Search

ObjectiveLoneliness is prevalent in people with HIV (PWH) and associated with adverse health-related consequences, including depression. Chronic inflammation has been linked to depression in PWH, though its association with loneliness is less well established. Simultaneous examination of inflammation, loneliness and depression is needed to clarify these relationships. This study investigated the relationship between loneliness and inflammation, and the effects of loneliness and inflammation on depression in PWH.Methods82 PWH who were on suppressive ART (mean age [SD] = 53.2 [9.0]) completed the UCLA Loneliness Scale-Version 3 and the Center for Epidemiologic Studies Depression Scale as part of a comprehensive evaluation. Biomarkers of systemic inflammation (CRP, IL-6, CCL2/MCP-1, sCD14) and coagulation (D-dimer) were measured in blood using commercial immunoassays.ResultsMultivariable linear regression analyses revealed that higher D-dimer, CCL2/MCP-1, and sCD14 were significant predictors of loneliness (ps

Introduction: Urine drug screens (UDS) have unproven clinical utility in emergency department (ED) chest pain presentations. A test with such limited clinical utility may exponentiate biases in care, but little is known about the epidemiology of UDS use for this indication. We hypothesized that UDS utilization varies nationally across race and gender.Methods: This was a retrospective observational analysis of adult ED visits for chest pain in the 2011–2019 National Hospital Ambulatory Medical Care Survey. We calculated the utilization of UDS across race/ethnicity and gender and then characterized predictors of use via adjusted logistic regression models.Results: We analyzed 13,567 adult chest pain visits, representative of 85.8 million visits nationally. Use of UDS occurred for 4.6% of visits (95% CI 3.9%-5.4%). White females underwent UDS at 3.3% of visits (95% CI 2.5%-4.2%), and Black females at 4.1% (95% CI 2.9%-5.2%). White males were tested at 5.8% of visits (95% CI 4.4%-7.2%), while Black males were tested at 9.3% of visits (95% CI 6.4%-12.2%). A multivariate logistic regression model including race, gender, and time period shows significantly increased odds of ordering UDS for Black patients (odds ratio [OR] 1.45 (95% CI 1.11-1.90, p = 0.007)) and male patients (OR 2.0 (95% CI 1.55-2.58, p < 0.001) as compared to White patients and female patients.Conclusion: We identified wide disparities in the utilization of UDS for the evaluation of chest pain. If UDS were used at the rate observed for White women, Black men would undergo nearly 50,000 fewer tests annually. Future research should weigh the potential of the UDS to magnify biases in care against the unproven clinical utility of the test.

ObjectiveGiven the aging population of people with HIV (PWH), along with increasing rates of binge drinking among both PWH and the general older adult population, this study examined the independent and interactive effects of HIV, binge drinking, and age on neurocognition.MethodParticipants were 146 drinkers stratified by HIV and binge drinking status (i.e., ≥4 drinks for women and ≥5 drinks for men within approximately 2 h): HIV+/Binge+ (n = 30), HIV-/Binge+ (n = 23), HIV+/Binge- (n = 55), HIV-/Binge- (n = 38). All participants completed a comprehensive neuropsychological battery measuring demographically-corrected global and domain-specific neurocognitive T scores. ANCOVA models examined independent and interactive effects of HIV and binge drinking on neurocognitive outcomes, adjusting for overall alcohol consumption, lifetime substance use, sex, and age. Subsequent multiple linear regressions examined whether HIV/Binge group moderated the relationship between age and neurocognition.ResultsHIV+/Binge+ participants had worse global neurocognition, processing speed, delayed recall, and working memory than HIV-/Binge- participants (p's < .05). While there were significant main effects of HIV and binge drinking, their interaction did not predict any of those neurocognitive outcomes (p's > .05). Significant interactions between age and HIV/Binge group showed that HIV+/Binge+ participants demonstrated steeper negative relationships between age and neurocognitive outcomes of learning, delayed recall, and motor skills compared to HIV-/Binge- participants (p's < .05).ConclusionsResults showed adverse additive effects of HIV and binge drinking on neurocognitive functioning, with older adults demonstrating the most vulnerability to these effects. Findings support the need for interventions to reduce binge drinking, especially among older PWH.

