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BACKGROUND: Serological responses to COVID-19 vaccination are diminished in recipients of solid organ transplants, especially in lung transplant recipients (LTR), probably as result of immunosuppressive treatment. There is currently no marker of immunosuppression that can be used to predict the COVID-19 vaccination response. Here, we study whether torque tenovirus (TTV), a highly prevalent virus can be used as an indicator of immunosuppression.METHODS: The humoral response to the mRNA 1273 vaccine was assessed in 103 LTR, who received a transplant between 4 and 237 months prior to vaccination, by measuring Spike (S)-specific IgG levels at baseline, 28 days after first, and 28 days after the second vaccination. TTV loads were determined by RT-PCR and Pearson's correlation coefficient was calculated to correlate serological responses to TTV load.RESULTS: Humoral responses to COVID-19 vaccination were observed in 41 of 103 (40%) LTR at 28 days after the second vaccination. Sixty-two of 103 (60%) were non-responders. Lower TTV loads at baseline (significantly) correlated with higher S-specific antibodies and a higher percentage of responders. Lower TTV loads also strongly correlated with longer time since transplantation, indicating that participants with lower TTV loads were longer after transplantation.CONCLUSIONS: This study shows a better humoral response to the SARS-CoV-2 vaccine in subjects with a lower TTV load pre-vaccination. In addition, TTV load correlates with the time after transplantation. Further studies on the use of TTV load in vaccination efficacy studies in immunocompromised cohorts should provide leads for the potential use of this marker for optimizing vaccination response.

Winter annual cover crops can be planted before soybean in Mississippi for many agronomic reasons. Incorporating winter annual cover crops into soybean production changes the seasonal hosts within fields. Some studies suggest that reducing tillage and using diverse species of cover crops can increase arthropod diversity and predator activity. Neonicotinoid seed treatments are often implemented to combat early season insect pests in soybean that follow cover crops, but negative effects on the environment such as reductions in biodiversity are often attributed to these compounds. We conducted an experiment to measure the effects on the diversity of the soybean epigeal and foliar communities when incorporating cover crops as well as insecticidal seed treatments into Mississippi soybean growing systems. Our results showed that legume cover crops had significant impacts on the epigeal community diversity of soybean planted behind them. These cover crops, especially hairy vetch, supported a more diverse foliar community before termination. To prevent increases in herbivorous arthropods, neonicotinoid seed treatments can be used without affecting epigeal predators such as beetles, ants, and spiders. The neonicotinoid seed treatments affected arthropod diversity, but the reductions were mainly caused by decreases in herbivorous pest insects that fed on treated soybean plants.

Due to improved efficiency and reduced cost of viral sequencing, molecular cluster analysis can be feasibly utilized alongside existing human immunodeficiency virus (HIV) prevention strategies. The goal of this paper is to elucidate how HIV molecular cluster and social network analyses are being integrated to implement HIV response interventions. We searched PubMed, Scopus, PsycINFO, and Cochrane Library databases for studies incorporating both HIV molecular cluster and social network data. We identified 32 articles that combined analyses of HIV molecular sequences and social or sexual networks. All studies were descriptive. Six studies described network interventions informed by molecular and social data but did not fully evaluate their efficacy. There is no current standard for incorporating molecular and social network analyses to inform interventions or data demonstrating its utility. More research must be conducted to delineate benefits and best practices for leveraging molecular data for network-based interventions.Debido a mejor eficiencia y costo reducido de la secuenciación viral, el análisis de complejos moleculares se puede utilizar de manera factible junto con las estrategias de prevención del virus de inmunodeficiencia humana (VIH) existentes. El objetivo de este repaso es de aclarar como integrar los análisis de las redes sociales y de los complejos moleculares del VIH para implementar intervenciones para controlar el VIH. Buscamos en las bases de datos de PubMed, Scopus, PsycINFO y Cochrane Library por estudios que incorporaran datos de redes sociales y grupos moleculares del VIH. Identificamos 32 estudios que combinaban análisis de secuencias moleculares del VIH y datos de redes sociales. Todos los estudios fueron descriptivos. Seis estudios describieron intervenciones informadas por datos moleculares y sociales, pero no evaluaron completamente su eficacia. No existe un estándar actual para incorporar análisis moleculares y sociales para informar intervenciones o datos que demuestren su eficacia. Se deben realizar más investigaciones para delinear los beneficios y las mejores prácticas de aplicar los datos moleculares y sociales para crear intervenciones del VIH.

Purpose There is an apparent disconnect between the understanding of best practice and service delivery in the support of people with learning disabilities at risk of behaviours that challenge. We suggest, is a problem of implementation. The purpose of this paper is to explore reasons why this might be the case: a failure to recognise the collective works of successive generations of research and practice; and a failure to address the macro-systems involved and systems changes needed to support implementation. Design/methodology/approach This paper reviews the consensus that exists in respect of best practice. Drawing upon ideas from implementation science the paper highlights the complexities involved in the implementation of all evidence-based practices and uses this as a framework to propose ways in which an infrastructure that facilitates the delivery of services in the learning disabilities field might be built. Findings This paper highlights core recommended practices that have been consistent over time and across sources and identifies the systems involved in the implementation process. This paper demonstrates that many of the necessary building blocks of implementation already exist and suggests areas that are yet to be addressed. Critically, the paper highlights the importance of, and the part that all systems need to play in the process. Originality/value In the absence of any generalised implementation frameworks of evidence-based practice in the learning disabilities field, the paper suggests that the findings may provide the basis for understanding how the gap that exists between best practice and service delivery in the support of people with a learning disability at risk of behaviours that challenge might be closed.

