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To investigate the symptoms of SARS-CoV-2 infection, their dynamics and their discriminatory power for the disease using longitudinally, prospectively collected information reported at the time of their occurrence. We have analysed data from a large phase 3 clinical UK COVID-19 vaccine trial. The alpha variant was the predominant strain. Participants were assessed for SARS-CoV-2 infection via nasal/throat PCR at recruitment, vaccination appointments, and when symptomatic. Statistical techniques were implemented to infer estimates representative of the UK population, accounting for multiple symptomatic episodes associated with one individual. An optimal diagnostic model for SARS-CoV-2 infection was derived. The 4-month prevalence of SARS-CoV-2 was 2.1%; increasing to 19.4% (16.0%–22.7%) in participants reporting loss of appetite and 31.9% (27.1%–36.8%) in those with anosmia/ageusia. The model identified anosmia and/or ageusia, fever, congestion, and cough to be significantly associated with SARS-CoV-2 infection. Symptoms’ dynamics were vastly different in the two groups; after a slow start peaking later and lasting longer in PCR+ participants, whilst exhibiting a consistent decline in PCR- participants, with, on average, fewer than 3 days of symptoms reported. Anosmia/ageusia peaked late in confirmed SARS-CoV-2 infection (day 12), indicating a low discrimination power for early disease diagnosis.
Liberty was in their hearts, but the old bondage was nevertheless perpetuated in their habits and, moreover, they were not united among themselves. Juan Bautista Alberdi
A number of recent publications have added to our knowledge of the century in which Argentina seems to have been transformed from a traditional colonial society into a modern and prosperous nation. Most of these new studies lean toward socioeconomic and sociopolitical analysis, testimony to the influence of Tulio Halperin Donghi's work on the Independence period and James Scobie's work on Buenos Aires. Because these two studies of the mid-1970s are so well known, this article will review only the literature that has appeared since. All modern scholars agree that the economy since 1820 expanded at least in the littoral region and that the century ended in an upsurge of technological innovation and export-led growth that extended even into the interior. Most also concur that the benefits of economic progress were not shared equally. The critical questions seem to be who got what and why?
The following three articles, together with this brief introduction, review the consequences of the paradigm shift in Latin American economic historiography from structuralism to the New Institutional Economics (NIE). Joseph Love analyzes the basic tenets of structuralism, their connection to dependency, the influence of CEPAL on policymaking, and how a generation of historians utilized the methodologies of structuralism to research historical problems in Latin American development. John H. Coatsworth's contribution correlates the decline of the structuralist model to the rise of research interests in the role of institutions in economic history and examines the latest long-range comparisons of productivity between the Latin American and U.S. economies. Commenting on the recent research utilizing the NIE, Coatsworth agrees with Love that the relative economic stagnation of the past quarter century may not render structuralism entirely irrelevant. Sandra Kuntz Ficker summarizes the basic positions held by the structuralist and dependentista schools with respect to commercial policy and concludes with a discussion of how the NIE contributes to innovative research on Latin American foreign trade. These articles resulted from the authors' participation in a LARR- sponsored panel at the 2004 Latin American Studies Association Congress.
Early in the COVID-19 pandemic, the World Health Organization stressed the importance of daily clinical assessments of infected patients, yet current approaches frequently consider cross-sectional timepoints, cumulative summary measures, or time-to-event analyses. Statistical methods are available that make use of the rich information content of longitudinal assessments. We demonstrate the use of a multistate transition model to assess the dynamic nature of COVID-19-associated critical illness using daily evaluations of COVID-19 patients from 9 academic hospitals. We describe the accessibility and utility of methods that consider the clinical trajectory of critically ill COVID-19 patients.
To quantify the impact of clinical guidance and rapid respiratory and meningitis/encephalitis multiplex polymerase chain reaction (mPCR) testing on the management of infants.
Design:
Before-and-after intervention study.
Setting:
Tertiary-care children’s hospital.
Patients:
Infants ≤90 days old presenting with fever or hypothermia to the emergency department (ED).
Methods:
The study spanned 3 periods: period 1, January 1, 2011, through December 31, 2014; period 2, January 1, 2015, through April 30, 2018; and period 3, May 1, 2018, through June 15, 2019. During period 1, no standardized clinical guideline had been established and no rapid pathogen testing was available. During period 2, a clinical guideline was implemented, but no rapid testing was available. During period 3, a guideline was in effect, plus mPCR testing using the BioFire FilmArray respiratory panel 2 (RP 2) and the meningitis encephalitis panel (MEP). Outcomes included antimicrobial and ancillary test utilization, length of stay (LOS), admission rate, 30-day mortality. Outcomes were compared across periods using Kruskal-Wallis and Pearson tests and interrupted time series analysis.
Results:
Overall 5,317 patients were included: 2,514 in period 1, 2,082 in period 2, and 721 in period 3. Over the entire study period, we detected reductions in the use of chest radiographs, lumbar punctures, LOS, and median antibiotic duration. After adjusting for temporal trends, we observed that the introduction of the guideline was associated with reductions in ancillary tests and lumbar punctures. Use of mPCR testing with the febrile infant clinical guideline was associated with additional reductions in ancillary testing for all patients and a higher proportion of infants 29–60 days old being managed without antibiotics.
Conclusions:
Use of mPCR testing plus a guideline for young infant evaluation in the emergency department was associated with less antimicrobial and ancillary test utilization compared to the use of a guideline alone.
This study investigated the characteristics of subjective memory complaints (SMCs) and their association with current and future cognitive functions.
