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.

We use a comprehensive new dataset of asset-class returns in 38 developed countries to examine a popular class of retirement spending rules that prescribe annual withdrawals as a constant percentage of the retirement account balance. A 65-year-old couple willing to bear a 5 percent chance of financial ruin can withdraw just 2.31 percent per year, a rate materially lower than conventional advice (e.g., the 4% rule). Our estimates of failure rates under conventional withdrawal policies have important implications for individuals (e.g., savings rates, retirement timing, and retirement consumption), public policy (e.g., participation rates in means-tested programs), and society (e.g., elderly poverty rates).

Tree-afflicting pests, such as insects and pathogens, could change forests in ways promoting invasions by non-native plants. After tree death associated with the fungal pathogen oak wilt (Bretziella fagacearum (Bretz) Z.W. de Beer, Marincowitz, T.A. Duong & M.J. Wingfield) and its attempted containment (severing root connectivity and sanitation removal of infected trees), we examined change in cover of the non-native liana Oriental bittersweet (Celastrus orbiculatus Thunb.; hereafter Celastrus) at 28 sites in temperate black oak (Quercus velutina Lam.) forests, Ohio, USA. During our five-year study spanning 2020 to 2024, Celastrus cover increased significantly (P < 0.05) through time at oak wilt sites but not in untreated reference forest sites without evidence of oak wilt. Celastrus cover increased by an order of magnitude, up to an average of 32× among oak wilt treatments up to 10 years old. By 2024, Celastrus cover ranged from 6-22% on average in 5-10-year-old oak wilt treatments, compared with 1% cover in reference forest. Results indicate that non-native plant invasion accelerated following disturbance associated with a fungal pathogen and its attempted containment, and more generally, suggest that tree-afflicting pests can promote invasive plants in forests. Co-management of tree-afflicting pests and non-native plants may become increasingly important to ensure forests recovering from tree mortality are dominated by native plants.

A cyclical conditional maximum likelihood estimation procedure is developed for the multidimensional unfolding of two- or three-way dominance data (e.g., preference, choice, consideration) measured on ordered successive category rating scales. The technical description of the proposed model and estimation procedure are discussed, as well as the rather unique joint spaces derived. We then conduct a modest Monte Carlo simulation to demonstrate the parameter recovery of the proposed methodology, as well as investigate the performance of various information heuristics for dimension selection. A consumer psychology application is provided where the spatial results of the proposed model are compared to solutions derived from various traditional multidimensional unfolding procedures. This application deals with consumers intending to buy new luxury sport-utility vehicles (SUVs). Finally, directions for future research are discussed.

There is a growing awareness that diversity, health equity, and inclusion play a significant role in improving patient outcomes and advancing knowledge. The Pediatric Heart Network launched an initiative to incorporate diversity, health equity, and inclusion into its 2021 Scholar Award Funding Opportunity Announcement. This manuscript describes the process of incorporating diversity, health equity, and inclusion into the Pediatric Heart Network Scholar Award and the lessons learned. Recommendations for future Pediatric Heart Network grant application cycles are made which could be replicated by other funding agencies.

Efficient evidence generation to assess the clinical and economic impact of medical therapies is critical amid rising healthcare costs and aging populations. However, drug development and clinical trials remain far too expensive and inefficient for all stakeholders. On October 25–26, 2023, the Duke Clinical Research Institute brought together leaders from academia, industry, government agencies, patient advocacy, and nonprofit organizations to explore how different entities and influencers in drug development and healthcare can realign incentive structures to efficiently accelerate evidence generation that addresses the highest public health needs. Prominent themes surfaced, including competing research priorities and incentives, inadequate representation of patient population in clinical trials, opportunities to better leverage existing technology and infrastructure in trial design, and a need for heightened transparency and accountability in research practices. The group determined that together these elements contribute to an inefficient and costly clinical research enterprise, amplifying disparities in population health and sustaining gaps in evidence that impede advancements in equitable healthcare delivery and outcomes. The goal of addressing the identified challenges is to ultimately make clinical trials faster, more inclusive, and more efficient across diverse communities and settings.