Nerve agents inhibit acetylcholinesterase (AChE), leading to a build-up of acetylcholine (ACh) and overstimulation at cholinergic synapses. Current post-exposure nerve agent treatment includes atropine to treat overstimulation at muscarinic synapses, a benzodiazepine anti-convulsant, and an oxime to restore the function of AChE. Aside from the oxime, the components do not act directly to reduce the overstimulation at nicotinic synapses. The false transmitters acetylmonoethylcholine (AMECh) and acetyldiethylcholine (ADECh) are analogs of ACh, synthesised similarly at synapses. AMECh and ADECh are partial agonists, with reduced activity compared to ACh, so it was hypothesised the false transmitters could reduce overstimulation. Synthetic routes to AMECh and ADECh, and their precursors, monoethylcholine (MECh) and diethylcholine (DECh), were devised, allowing them to be produced easily on a laboratory-scale. The mechanism of action of the false transmitters was investigated in vitro. AMECh acted as a partial agonist at human muscarinic (M1 and M3) and muscle-type nicotinic receptors, and ADECh was a partial agonist only at certain muscarinic subtypes. Their precursors acted as antagonists at muscle-type nicotinic, but not muscarinic receptors. Administration of MECh and DECh improved neuromuscular function in the soman-exposed guinea-pig hemi-diaphragm preparation. False transmitters may therefore help reduce nerve agent induced overstimulation at cholinergic synapses.

In this matched case–control study, we sought to determined the association between probiotic use and invasive infections caused by typical probiotic organisms. The odds of probiotic use in cases were 127 times the odds of probiotic use in controls (95% CI, 6.21–2600). Further research into these rare but severe complications is needed.

Background: Tranexamic acid (TXA) is increasingly used in orthopedic surgery to reduce blood loss. Hence the present study was undertaken to compare the efficacy of topical TXA and intravenous (IV) TXA in reducing blood loss and transfusion rate in primary total hip and total knee arthroplasty.Methods: Total of 31 cases undergoing either primary THA (23 cases) or TKA (8 cases) during a study period from June were enrolled. Outcome measures were drained output, transfusion rate, drop in haemoglobin (Hb) and blood loss measured by Nadler et al formula.Results: In THR group, 12 (52.17%) cases and in TKA group, 3 (37.5%) cases were managed using IV TXA whereas 11 (47.82%) and 5 (62.5%) cases were managed using topical TXA in THR and TKR group respectively. The mean drain output was greater among IV TKR group (261.66±129.60 ml) as compared to topical TKR group (210±129.49 ml). In THR drain output in IV group was 216±104.08 ml. In both the groups, mean blood loss was lower in cases where IV TXA was administered as compared to topical TXA, (p>0.05). The mean drop in Hb was greater after topical administration of TXA in both the groups as compared to IV administered TXA. In THR group, 9 (39.13%) patients required blood transfusion. In sickle cell disease patients, we found more blood loss and drain output as compared to non-sickle cell disease (SCD) patients.Conclusions: Both IV and topical TXA are clinically effective and safe in decreasing calculated blood loss, Hb drop after THA and TKA.

Very little is known of the activities of the most senior managers in organisations providing social care in the community to people with intellectual disabilities. Yet the importance of the focus and activities of senior managers in directing and supporting staff practice and staff experiences is likely to be central to an organisation's functioning and support provided for staff and service users. This study employed Delphi methodology with a panel of 11 senior managers, mostly chief executives, managing small to very large organisations providing support for people with intellectual disabilities, in the UK. Answering three rounds of questions, senior managers described their face‐to‐face and non‐face‐to‐face contacts with staff and decision‐making. Narrative data were subject to quantitative and thematic analysis. In the last round, themes were subject to quantitative analysis. Most contacts between senior managers and staff were in formal structured contexts and all managers used social media to promote the organisations' ambitions regarding good practice. The panel focused upon accessing and understanding the informal aspects of their organisations and staff factors. Decisions were both short‐term reactive and long‐term strategic and an effort to link these was felt to improve organisational functioning. A framework for understanding senior managers' activities emerged showing two sources of demands and opportunity, extra‐organisational focused upon meeting legal and regulatory demands and intra‐organisational focused upon understanding and influencing informal staff practices/experiences and cultures within their organisations.

Emission estimates of carbon dioxide (CO2) and methane (CH4) and the meteorological factors affecting them are investigated over Sacramento, California, using an aircraft equipped with a cavity ring-down greenhouse gas sensor as part of the Alpha Jet Atmospheric eXperiment (AJAX) project. To better constrain the emission fluxes, we designed flights in a cylindrical pattern and computed the emission fluxes from two flights using a kriging method and Gauss's divergence theorem. Differences in wind treatment and assumptions about background concentrations affect the emission estimates by a factor of 1.5 to 7. The uncertainty is also impacted by meteorological conditions and distance from the emission sources. The vertical layer averaging affects the flux estimate, but the choice of raw wind or mass-balanced wind is more important than the thickness of the vertical averaging for mass-balanced wind for both urban and local scales. The importance of vertical mass transfer for flux estimates is examined, and the difference in the total emission estimate with and without vertical mass transfer is found to be small, especially at the local scale. The total flux estimates accounting for the entire circumference are larger than those based solely on measurements made in the downwind region. This indicates that a closed-shape flight profile can better contain total emissions relative to a one-sided curtain flight because most cities have more than one point source and wind direction can change with time and altitude. To reduce the uncertainty of the emission estimate, it is important that the sampling strategy account not only for known source locations but also possible unidentified sources around the city. Our results highlight that aircraft-based measurements using a closed-shape flight pattern are an efficient and useful strategy for identifying emission sources and estimating local- and city-scale greenhouse gas emission fluxes.