Floodplain encroachment by embankments heightens flood risk. This is exacerbated by climate change and land‐use modifications. This paper assesses the impact of embankments on sediment transport, channel geometry, conveyance capacity, and flood inundation of a reach of the Nakkhu River, Nepal. Using the CAESAR‐Lisflood landscape evolution model based on a 2‐m digital elevation model, we simulate four flood scenarios with and without embankments and sediment transport: a historical 25‐year return period flood event used to design the embankments, 50‐year, 100‐year, and 1000‐year return period flood events forecast using the Generalized Logistic Model (using data from 1992 to 2017). Our results indicate that flow confinement by embankments reduces inundation by 99% (from 22.5 to 0.3 ha) for the historical 25‐year flood discharge of 42.23 m3/s ${\mathrm{m}}^{3}/\mathrm{s}$ and by 15% (from 28.8 to 24.4 ha) for the 1000‐year return period flood discharge of 95 m3/s ${\mathrm{m}}^{3}\mathrm{/}\mathrm{s}$ (similar to a 25‐year maximum mid‐future). The presence of embankments increases downstream sediment transport by more than 32% for all flood scenarios considered. Inclusion of sediment transport leads to a fivefold increase in predicted inundation area for a 25‐year maximum mid‐future flood compared to the no‐sediment case in the embanked channel. Changes in channel geometry due to sedimentation significantly reduce conveyance capacity increasing overtopping flood risk, particularly where the channel is sinuous or located on flat terrain. Our results indicate that sediment erosion in outer meanders may threaten embankment stability by promoting undercuts. It is recommended that sediment transport effects be factored into embankment design and floodplain planning. Plain Language Summary: Our research explores the impact of flood protection embankments being constructed along the Nakkhu River in the Kathmandu Valley, Nepal, in a region that is experiencing rapid urban growth. Using advanced computer simulations, we study how these embankments influence the erosion and deposition of sediment in the river, and hence impact flood risk. Our findings indicate that the construction of embankments increases sediment transport, and alters the geometry of the river increasing downstream flood risk during extreme flood events. This is particularly the case for embankments designed to follow natural, meandering river courses. We recommend incorporating sediment transport analysis into the planning and design of embankments and developments in floodplain areas to reduce the risk of flooding. Our study indicates that embankment construction by itself may not always be a sustainable long‐term flood‐protection measure for rivers carrying high sediment loads. Key Points: Inclusion of sediment processes is very important in predicting the effect of embankments on river flood riskFor the embanked Nakkhu, predicted inundation is fivefold larger for 25‐year maximum mid‐future event when sediment transport is includedSedimentation reduces channel capacity for flat terrain and large meanders; erosion at outer meanders threatens Nakkhu embankment stability [ABSTRACT FROM AUTHOR]

Topographic data is a fundamental input to flood hazard models and controls the quality of the outputs. However, open-access global digital elevation models (DEMs) are dated and limited to 30 m resolution, which hinders modelling efforts in urban or topographically complex environments. We used the flood prone and expanding city of Kathmandu, Nepal, to evaluate the impact of topographic data source and resolution on flood model outputs. All DEMs evaluated featured spatially correlated topographic sinks with depths exceeding 20 m that required hydrological conditioning before being used in flood modelling. Incomplete hydrological conditioning appeared related to the overestimation of flood extent and therefore limited agreement when comparing a global 90 m resolution flood hazard model with a bespoke city-scale model at 10 m resolution (F1 score = 0.40). Instead, we found that the height above nearest drainage (HAND) metric was better able to replicate the higher resolution flood map as an indicator of flood susceptibility requiring only topographic information as an input. We also found that the computationally efficient FastFlood model was able to match the inundation extent (F1 score = 0.79) and flood depths (mean absolute error and root mean square error of 0.46 and 0.76 m respectively) of a published 10 m physics-based flood hazard model whilst requiring 212 times less computation time. Our analysis demonstrated that mapping city-scale flood inundation required hydrologically conditioned high-resolution topographic data but not physically complex flood models, highlighting the need for greater availability of high quality open access topographic data. [ABSTRACT FROM AUTHOR]

Multitasking has been demonstrated to negatively impact performance across a wide range of tasks, including in the classroom, yet students continue to multitask. This study examined the relationship between college students' perceptions and performance of technology-based multitasking. Technology-based multitasking and self-efficacy data were collected and analyzed from 265 undergraduate students. Students engaged in a technology-based multitasking perceptions survey, a video + survey multitasking task or a video-only non-multitasking task, and a technology-based self-efficacy survey. An analysis of student perceptions indicated that students understood that different tasks required different levels of mental effort to complete successfully and that multitasking across high-mental effort tasks required greater effort than multitasking across low-mental effort tasks. In addition, students in the video + survey multitasking group significantly underperformed students in the video-only non-multitasking group. Finally, the relationship between technology-based multitasking and self-efficacy was addressed in a correlational analysis between student technology-based multitasking scores and technology-based self-efficacy scores, yielding no significant relationship. The study findings indicate that most students have an understanding and awareness of multitasking, but ultimately, whether they believed they could multitask or not, multitasking significantly impeded performance. [ABSTRACT FROM AUTHOR]