Among the most widely distributed species globally, common reed [Phragmites australis (Cav.) Trin. ex Steud.] has generated extensive interest in invasive plant science and management because its introduced strains are highly invasive and often form monocultures that alter ecosystem properties. In desert wetlands in Las Vegas, NV, USA, where management goals included reducing hazardous P. australis fuels and increasing native plant diversity, we assessed variation in P. australis cover, the degree of native plant colonization, and soil seedbanks after P. australis management treatments (cutting, glyphosate–imazapyr herbicide) and wildfires across gradients in soil properties. Based on change in P. australis cover during six measurement events over 24 mo, 24 study sites formed three groups: (1) decreasing cover, where initially high P. australis cover (60% to 85%) decreased to <5% following multiple cutting or herbicide treatments; (2) sustaining low cover, where wildfire or clearing was associated with initially low P. australis cover which remained low (<30%) after multiple herbicide applications; and (3) sustaining high cover (45% to 100% initially and remaining at 30% to 100%), including sites unmanaged or treated/burned only once. High soil salinity correlated with low postmanagement P. australis cover. No native plants were detected in the sustaining high P. australis cover group, despite natives occurring in the seedbank. Where management reduced P. australis cover, minimal native plant colonization did occur. Secondary invasion by other non-native plants was nearly absent. Our results suggest that if P. australis can be initially cleared, multiple herbicide applications can persistently keep cover low, especially on drier, saline soils. Slow native plant colonization suggests that a phased approach may be useful to initially reduce P. australis cover, keep it low via repeated treatments, and actively revegetate sites with native species tailored to the moisture–salinity gradient across P. australis–invaded habitats.

People living with mental illness report a broad spectrum of nutrition risks, beyond malnutrition, but appropriate and adequately validated nutrition risk screening tools for mental health settings are lacking. This study aimed to develop a nutrition-risk screening tool, the NutriMental Screener, and to perform preliminary feasibility and validity testing. In an international, stakeholder engaging approach, a multifaceted nutrition-risk screening tool for mental health services was developed by means of workshops with international stakeholders and two online surveys. Feasibility of the NutriMental screener was tested as part of a research study in Switzerland with 196 participants, evenly distributed across the three study groups (sixty-seven outpatients and sixty-five inpatients with psychotic or depressive disorders as well as sixty-four controls without mental illness). The NutriMental screener consists of ten items covering different nutritional issues that indicate the need for referral to a dietitian or clinical nutritionist. Almost all patients (94·7 %) reported at least one nutrition risk by means of the NutriMental screener. Prevalence for nutrition risks via NutriMental screener was higher in patients than in controls. Almost every second patient expressed a desire for nutritional support (44·7 %). After further validity testing is completed, there is the potential for the NutriMental Screener to replace malnutrition screening tools as routine screening in various mental health settings aiming to organise nutritional therapy prescriptions in a more targeted and efficient manner.

Herbicides that persist in the forest litter and soil following their use for managing invasive plant species may negatively affect restoration efforts as well as minimize reinvasion via their residual phytotoxic activity. This study determined the impact of an herbicide mixture comprising triclopyr, dicamba, picloram, and aminopyralid (TDPA) for the control of dense infestations of a woody invader, Pinus contorta Douglas ex Loudon, on the germination of reinvading P. contorta and three New Zealand native species (Chionochloa rubra Zotov, Nothofagus cliffortiodes (Hook. f.) Oerst., and Leptospermum scoparium J.R. Forst. & G. Forst.) used in restoration. Given the essential role of ectomycorrhizal fungi in facilitating conifer reinvasion, the impact of residual herbicides present in mineral soil on the ectomycorrhizal infection of P. contorta seedling roots was also examined. Germination trials were conducted using intact forest litter–soil cores collected at 27, 112 and 480 d (after herbicide spraying) from sprayed and adjacent unsprayed dense P. contorta infestations. At the same time, mineral soil was also collected for the ectomycorrhizal infection study. Post-spray herbicide residue bound in the litter significantly decreased survival, germination rate, root and shoot growth, and also caused malformation of P. contorta seedlings. Similar results were recorded for native species’ germination; however, overall viability of native seed was poor, resulting in low germination rates. There was no difference in levels of ectomycorrhizal infection rates of P. contorta between treatments. Results indicate residual levels of TDPA herbicide in forest floor litter negatively affect P. contorta reinvasion, native recruitment, and active restoration management. Ectomycorrhizal fungi, however, are unaffected by this herbicide mixture and therefore remain a risk to facilitating reinvasion as residual herbicide declines.