Objectives\ud Positive Behavioral Support (PBS) is considered the treatment framework of choice for children with intellectual and developmental disabilities (IDD) at risk of behavior that challenges. PBS demands stakeholder engagement, yet little research has explored goal formation in this context for caregivers of children with IDD.\ud \ud Methods\ud We used Talking Mats and semi-structured interviews to support 12 caregivers of children with IDD who displayed behaviours that challenge, to develop goals for PBS. Interviews covered quality of life for caregivers and their child, adaptive and challenging aspects of child behavior, and aspects of caregiver’s own behavior.\ud \ud Results\ud Caregivers were able to form individualised and meaningful goals in relation to all domains, demonstrating rich insight into personal needs and needs of their child. The process of forming goals was psychologically and emotionally complex given prior experiences and needs of participants but effectively supported by the interview method.\ud \ud Conclusions\ud We conclude that goal formation in PBS requires careful consideration and structuring but has the potential to support effective working relationships and ensure assessment and intervention is aligned with the needs and aspirations of families.

Background Serious bacterial infections associated with substance use often result in long hospitalizations, premature discharges, and high costs. Out-of-hospital treatment options in people with substance use disorder (SUD) are often limited. Methods We describe a novel multidisciplinary and interprofessional care conference, “OPTIONS-DC,” to identify treatment options agreeable to both patients and providers using the frameworks of harm reduction and patient-centered care. We retrospectively reviewed charts of patients who had an OPTIONS-DC between February 2018 and July 2019 and used content analysis to understand the conferences’ effects on antibiotic treatment options. Results Fifty patients had an OPTIONS-DC during the study window. Forty-two (84%) had some intravenous (IV) substance use and 44 (88%) had an active substance use disorder. Participants’ primary substances included opioids (65%) or methamphetamines (28%). On average, conferences lasted 28 min. OPTIONS-DC providers recommended out-of-hospital antibiotic treatment options for 34 (68%) of patients. OPTIONS-DC recommended first line therapy of IV antibiotics for 35 (70%) patients, long-acting injectable antibiotics for 14 (28%), and oral therapy for 1 (2%). 35 (70%) patients that had an OPTIONS-DC completed an antibiotic course and 6 (12%) left the hospital prematurely. OPTIONS-DC expanded treatment options by exposing and contextualizing SUD, psychosocial risk and protective factors; incorporating patient preferences; and allowing providers to tailor antibiotic and SUD recommendations. Conclusions OPTIONS-DC is a feasible intervention that allows providers to integrate principles of harm reduction and offer patient-centered choices among patients needing prolonged antibiotic treatment.

BackgroundGiven the much greater COVID-19 mortality risk experienced by people with intellectual disabilities, understanding the willingness of people with intellectual disabilities to take a COVID-19 vaccine is a major public health issue.MethodIn December 2020-February 2021, across the United Kingdom 621 adults with intellectual disabilities were interviewed remotely and 348 family carers or support workers of adults with intellectual disabilities with greater needs completed an online survey, including a question on willingness to take a COVID-19 vaccine if offered. Results87.0% of interviewees with intellectual disabilities were willing to take a COVID-19 vaccine, with willingness associated with white ethnicity, having already had a flu vaccine, gaining information about COVID-19 from television but not from social media, and knowing COVID-19 social restrictions rules. 81.7% of surveyed carers of adults with intellectual disabilities with greater needs reported that the person would be willing to take a COVID-19 vaccine, with willingness associated with white ethnicity, having a health condition of concern in the context of COVID-19, having had a flu vaccine, being close to someone who had died due to COVID-19, and having shielded at some point during the pandemic.ConclusionsReported willingness to take the COVID-19 vaccine is high amongst adults with intellectual disabilities in the UK, with factors associated with willingness having clear implications for public health policy and practice.

Background: Pancreatic ductal adenocarcinoma (PDAC) has a low overall survival rate primarily due to late onset of symptoms and rapid progression. Early symptoms, which include abdominal and back pain, diarrhea, weight loss, and jaundice are non-specific for PDAC and may be associated with other gastrointestinal diseases. PDAC lacks reliable and accurate tests for early detection. We aimed to discover biomarkers carrying a PDAC-specific DNA methylation signature in blood cell-free DNA, and to develop and validate a non-invasive test for PDAC detection. Methods: Reduced representative bisulfite sequencing (RRBS) was previously performed on tissue and plasma samples from PDAC patients and healthy individuals to identify PDAC-specific methylation markers. These markers were combined with previously reported cancer methylation markers for a second round of marker screening. The resulting markers were utilized to develop a targeted methylation sequencing assay for plasma DNA, designated as PDACatch. The PDACatch assay was validated on an independent sample set to demonstrate its efficacy for pancreatic cancer methylation signature detection. Results: The PDACatch assay was performed on 91 PDAC plasma and 84 healthy plasma samples obtained from commercial biobanks. In this independent verification sample set, the PandaX assay predicted PDAC from healthy with AUC of 0.91; accuracy remained high for classification of both stage I and early-stage (I/IIa) samples. Conclusion: The PDACatch assay, a ctDNA methylation based blood test, achieved a high accuracy for detecting PDAC at early stages, indicating its potential in screening effectiveness. Citation Format: Athurva J. Gore, Justin Dang, Alan Fung, Bin Xie, Rui Liu. Non-invasive early detection of pancreatic ductal adenocarcinoma using methylation signatures in circulating tumor DNA [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1421.

Experiments were conducted in 2016 and 2017 in Stoneville, MS and Starkville, MS to determine the impact of different insecticide management options for thrips on herbicide injured peanut. Insecticide treatments included imidacloprid in-furrow at-planting, one or two foliar applications of acephate, and an untreated control with and without an application of flumioxazin. In Stoneville, herbicide applications were made immediately following planting, and in Starkville, applications were made as plants were emerging to maximize herbicide injury. The Stoneville experiment also had an additional factor in which plots were flooded or not flooded to simulate a heavy rainfall in order to maximize herbicide injury and also to give added stress from saturated soils. Thrips counts, thrips injury ratings, plant vigor ratings, plant biomass, width between plant canopies, and yield were recorded. Few interactions were observed, but temporary flooding, herbicide injury, and thrips injury affected peanut growth as measured by biomass and canopy. Imidacloprid was the most consistent insecticide treatment for reducing thrips numbers and injury, but acephate provided some protection. Temporary flooding during the seedling stage, flumioxazin injury, and thrips injury all reduced peanut pod yield. Based on these results, every attempt should be made to minimize early season stress in peanuts including the use of an effective in-furrow insecticide.