Objectives: To determine the incremental yield of prenatal exome sequencing (PES) over standard testing in fetuses with an isolated congenital heart abnormality (CHA), CHA associated with extra‐cardiac malformations (ECMs) and CHA dependent upon anatomical subclassification. Methods: A systematic review of the literature was performed using MEDLINE, EMBASE, Web of Science and grey literature January 2010‐February 2023. Studies were selected if they included greater than 20 cases of prenatally diagnosed CHA when standard testing (QF‐PCR/chromosome microarray/karyotype) was negative. Pooled incremental yield was determined. PROSPERO CRD 42022364747. Results: Overall, 21 studies, incorporating 1957 cases were included. The incremental yield of PES (causative pathogenic and likely pathogenic variants) over standard testing was 17.4% (95% CI, 13.5%–21.6%), 9.3% (95% CI, 6.6%–12.3%) and 35.9% (95% CI, 21.0%–52.3%) for all CHAs, isolated CHAs and CHAs associated with ECMs. The subgroup with the greatest yield was complex lesions/heterotaxy; 35.2% (95% CI 9.7%–65.3%). The most common syndrome was Kabuki syndrome (31/256, 12.1%) and most pathogenic variants occurred de novo and in autosomal dominant (monoallelic) disease causing genes (114/224, 50.9%). Conclusion: The likelihood of a monogenic aetiology in fetuses with multi‐system CHAs is high. Clinicians must consider the clinical utility of offering PES in selected isolated cardiac lesions. Key points: What is already known? Congenital heart abnormalities are the most commonly occurring congenital anomalies and can be associated with chromosomal or monogenic conditions.With the increasing use of fetal sequencing, there is a need to define the association between monogenic conditions and specific cardiac abnormalities, particularly when isolated to facilitate triaging for prenatal sequencing. What does this study add? The incremental yield of prenatal exome sequencing over and above chromosome microarray for congenital heart abnormalities is 9.3% in isolated lesions and 35.2% in the presence of complex lesions/heterotaxy.Clinicians should consider the clinical utility of offering prenatal exome sequencing in selected isolated cardiac lesions dependent on resources available. [ABSTRACT FROM AUTHOR]

We present a new model called Bayesian Estimated Glacial Lake Volume (BE‐GLAV) to estimate the volume of proglacial lakes. Presuming the lake cross‐section as trapezoidal, BE‐GLAV uses a Bayesian calibration approach to adjust the cross‐sectional geometry to match modeled and observed lake surface widths. We validated our model using bathymetric measurements from lakes spread across High Mountain Asia (specifically, the Himalaya and Tien‐Shan), with aerial extents ranging from 0.01 to 5.5 km2. The modeled lake volumes agreed with the measured lake volume with a root‐mean‐square absolute uncertainty of ∼14%. With minimum and maximum errors of ∼0.3% and ∼61.2%, BE‐GLAV performed well compared to 10 other models in a model inter‐comparison experiment. Using the measured set of volumes, our model can constrain both the root mean square (RMS) error and the maximum percentage error in modeled lake volume, unlike other models, some of which can compute just the RMS uncertainty. Plain Language Summary: To estimate proglacial lake volume, we suggest a novel numerical model called BE‐GLAV, which is based on Bayesian calibration. The model minimizes the discrepancy between the measured and modeled lake surface width by assuming that the proglacial cross‐section is trapezoidal in shape. The model was applied to 66 lakes located in the Himalaya and Tien‐Shan. Modeled and measured volumes were in good agreement with each other (∼14% mean absolute uncertainty). We also compared our volume estimates to those predicted by 10 other models. These 10 models were scaling relationships between the area and volume of proglacial lakes. The comparison showed that, our model was among the top five performers, reducing the maximum error in lake volume by more than five times. BE‐GLAV is a good alternative to scaling models in areas where bathymetric surveys are scarce. When compared to scaling models, it is easy to implement and requires little calibration. Key Points: Bayesian calibration based estimation of proglacial lake volumeModel was validated over 66 lakes and the maximum error in modelled volume got reduced by >5 times as compared to scaling modelsRequires minimal calibration with observations as compared to scaling models [ABSTRACT FROM AUTHOR]