Methods:
A cohort of 209 community-dwelling individuals without dementia aged 47–90 years old was recruited for this 3-year study. Participants underwent neuropsychological and clinical assessments annually. Participants were divided into SMCs and non-memory complainers (NMCs) using a single question at baseline and a memory complaints questionnaire following baseline, to evaluate differential patterns of complaints. In addition, comprehensive assessment of memory complaints was undertaken to evaluate whether severity and consistency of complaints differentially predicted cognitive function.
Results:
SMC and NMC individuals were significantly different on various features of SMCs. Greater overall severity (but not consistency) of complaints was significantly associated with current and future cognitive functioning.
Conclusions:
SMC individuals present distinctive features of memory complaints as compared to NMCs. Further, the severity of complaints was a significant predictor of future cognition. However, SMC did not significantly predict change over time in this sample. These findings warrant further research into the specific features of SMCs that may portend subsequent neuropathological and cognitive changes when screening individuals at increased future risk of dementia.
In a scandalous story reported about the caliph al-Maʾmūn (r. 813–33 CE), the opinionated dynast does the unthinkable. He decides to declare permissible that most controversial of unions: ‘pleasure’ (mutʿa) marriage, by which a man and woman were joined in wedlock only temporarily for some preset period of time. As remembered in Sunni sources, scholars in the caliph's court act quickly to correct the edict. They vociferously remind him that the Qurʾan and the Prophet's Sunna had made clear that mutʿa (also known as temporary marriage) was strictly prohibited. Some eight centuries later in India, during a meeting of his famed interfaith salon, the Mughal Emperor Akbar the Great (r. 1556–1605 CE) discovered to his chagrin that he had far, far exceeded a Muslim man's Shariʿa limit of only four wives at any one time. Tasking his thought, the emperor recalled that his shaykh, the staunch Sunni revivalist ʿAbd al-Nabī al-Gangūhī (d. 1583–4), had once remarked that an early Muslim scholar in Kufa had held that a Muslim could marry up to nine women. In response to a hasty correspondence sent by Akbar, ʿAbd al-Nabī clarified to his former charge and current sovereign that he had only noted this unusual opinion as an example of early juristic disagreement. No scholar could now actually give a ruling to that effect. Fortunately, the emperor's courtiers proved more pliant. One noted that Imāmī Shiʿites (true) and the Mālikī school of law (untrue) allowed a limitless number of wives if they were by mutʿa marriages. Akbar immediately appointed a presumably ill-informed Mālikī judge to declare all his marriages legal, with the emperor's advisors explaining (somewhat correctly) that all other judges in the realm would have to respect this ruling.
In recent decades, some Muslim intellectuals have revived al-Maʾmūn's and Akbar's call. In countries like Egypt, the occasional advocate of temporary marriage has argued for its suitability as a solution to the dire challenges facing Muslim youth, who find the socio-economic demands of normal marriage unmanageable.
Radiocarbon dating using charcoal and bone collagen, two standards of archaeological chronology, can be difficult to impossible in environments where natural burning is common and bone does not preserve well. In such settings, charcoal ages cannot always be trusted and collagen is unavailable. Calcined bone can be a viable alternative medium in these situations but it has rarely been exploited in the Americas. One area that could benefit from its use is the forested Pacific Northwest. We compare calcined bone ages with charcoal and/or collagen dates from individual features or discrete cultural strata in 10 Washington, Oregon, Idaho, and British Columbia sites dating between 9000 and 100 B.P. Resulting radiocarbon age estimates based on calcined bone closely match those based on charcoal and/or collagen in nearly all cases. We obtained calcined bone dates from three additional Holocene-aged sites that had not previously produced accurate results, obtaining findings consistent with estimates based on cross dating. Preserving well where all other organic media of cultural origin are lost or unreliable, calcined bone holds promise for dating sites in conifer forests and other acidic soil settings, and can allow researchers to refine archaeological sequences that have long defied accurate chronometric analysis.
HIV-associated cognitive impairments are prevalent, and are consistent with injury to both frontal cortical and subcortical regions of the brain. The current study aimed to assess the association of HIV infection with functional connections within the frontostriatal network, circuitry hypothesized to be highly vulnerable to HIV infection. Fifteen HIV-positive and 15 demographically matched control participants underwent 6 min of resting-state functional magnetic resonance imaging (RS-fMRI). Multivariate group comparisons of age-adjusted estimates of connectivity within the frontostriatal network were derived from BOLD data for dorsolateral prefrontal cortex (DLPFC), dorsal caudate and mediodorsal thalamic regions of interest. Whole-brain comparisons of group differences in frontostriatal connectivity were conducted, as were pairwise tests of connectivity associations with measures of global cognitive functioning and clinical and immunological characteristics (nadir and current CD4 count, duration of HIV infection, plasma HIV RNA). HIV – associated reductions in connectivity were observed between the DLPFC and the dorsal caudate, particularly in younger participants (<50 years, N=9). Seropositive participants also demonstrated reductions in dorsal caudate connectivity to frontal and parietal brain regions previously demonstrated to be functionally connected to the DLPFC. Cognitive impairment, but none of the assessed clinical/immunological variables, was also associated with reduced frontostriatal connectivity. In conclusion, our data indicate that HIV is associated with attenuated intrinsic frontostriatal connectivity. Intrinsic connectivity of this network may therefore serve as a marker of the deleterious effects of HIV infection on the brain, possibly via HIV-associated dopaminergic abnormalities. These findings warrant independent replication in larger studies. (JINS, 2015, 21, 1–11)