Respiratory failure due to SARS-CoV-2 has caused widespread mortality, creating an urgent need for effective treatments and a long-term need for antivirals for future emergent coronaviruses. Pharmacotherapy for respiratory viruses has largely been unsuccessful with the exception of early treatment of influenza viruses, which shortens symptom duration and prevents infection in close contacts. Under the rapidly evolving circumstances of the COVID-19 pandemic, most clinical trials of experimental treatments in the United States have focused on later stages of the disease process. Worldwide, the clinical studies of the most impactful drugs, remdesivir and dexamethasone in ACTT-1, RECOVERY, and Solidarity, have studied hospitalized patients. Less than half of clinical trials in the U.S. have investigated oral agents, and the majority have taken place in hospitals at a disease stage where the viral load is already decreasing. The limited success of treatments for respiratory viruses and the viral dynamics of COVID-19 suggest that an antiviral therapy with the greatest impact against pandemic coronaviruses would be orally administered, well-tolerated, target a highly conserved viral protein or host-coronavirus interaction and could be used effectively throughout the world, including resource-poor settings. We examine the treatment of respiratory viral infections and current clinical trials for COVID-19 to provide a framework for effective antiviral therapy and prevention of future emergent coronaviruses and call attention to the need for continued preclinical drug discovery.

Introduction Sexual violence is a significant public health concern in the United States, affecting as many as one in two women and one in four men. However, few medical schools offer education on trauma-informed communication with patients who disclose sexual assault (SA). The goal of this training was to provide medical students with an understanding of how to empathically respond to SA disclosures, collect pertinent medical information while avoiding retraumatization, and empower patients to feel in control of their care. Methods One hundred forty-nine second-year medical students at Rush Medical College attended a 1-hour didactic lecture discussing the needs of SA survivors followed by small-group sessions during which they practiced trauma-informed communication skills. Students completed anonymous pre- and postsession surveys featuring nine Likert-scale questions that assessed comfort level providing trauma-informed care. Results Of the 149 attendees, 88 (59%) completed matched pre- and posttraining surveys that demonstrated significant improvement in all assessed metrics of trauma-informed care, including comfort collecting information, empowering survivors, and responding to and normalizing patients’ concerns. Two weeks after completing the training, all 149 students also correctly answered a free-response question testing retention of key training takeaways on their Sexuality and Reproduction final exam. Discussion The training significantly improved medical student comfort in providing trauma-informed care across all collected metrics. The training can be feasibly reproduced at other institutions so that future physicians across specialties can provide trauma-informed care, ideally improving the acute and chronic health outcomes that disproportionately affect SA survivors.

Introduction: We sought to determine the effect of low and moderate normobaric hypoxia on oxygen consumption and anaerobic contribution during interval running at different exercise intensities. Methods: Eight runners (age, 25 +/- 7 yr, V[spacing dot above]O2max: 72.1 +/- 5.6 mL[middle dot]kg-1[middle dot]min-1) completed three separate interval sessions at threshold (4 x 5 min, 2-min recovery), V[spacing dot above]O2max (8 x 90 s, 90-s recovery), and race pace (10 x 45 s, 1 min 45 s recovery) in each of; normoxia (elevation: 580 m, FiO2: 0.21), low (1400 m, 0.195) or moderate (2100 m, 0.18) normobaric hypoxia. The absolute running speed for each intensity was kept the same at each altitude to evaluate the effect of FiO2 on physiological responses. Expired gas was collected throughout each session, with total V[spacing dot above]O2 and accumulated oxygen deficit calculated. Data were compared using repeated-measures ANOVA. Results: There were significant differences between training sessions for peak and total V[spacing dot above]O2, and anaerobic contribution (P < 0.001, P = 0.01 respectively), with race pace sessions eliciting the lowest and highest responses respectively. Compared to 580 m, total V[spacing dot above]O2 at 2100 m was significantly lower (P < 0.05), and anaerobic contribution significantly higher (P < 0.05) during both threshold and V[spacing dot above]O2max sessions. No significant differences were observed between altitudes for race pace sessions. Conclusions: To maintain oxygen flux, completing acute exercise at threshold and V[spacing dot above]O2max intensity at 1400 m simulated altitude appears more beneficial compared with 2100 m. However, remaining at moderate altitude is a suitable when increasing the anaerobic contribution to exercise is a targeted response to training.

The questionable efficacy of Live High Train High altitude training (LHTH) is compounded by minimal training quantification in many studies. We sought to quantify the training load (TL) periodization in a cohort of elite runners completing LHTH immediately prior to competition. Eight elite runners (6 males, 2 females) with a V̇O2peak of 70 ± 4 mL·kg-1·min-1 were monitored during 4 weeks of sea-level training, then 3-4 weeks LHTH in preparation for sea-level races following descent to sea-level. TL was calculated using the session rating of perceived exertion (sRPE) method, whereby duration of each training session was multiplied by its sRPE, then summated to give weekly TL. Performance was assessed in competition at sea-level before, and within 8 days of completing LHTH, with runners competing in 800 m (n = 1, 1500 m/mile (n = 6) and half-marathon (n = 1). Haemoglobin mass (Hbmass) via CO rebreathing and running economy (RE) were assessed pre and post LHTH. Weekly TL during the first 2 weeks at altitude increased by 75% from preceding sea-level training (p = 0.0004, d = 1.65). During the final week at altitude, TL was reduced by 43% compared to the previous weeks (p = 0.002; d = 1.85). The ratio of weekly TL to weekly training volume increased by 17% at altitude (p = 0.009; d = 0.91) compared to prior sea-level training. Hbmass increased by 5% from pre- to post-LHTH (p = 0.006, d = 0.20). Seven athletes achieved lifetime personal best performances within 8 days post-altitude (overall improvement 1.1 ± 0.7%, p = 0.2, d = 0.05). Specific periodization of training, including large increases in training load upon arrival to altitude (due to increased training volume and greater stress of training in hypoxia) and tapering, were observed during LHTH in elite runners prior to personal best performances. Periodization should be individualized and align with timing of competition post-altitude.

