Network meta-analysis allows the synthesis of relative effects from several treatments. Two broad approaches are available to synthesize the data: arm-synthesis and contrast-synthesis, with several models that can be fitted within each. Limited evaluations comparing these approaches are available. We re-analyzed 118 networks of interventions with binary outcomes using three contrast-synthesis models (CSM; one fitted in a frequentist framework and two in a Bayesian framework) and two arm-synthesis models (ASM; both fitted in a Bayesian framework). We compared the estimated log odds ratios, their standard errors, ranking measures and the between-trial heterogeneity using the different models and investigated if differences in the results were modified by network characteristics. In general, we observed good agreement with respect to the odds ratios, their standard errors and the ranking metrics between the two Bayesian CSMs. However, differences were observed when comparing the frequentist CSM and the ASMs to each other and to the Bayesian CSMs. The network characteristics that we investigated, which represented the connectedness of the networks and rareness of events, were associated with the differences observed between models, but no single factor was associated with the differences across all of the metrics. In conclusion, we found that different models used to synthesize evidence in a network meta-analysis (NMA) can yield different estimates of odds ratios and standard errors that can impact the final ranking of the treatment options compared.

Objectives/Goals: To explore the caregivers’ lived experiences related to facilitators of and barriers to effective primary care or neurology follow-up for children discharged from the pediatric emergency department (PED) with headaches. Methods/Study Population: We used the descriptive phenomenology qualitative study design to ascertain caregivers’ lived experiences with making follow-up appointments after their child’s PED visit. We conducted semi-structured interviews with caregivers of children with headaches from 4 large urban PEDs over HIPAA-compliant Zoom conferencing platform. A facilitator/co-facilitator team (JH and SL) guided all interviews, and the audio of which was transcribed using the TRINT software. Conventional content analysis was performed by two coders (JH and AS) to generate new themes, and coding disputes were resolved by team members using Atlas TI (version 24). Results/Anticipated Results: We interviewed a total of 11 caregivers (9 mothers, 1 grandmother, and 1 father). Among interviewees, 45% identified as White non-Hispanic, 45% Hispanic, 9% as African-American, and 37% were publicly insured. Participants described similar experiences in obtaining follow-up care that included long waits to obtain neurology appointments. Participants also described opportunities to overcome wait times that included offering alternative healthcare provider types as well as telehealth options. Last, participants described desired action while awaiting neurology appointments such as obtaining testing and setting treatment plans. Discussion/Significance of Impact: Caregivers perceived time to appointment as too long and identified practical solutions to ease frustrations while waiting. Future research should explore sharing caregiver experiences with primary care providers, PED physicians, and neurologists while developing plans to implement caregiver-informed interventions.

The classical trinity of tests is used to check for the presence of a tremble in economic experiments in which the response variable is binary. A tremble is said to occur when an agent makes a decision completely at random, without regard to the values taken by the explanatory variables. The properties of the tests are discussed, and an extension of the methodology is used to test for the presence of a tremble in binary panel data from a well-known economic experiment.

The EU's non-financial reporting (NFR) regulations have significant impacts on Global South stakeholders, firms that must report, actors lower in the value chain, and organisations seeking investment from NFR-compliant firms or institutions. This paper sets forth six proposals to improve the global equity and sustainability implications of the EU's NFR from a Global South perspective. The proposals involve (1) developing regulation cooperatively with the Global South; (2) streamlining reporting to enable the regulations to have real effects and limit incorrect accounting; (3) digitalising reporting through accessible technologies for greater accountability and lower administrative burdens; (4) mandating scope 3 emissions accounting and incentivising related investment; (5) anchoring financial institutions' role in ethical investment and bridging Northern and Southern actors; and (6) strengthening citizen data and sustainability literacy to close the circle of incentives, implementation, and impact.

Extraintestinal pathogenic Escherichia coli (ExPEC) causes invasive E. coli disease (IED), including bacteraemia and (uro)sepsis, resulting in a high disease burden, especially among older adults. This study describes the epidemiology of IED in England (2013–2017) by combining laboratory surveillance and clinical data. A total of 191 612 IED cases were identified. IED incidence increased annually by 4.4–8.2% across all ages and 2.8–7.6% among adults ≥60 years of age. When laboratory-confirmed urosepsis cases without a positive blood culture were included, IED incidence in 2017 reached 149.4/100 000 person-years among all adults and 368.4/100 000 person-years among adults ≥60 years of age. Laboratory-confirmed IED cases were identified through E. coli-positive blood samples (55.3%), other sterile site samples (26.3%), and urine samples (16.6%), with similar proportions observed among adults ≥60 years of age. IED-associated case fatality rates ranged between 11.8–13.2% among all adults and 13.1–14.7% among adults ≥60 years of age. This study reflects the findings of other published studies and demonstrates IED constitutes a major and growing global health concern disproportionately affecting the older adult population. The high case fatality rates observed despite available antibiotic treatments emphasize the growing urgency for effective intervention strategies. The burden of urosepsis due to E. coli is likely underestimated and requires additional investigation.

