment significantly improved Q-LES-Q-SF Total score from baseline to Day 43 compared with PBO (LSMD, 2.9; 95% CI, 1.15 to 4.59; P=.001).
The Q-LES-Q-SF items with the lowest mean scores at baseline in both groups were mood, leisure time activities, and sexual drive, interest, and/or performance. By Day 43, LUMA 42 mg treatment significantly improved 8 of the 14 items in the Q-LES-Q-SF (P<0.05). Overall life satisfaction also significantly improved with LUMA treatment (P=.0016). The largest improvements with LUMA 42 mg compared with PBO (ES>0.3,) were seen for the ability to function in daily life, family relationships, household activities, leisure time activities, and mood (all LSMD=0.3; all P<.01).
Conclusion
In patients with bipolar depression, treatment with LUMA 42 mg compared with PBO significantly improved patient quality of life and functional impairment. These results support LUMA 42 mg as treatment of MDEs associated with bipolar I or bipolar II disorder in adults.
Maternal protein restriction is often associated with structural and functional sequelae in offspring, particularly affecting growth and renal-cardiovascular function. However, there is little understanding as to whether hypertension and kidney disease occur because of a primary nephron deficit or whether controlling postnatal growth can result in normal renal-cardiovascular phenotypes. To investigate this, female Sprague-Dawley rats were fed either a low-protein (LP, 8.4% protein) or normal-protein (NP, 19.4% protein) diet prior to mating and until offspring were weaned at postnatal day (PN) 21. Offspring were then fed a non ‘growth’ (4.6% fat) which ensured that catch-up growth did not occur. Offspring growth was determined by weight and dual energy X-ray absorptiometry. Nephron number was determined at PN21 using the disector-fractionator method. Kidney function was measured at PN180 and PN360 using clearance methods. Blood pressure was measured at PN360 using radio-telemetry. Body weight was similar at PN1, but by PN21 LP offspring were 39% smaller than controls (Pdiet < 0.001). This difference was due to proportional changes in lean muscle, fat, and bone content. LP offspring remained smaller than NP offspring until PN360. In LP offspring, nephron number was 26% less in males and 17% less in females, than NP controls (Pdiet < 0.0004). Kidney function was similar across dietary groups and sexes at PN180 and PN360. Blood pressure was similar in LP and NP offspring at PN360. These findings suggest that remaining on a slow growth trajectory after exposure to a suboptimal intrauterine environment does not lead to the development of kidney dysfunction and hypertension.
Structural racism in the USA has roots that extend deep into healthcare and medical research, and it remains a key driver of illness and early death for Black, Indigenous, People of Color (BIPOC). Furthermore, the persistence of racism within academic medicine compels an interrogation of education and research within this context. In the spirit of this interrogation, this article highlights a unique model of community-engaged education that integrates cultural humility. As an individual and institutional stance, cultural humility denotes lifelong learning and self-critique, the mitigation of power imbalances, and accountability. The integration of cultural humility emphasizes that when space is created for BIPOC communities to lead the way, education regarding healthcare and research can be effectively reimagined. Demonstrating this effectiveness, six community partners led the development and implementation of a five-module Structural Racism in Healthcare and Research course. Using a cohort model approach, the pilot course enrolled 12 community members and 12 researchers. The curriculum covered topics such as history of racism in healthcare and research, and introduced participants to a cultural resilience framework. Evaluation results demonstrated a significant increase in participants’ knowledge and ability to identify and take action to address inequities related to racism in healthcare and research.