BACKGROUND Partner notification (PN) is commonly offered to persons recently diagnosed with human immunodeficiency virus (HIV) to improve linkage to care and prevent onward transmission. Yet, much remains unknown about the factors associated with successful PN participation in populations at highest risk. METHODS Data were collected during the first 2 waves (2013-2015) of "uConnect," a population-based cohort study of young black men who have sex with men in Chicago (N = 618). Participants completed a biobehavioral survey and were tested for HIV. Among HIV-infected participants (N = 187), weighted logistic regression models examined the relationship between participant characteristics and being offered PN and providing partner names. RESULTS 30.3% (n = 187) of the sample was HIV-positive, of which 71.7% (n = 134) were offered PN, including: 8.2% (n = 11) by the city health department; 51.5% (n = 69) by health care providers; and 40.3% (n = 54) by both. Being offered PN was significantly associated with criminal justice involvement history (adjusted odds ratio [aOR], 2.49; 95% confidence interval [CI], 1.38-4.49), volatile nitrates usage (aOR, 2.88; 95% CI, 1.20-6.94), and recent conversations with HIV outreach workers (aOR, 2.68; 95% CI, 1.25-5.77). Providing partner names was significantly associated with intermittent (aOR, 7.26; 95% CI, 1.75-30.07) and heavy (aOR, 11.47; 95% CI, 2.57-51.22) marijuana use, and being offered PN by both the city health department and health care provider (aOR, 8.36; 95% CI, 2.73-25.62). CONCLUSIONS A substantial proportion of HIV-diagnosed individuals were never offered PN. Being offered PN by multiple sources is associated with participation, and improved collaboration within health systems may improve participation rates.

Due to significant declines in the price of genome sequencing technology, the bioinformatics sciences are experiencing a massive upswing in data generation resulting in an increasing need for data distribution and access. The sheer number of biological areas of study, many of which benefit from the scientific breakthroughs of one another, are adding to the increase of shared data usage. The need for effective data management, analysis, and access are becoming more critical. While there are commonalities facing both precision medicine and metagenomics, each area has its own unique challenges and needs. A workshop was held in April 2016 at Lawrence Berkeley National Laboratory that brought together scientists from both fields, along with experts in computing and networking. Presenters and attendees discussed current research and pressing data issues facing the bioinformatics field today and in the near future.

Purpose Little is known about the characteristics of residential educational settings for young people with intellectual or developmental disabilities (IDD) in England. Previous research has focussed on the characteristics and experiences of the young people attending such settings rather than the setting itself; therefore, an overview of national provision is needed. The paper aims to discuss these issues. Design/methodology/approach As part of a larger project, data were collected for all residential schools and colleges in England. Data relate to settings offering residential provision for at least 4 nights per week for 30 weeks per year, either at the school/college itself, or in an associated residential home. Due to the remit of the main project, settings offering placements only to young people aged under 16 were excluded. Data were collected from a range of sources, including school/college websites, Ofsted and Department for Education resources, and liaison directly with the setting. Findings In total, 342 residential educational settings were identified with 57 of these offering post-16 provisions only. A range of data is presented about these settings, including location, placement numbers and types available, age range catered for, special educational needs categories registered for, governance arrangements (e.g. LA maintained, privately owned, and charitable organisation), and Ofsted educational ratings. Originality/value These data provide a national overview of residential educational settings for young people with IDD. This enables a clearer picture of the location and type of provision offered and allows comparisons both within and between areas.

Objectives Actical® actigraphy is commonly used to monitor athlete sleep. The proprietary software, called Actiware®, processes data with three different sleep-wake thresholds (Low, Medium or High), but there is no standardisation regarding their use. The purpose of this study was to examine validity and bias of the sleep-wake thresholds for processing Actical® sleep data in team sport athletes. Design Validation study comparing actigraph against accepted gold standard polysomnography (PSG). Methods Sixty seven nights of sleep were recorded simultaneously with polysomnography and Actical® devices. Individual night data was compared across five sleep measures for each sleep-wake threshold using Actiware® software. Accuracy of each sleep-wake threshold compared with PSG was evaluated from mean bias with 95% confidence limits, Pearson moment-product correlation and associated standard error of estimate. Results The Medium threshold generated the smallest mean bias compared with polysomnography for total sleep time (8.5 min), sleep efficiency (1.8%) and wake after sleep onset (−4.1 min); whereas the Low threshold had the smallest bias (7.5 min) for wake bouts. Bias in sleep onset latency was the same across thresholds (−9.5 min). The standard error of the estimate was similar across all thresholds; total sleep time ∼25 min, sleep efficiency ∼4.5%, wake after sleep onset ∼21 min, and wake bouts ∼8 counts. Conclusions Sleep parameters measured by the Actical® device are greatly influenced by the sleep-wake threshold applied. In the present study the Medium threshold produced the smallest bias for most parameters compared with PSG. Given the magnitude of measurement variability, confidence limits should be employed when interpreting changes in sleep parameters.

Background People with intellectual disabilities, if convicted of offences, may be sentenced to prison, but little is known about their life when they are released. Method This study followed up men with intellectual disabilities who were leaving prisons in England. Results The men were hard to contact, but 38 men were interviewed, on average 10 weeks after leaving prison. The men were living in a variety of situations and often were very under-occupied, with limited social networks. A total of 70% were above the clinical cut-off for anxiety, and 59.5% were above the clinical cut-off for depression. The men were receiving little support in the community, and many had been reinterviewed by police. Conclusions Community teams need to provide better support to this very vulnerable group.