We present a re-discovery of G278.94+1.35a as possibly one of the largest known Galactic supernova remnants (SNRs) – that we name Diprotodon. While previously established as a Galactic SNR, Diprotodon is visible in our new Evolutionary Map of the Universe (EMU) and GaLactic and Extragalactic All-sky MWA (GLEAM) radio continuum images at an angular size of $3{{{{.\!^\circ}}}}33\times3{{{{.\!^\circ}}}}23$, much larger than previously measured. At the previously suggested distance of 2.7 kpc, this implies a diameter of 157$\times$152 pc. This size would qualify Diprotodon as the largest known SNR and pushes our estimates of SNR sizes to the upper limits. We investigate the environment in which the SNR is located and examine various scenarios that might explain such a large and relatively bright SNR appearance. We find that Diprotodon is most likely at a much closer distance of $\sim$1 kpc, implying its diameter is 58$\times$56 pc and it is in the radiative evolutionary phase. We also present a new Fermi-LAT data analysis that confirms the angular extent of the SNR in gamma rays. The origin of the high-energy emission remains somewhat puzzling, and the scenarios we explore reveal new puzzles, given this unexpected and unique observation of a seemingly evolved SNR having a hard GeV spectrum with no breaks. We explore both leptonic and hadronic scenarios, as well as the possibility that the high-energy emission arises from the leftover particle population of a historic pulsar wind nebula.

Health Security is a major concern for the Democratic Republic of the Congo (DRC). It is the second largest country in Africa, borders nine other countries, has more than 80 million inhabitants, and has suffered from decades of neglect and conflicts together with multiple recurrent disease outbreaks, including Ebola.

As TeV gamma-ray astronomy progresses into the era of the Cherenkov Telescope Array (CTA), instantaneously following up on gamma-ray transients is becoming more important than ever. To this end, a worldwide network of Imaging Atmospheric Cherenkov Telescopes has been proposed. Australia is ideally suited to provide coverage of part of the Southern Hemisphere sky inaccessible to H.E.S.S. in Namibia and the upcoming CTA-South in Chile. This study assesses the sources detectable by a small, transient-focused array in Australia based on CTA telescope designs. The TeV emission of extragalactic sources (including the majority of gamma-ray transients) can suffer significant absorption by the extragalactic background light. As such, we explored the improvements possible by implementing stereoscopic and topological triggers, as well as lowered image cleaning thresholds, to access lower energies. We modelled flaring gamma-ray sources based on past measurements from the satellite-based gamma-ray telescope Fermi-LAT. We estimate that an array of four Medium-Sized Telescopes (MSTs) would detect $\sim$24 active galactic nucleus flares >5$\sigma$ per year, up to a redshift of $z\approx1.5$. Two MSTs achieved $\sim$80–90% of the detections of four MSTs. The modelled Galactic transients were detectable within the observation time of one night, 11 of the 21 modelled gamma-ray bursts were detectable, as were $\sim$10% of unidentified transients. An array of MST-class telescopes would thus be a valuable complementary telescope array for transient TeV gamma-ray astronomy.

Declining labor force participation of older men throughout the 20th century and recent increases in participation have generated substantial interest in understanding the effect of public pensions on retirement. The National Bureau of Economic Research's International Social Security (ISS) Project, a long-term collaboration among researchers in a dozen developed countries, has explored this and related questions. The project employs a harmonized approach to conduct within-country analyses that are combined for meaningful cross-country comparisons. The key lesson is that the choices of policy makers affect the incentive to work at older ages and these incentives have important effects on retirement behavior.

The Fremont provide an important case study to examine the resilience of ancient farmers to climatic downturns, because they lived at the far northern margin of intensive maize agriculture in the American West, where the constraints on maize production are made abundantly clear. Using a tree-ring and simulation-based reconstruction of average annual precipitation and maize growing degree days, along with cost-distance to perennial streams, we model spatial variability in Fremont site density in the eastern Great Basin. The results of our analysis have implications for defining the ecological envelope in which farming is a viable strategy across this arid region and can be used to predict where and why maize farming strategies might evolve and eventually collapse as climate changes over time.

Iodine is a trace element required to produce the thyroid hormones, which are critical for development, growth and metabolism. To ensure appropriate population iodine nutrition, convenient and accurate methods of monitoring are necessary. Current methods for determining iodine status either involve a significant participant burden or are subject to considerable intra-individual variation. The continuous secretion of iodide in saliva potentially permits its use as a convenient, non-invasive assessment of status in populations. To assess its likely effectiveness, we reviewed studies analysing the association between salivary iodide concentration (SIC) and dietary iodine intake, urinary iodide concentration (UIC) and/or 24-h urinary iodide excretion (UIE). Eight studies conducted in different countries met the inclusion criteria, including data for 921 subjects: 702 healthy participants and 219 with health conditions. SIC correlated positively with UIC and/or UIE in four studies, with the strength of relationship ranging from r = 0·19 to r = 0·90 depending on sampling protocol, age, and if salivary values were corrected for protein concentration. Additionally, SIC positively correlated with dietary intake, being strongest when saliva was collected after dinner. SIC varied with external factors, including thyroid function, use of some medications, smoking and overall health status. Evidence provided here supports the use of SIC as a viable, low-burden method for determining iodine status in populations. However, small sample sizes and high variability indicates the need for more extensive analyses across age groups, ethnicities, disease states and dietary groups to clarify the relative accuracy and reliability in each case and standardise procedure.