There is evidence to suggest athletes have adopted recombinant human erythropoietin (rHuEPO) dosing regimens that diminish the likelihood of being caught by direct detection techniques. However, the temporal response in physiology, performance, and Athlete Biological Passport (ABP) parameters to such regimens is not clearly understood. Participants were assigned to a high-dose only group (HIGH, n = 8, six rHuEPO doses of 250 IU/kg over two weeks), a combined high micro-dose group (COMB, n = 8, high-dose plus nine rHuEPO micro-doses over a further three weeks), or one of two placebo control groups who received saline in the same pattern as the HIGH (HIGH-PLACEBO, n = 4) or COMB (COMB-PLACEBO, n = 4) groups. Temporal changes in physiology and performance were tracked by graded exercise test (GXT) and haemoglobin mass assessment at baseline, after high dose, after micro-dose (COMB and COMB-PLACEBO only) and after a four-week washout. Venous blood samples were collected throughout the baseline, rHuEPO administration, and washout periods to determine the haematological and ABP response to each dosing regimen. Physiological adaptations induced by a two-week rHuEPO high-dose were maintained by rHuEPO micro-dosing for at least three weeks. However, all participants administered rHuEPO registered at least one suspicious ABP value during the administration or washout periods. These results indicate there is sufficient sensitivity in the ABP to detect use of high rHuEPO doping regimens in athletic populations and they provide important empirical examples for use by anti-doping experts. Copyright © 2017 John Wiley & Sons, Ltd.

High ozone (O3) concentrations at low altitudes (1.5e4 km) were detected from airborne Alpha Jet Atmospheric eXperiment (AJAX) measurements on 30 May 2012 off the coast of California (CA). We investigate the causes of those elevated O3 concentrations using airborne measurements and various models. GEOS-Chem simulation shows that the contribution from local sources is likely small. A back trajectory model was used to determine the air mass origins and how much they contributed to the O3 over CA. Low-level potential vorticity (PV) from Modern Era Retrospective analysis for Research and Applications 2 (MERRA-2) reanalysis data appears to be a result of the diabatic heating and mixing of airs in the lower altitudes, rather than be a result of direct transport from stratospheric intrusion. The Q diagnostic, which is a measure of the mixing of the air masses, indicates that there is sufficient mixing along the trajectory to indicate that O3 from the different origins is mixed and transported to the western U.S.The back-trajectory model simulation demonstrates the air masses of interest came mostly from the mid troposphere (MT, 76), but the contribution of the lower troposphere (LT, 19) is also significant compared to those from the upper troposphere/lower stratosphere (UTLS, 5). Air coming from the LT appears to be mostly originating over Asia. The possible surface impact of the high O3 transported aloft on the surface O3 concentration through vertical and horizontal transport within a few days is substantiated by the influence maps determined from the Weather Research and Forecasting Stochastic Time Inverted Lagrangian Transport (WRF-STILT) model and the observed increases in surface ozone mixing ratios. Contrasting this complex case with a stratospheric-dominant event emphasizes the contribution of each source to the high O3 concentration in the lower altitudes over CA. Integrated analyses using models, reanalysis, and diagnostic tools, allows high ozone values detected by in-situ measurements to be attributed to multiple source processes.

Following transplantation, patients must take immunosuppressive medication for life. Torquetenovirus (TTV) is thought to be marker for immunosuppression, and TTV&ndash, DNA levels after organ transplantation have been investigated, showing high TTV levels, associated with increased risk of infections, and low TTV levels associated with increased risk of rejection. However, this has been investigated in studies with relatively short follow-up periods. We hypothesized that TTV levels can be used to assess long term outcomes after renal transplantation. Serum samples of 666 renal transplant recipients were tested for TTV DNA. Samples were taken at least one year after renal transplantation, when TTV levels are thought to be relatively stable. Patient data was reviewed for graft failure, all-cause mortality and death due to infectious causes. Our data indicates that high TTV levels, sampled more than one year post-transplantation, are associated with all-cause mortality with a hazard ratio (HR) of 1.12 (95% CI, 1.02&ndash, 1.23) per log10 increase in TTV viral load, (p = 0.02). Additionally, high TTV levels were also associated with death due to infectious causes (HR 1.20 (95% CI 1.01&ndash, 1.43), p = 0.04). TTV levels decrease in the years following renal transplantation, but remain elevated longer than previously thought. This study shows that TTV level may aid in predicting long-term outcomes, all-cause mortality and death due to an infectious cause in renal transplant patients sampled over one year post-transplantation.

Background Children with intellectual disability have an IQ < 70, associated deficits in adaptive skills and are at increased risk of having clinically concerning levels of behaviour problems. In addition, parents of children with intellectual disability are likely to report high levels of mental health and other psychological problems. The Early Positive Approaches to Support (E-PAtS) programme for family caregivers of young children (5 years and under) with intellectual and developmental disabilities is a group-based intervention which aims to enhance parental psychosocial wellbeing and service access and support positive development for children. The aim of this study is to assess the feasibility of delivering E-PAtS to family caregivers of children with intellectual disability by community parenting support service provider organisations. The study will inform a potential, definitive RCT of the effectiveness and cost-effectiveness of E-PAtS. Methods This study is a feasibility cluster randomised controlled trial, with embedded process evaluation. Up to 2 family caregivers will be recruited from 64 families with a child (18 months to 5 years) with intellectual disability at research sites in the UK. Participating families will be allocated to intervention: control on a 1:1 basis; intervention families will be offered the E-PAtS programme immediately, continuing to receive usual practice, and control participants will be offered the opportunity to attend the E-PAtS programme at the end of the follow-up period and will continue to receive usual practice. Data will be collected at baseline, 3 months post-randomisation and 12 months post-randomisation. The primary aim is to assess feasibility via the assessment of: recruitment of service provider organisations; participant recruitment; randomisation; retention; intervention adherence; intervention fidelity and the views of participants, intervention facilitators and service provider organisations regarding intervention delivery and study processes. The secondary aim is preliminary evaluation of a range of established outcome measures for individual family members, subsystem relationships and overall family functioning, plus additional health economic outcomes for inclusion in a future definitive trial. Discussion The results of this study will inform a potential future definitive trial, to evaluate the effectiveness and cost-effectiveness of the E-PAtS intervention to improve parental psychosocial wellbeing. Such a trial would have significant scientific impact internationally in the intellectual disability field. Trial registration ISRCTN70419473

Purpose The purpose of this paper is to present an update on the Ealing Intensive Therapeutic and Short Breaks Service (ITSBS). Design/methodology/approach The challenges the service has faced are reviewed, including the service’s response to those challenges. Also provided is a more detailed analysis of the outcomes of the service. Findings The ITSBS continues to succeed in supporting young people with intellectual disabilities and challenging behaviour to stay at home with their families. Originality/value Despite considerable challenges and adaptations to the model, the ITSBS is still achieving successful outcomes for vulnerable young people and is considered nationally to be a best-practice model. Few prior articles have provided an account of how innovative service models are maintained and evolve over time.

Purpose: There is debate as to which environmental intervention produces the most benefit for team sport athletes, particularly comparing heat and altitude. This quasi-experimental study aimed to compare blood volume (BV) responses with heat and altitude training camps in Australian footballers. Methods: The BV of 7 professional Australian footballers (91.8 [10.5] kg, 191.8 [10.1] cm) was measured throughout 3 consecutive spring/summer preseasons. During each preseason, players participated in altitude (year 1 and year 2) and heat (year 3) environmental training camps. Year 1 and year 2 altitude camps were in November/December in the United States, whereas the year 3 heat camp was in February/March in Australia after a full exposure to summer heat. BV, red cell volume, and plasma volume (PV) were measured at least 3 times during each preseason. Results: Red cell volume increased substantially following altitude in both year 1 (d = 0.67) and year 2 (d = 1.03), before returning to baseline 4 weeks postaltitude. Immediately following altitude, concurrent decreases in PV were observed during year 1 (d = −0.40) and year 2 (d = −0.98). With spring/summer training in year 3, BV and PV were substantially higher in January than temporally matched postaltitude measurements during year 1 (BV: d = −0.93, PV: d = −1.07) and year 2 (BV: d = −1.99, PV: d = −2.25), with year 3 total BV, red cell volume, and PV not changing further despite the 6-day heat intervention. Conclusions: We found greater BV after training throughout spring/summer conditions, compared with interrupting spring/summer exposure to train at altitude in the cold, with no additional benefits observed from a heat camp following spring/summer training.

The NASA Ames Research Center operates a new research platform for atmospheric studies: an instrumented Alpha Jet. The present complement of instruments allows for the determination of carbon dioxide, ozone, water vapor, and methane concentrations as well as measurements of three-dimensional wind speeds, temperature, and pressure. Planned future instrumentation includes an Air-Core sampler and an instrument to measure formaldehyde. We give examples of measurements that have been made, including measurements carried out during a downward spiral over an expected methane source. An attractive property of this airborne system is its ability to respond rapidly to unexpected atmospheric events such as large forest fires or severe air quality events.

Background: Probiotics are protective against Clostridioides difficile infection and antibiotic-associated diarrhea, and they may decrease risk of infections following complex abdominal surgeries. Infectious risks associated with probiotic use are not well described in the literature. We describe probiotic use among patients with bloodstream infections (BSIs) due to organisms typically found in probiotics. Methods: Patients with positive blood cultures with Lactobacillus spp, Saccharomyces spp, and Bifidobacterium spp at our large academic hospital from October 2016 through October 2019 were identified using Theradoc, a clinical surveillance tool. Clinical data and orders for probiotics, including probiotic capsules, probiotic yogurt, and kefir, were extracted from the electronic medical record. Cases were considered distinct if the cultures were collected 7 or more days apart. True infections were defined as positive cultures which were treated with antimicrobials and had provider documentation outlining clinical relevance of culture data. Results: Among 26 distinct episodes of BSI, 16 (62%) were considered true infections. The remaining 10 cases were interpreted as contaminants or of unclear significance. Of the 16 cases representing true infection in 14 patients, 6 (38%) had received probiotics in the hospital in the preceding month. Among these patients, 5 had Lactobacillus bacteremia and had received Lactobacillus capsules, probiotic yogurt, and/or kefir. One patient had Saccharomyces fungemia following receipt of probiotic yogurt and kefir. All 6 patients with BSI possibly related to probiotic use had an antecedent gastrointestinal procedure or surgery within a month of the BSI, and 2 had intra-abdominal abscesses from which the same organism was cultured. Of the 16 true BSIs, 9 occurred in immunocompromised hosts, but antecedent probiotic use was confirmed in only 1 of these cases. Two episodes caused by different organisms occurred within the same month; all other episodes were >60 days apart. Conclusions: In our retrospective review of BSIs with organisms typically found in probiotics over a 3-year period at a large academic hospital, more than one-third of those with clinically relevant BSIs had antecedent probiotic use within the hospital. All patients with infections possibly related to probiotic use had recent gastrointestinal procedures or surgery, raising concern for probiotic use following interventions that increase the risk for gastrointestinal tract leakage or translocation. Further research is necessary to assess the risk of bloodstream infection in postoperative patients treated with probiotics.Funding: NoneDisclosures: None

IntroductionInhaled marijuana has been infrequently identified as a potential risk factor for the development of spontaneous pneumomediastinum (SPM), a rare finding of free air in the mediastinum likely caused by barotrauma during breathing manoeuvres. The mechanism of inhalation drug use is often not ascertained by physicians, thus little is known about how different smoking techniques precipitate pulmonary injury. We aimed to evaluate the frequency of marijuana use in patients with non-traumatic pneumomediastinum over a 12-month period, identifying additional relevant clinical features or risk factors, and determining the extent to which clinicians record smoking techniques.MethodsWe performed a retrospective chart review over a 1-year period, identifying patients presenting to the hospital with a diagnosis of pneumomediastinum in the absence of trauma, malignancy or iatrogenic cause.ResultsWe identified 21 cases, 14 of which (66.7%) were associated with marijuana use, average age was 22.5 years (range 18–30), with male predominance (64.2%). Daily or more use was reported in 50% of cases. Concurrent risk factors including vomiting (57.1%) and coughing (42.9%) were commonly present. The mechanism of smoking was described in only two cases (14.3%).DiscussionInhaled marijuana may be an underappreciated risk factor for the development of SPM, caused by air leakage around the bronchovascular sheaths during successive inhalation through a high-resistance smoking apparatus or forced exhalation against a closed glottis. Physicians should be aware of this association in order to provide appropriate counselling. Further research is needed to direct the safe use of smoking devices and techniques.

Purpose: To determine if a series of trials with fraction of inspired oxygen (FiO2) content deception could improve 4000-m cycling time-trial (TT) performance. Methods: A total of 15 trained male cyclists (mean [SD] body mass 74.2 [8.0] kg, peak oxygen uptake 62 [6] mL·kg−1·min−1) completed six 4000-m cycling TTs in a semirandomized order. After a familiarization TT, cyclists were informed in 2 initial trials they were inspiring normoxic air (NORM, FiO2 0.21); however, in 1 trial (deception condition), they inspired hyperoxic air (NORM-DEC, FiO2 0.36). During 2 subsequent TTs, cyclists were informed they were inspiring hyperoxic air (HYPER, FiO2 0.36), but in 1 trial, normoxic air was inspired (HYPER-DEC). In the final TT (NORM-INFORM), the deception was revealed and cyclists were asked to reproduce their best TT performance while inspiring normoxic air. Results: Greater power output and faster performances occurred when cyclists inspired hyperoxic air in both truthful (HYPER) and deceptive (NORM-DEC) trials than NORM (P P Conclusions: Cycling performance improved with acute exposure to hyperoxia. Mechanisms for the improvement were likely physiological; however, improvement in a deception trial suggests an additional placebo effect. Finally, a particular sequence of oxygen deception trials may have built psychophysiological belief in cyclists such that performance improved in a subsequent normoxic trial.

Deserts are fragile and highly sensitive ecosystems that increasingly are affected by upwind urban areas and industrial activities. The Los Angeles Basin (LAB) contributes to poor air quality in downwind deserts including the Mojave Desert. Few studies have investigated potential air pollution inputs to the Mojave, whose fragile ecosystem includes endangered plant and animal species. Data were collected on 19 August 2015 by a mobile air quality laboratory, AMOG (AutoMObile trace Gas) Surveyor, that observed inputs can arise from the LAB as well as the San Joaquin Valley (SJV), California. The campaign used a strong methane (CH4) plume as a tracer for the downwind fate of emissions from Bakersfield area petroleum production and also measured ozone (O3). Additional in situ concurrent airborne GHG and O3 data were collected by AJAX - Alpha Jet Atmospheric eXperiment. Both AMOG and AJAX measure winds. Mojave Desert air quality was very poor (visibility ~4 km). Based on the winds, an additional source was inferred beyond the LAB and SJV Basins. Numerical transport modeling and analysis of aerosol lidar data collected the same day by the Cloud Profiling LiDAR onboard the Earth Research-2 stratospheric airplane demonstrated that fires in Northern California were responsible, with prevailing winds transporting air southwards along the eastern Sierra Nevada Range (Bishop Valley) to the Mojave. Whereas the southern and eastern Mojave are impacted by SJV and LAB outflow, the north Mojave generally avoids these inputs. This study shows it can be affected by even distant wildfires, which likely will increase in occurrence and intensity from climate change. Thus, regulatory efforts to reduce air quality impacts on the endangered Mojave ecosystem must include wildfires and also account for the significant differences between different regions of the Mojave. Currently, there is a paucity of studies, highlighting the critical need for field research.

Methane (CH4) inventory uncertainties are large, requiring robust emission derivation approaches. We report on a fused airborne–surface data collection approach to derive emissions from an active oil field near Bakersfield, central California. The approach characterizes the atmosphere from the surface to above the planetary boundary layer (PBL) and combines downwind trace gas concentration anomaly (plume) above background with normal winds to derive flux. This approach does not require a well-mixed PBL; allows explicit, data-based, uncertainty evaluation; and was applied to complex topography and wind flows. In situ airborne (collected by AJAX – the Alpha Jet Atmospheric eXperiment) and mobile surface (collected by AMOG – the AutoMObile trace Gas – Surveyor) data were collected on 19 August 2015 to assess source strength. Data included an AMOG and AJAX intercomparison transect profiling from the San Joaquin Valley (SJV) floor into the Sierra Nevada (0.1–2.2 km altitude), validating a novel surface approach for atmospheric profiling by leveraging topography. The profile intercomparison found good agreement in multiple parameters for the overlapping altitude range from 500 to 1500 m for the upper 5 % of surface winds, which accounts for wind-impeding structures, i.e., terrain, trees, buildings, etc. Annualized emissions from the active oil fields were 31.3 ± 16 Gg methane and 2.4 ± 1.2 Tg carbon dioxide. Data showed the PBL was not well mixed at distances of 10–20 km downwind, highlighting the importance of the experimental design.