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Background The frequency of asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections is unclear and may be influenced by how symptoms are evaluated. In this study, we sought to determine the frequency of asymptomatic SARS-CoV-2 infections in a prospective cohort of health care workers (HCWs). Methods A prospective cohort of HCWs, confirmed negative for SARS-CoV-2 exposure upon enrollment, were evaluated for SARS-CoV-2 infection by monthly analysis of SARS-CoV-2 antibodies as well as referral for polymerase chain reaction testing whenever they exhibited symptoms of coronavirus disease 2019 (COVID-19). Participants completed the standardized and validated FLU-PRO Plus symptom questionnaire scoring viral respiratory disease symptom intensity and frequency at least twice monthly during baseline periods of health and each day they had any symptoms that were different from their baseline. Results Two hundred sixty-three participants were enrolled between August 25 and December 31, 2020. Through February 28, 2021, 12 participants were diagnosed with SARS-CoV-2 infection. Symptom analysis demonstrated that all 12 had at least mild symptoms of COVID-19, compared with baseline health, near or at time of infection. Conclusions These results suggest that asymptomatic SARS-CoV-2 infection in unvaccinated, immunocompetent adults is less common than previously reported. While infectious inoculum doses and patient factors may have played a role in the clinical manifestations of SARS-CoV-2 infections in this cohort, we suspect that the high rate of symptomatic disease was due primarily to participant attentiveness to symptoms and collection of symptoms in a standardized, prospective fashion. These results have implications for studies that estimate SARS-CoV-2 infection prevalence and for public health measures to control the spread of this virus.

MotivationGeneral protein language models have been shown to summarize the semantics of protein sequences into representations that are useful for state-of-the-art predictive methods. However, for antibody specific problems, such as restoring residues lost due to sequencing errors, a model trained solely on antibodies may be more powerful. Antibodies are one of the few protein types where the volume of sequence data needed for such language models is available, e.g. in the Observed Antibody Space (OAS) database.ResultsHere, we introduce AbLang, a language model trained on the antibody sequences in the OAS database. We demonstrate the power of AbLang by using it to restore missing residues in antibody sequence data, a key issue with B-cell receptor repertoire sequencing, e.g. over 40% of OAS sequences are missing the first 15 amino acids. AbLang restores the missing residues of antibody sequences better than using IMGT germlines or the general protein language model ESM-1b. Further, AbLang does not require knowledge of the germline of the antibody and is seven times faster than ESM-1b.Availability and implementationAbLang is a python package available at https://github.com/oxpig/AbLang.Supplementary informationSupplementary data are available at Bioinformatics Advances online.

As diving foragers, sea ducks are vulnerable to underwater anthropogenic activity, including ships, underwater construction, seismic surveys and gillnet fisheries. Bycatch in gillnets is a contributing source of mortality for sea ducks, killing hundreds of thousands of individuals annually. We researched underwater hearing in sea duck species to increase knowledge of underwater avian acoustic sensitivity and to assist with possible development of gillnet bycatch mitigation strategies that include auditory deterrent devices. We used both psychoacoustic and electrophysiological techniques to investigate underwater duck hearing in several species including the long-tailed duck (Clangula hyemalis), surf scoter (Melanitta perspicillata) and common eider (Somateria mollissima). Psychoacoustic results demonstrated that all species tested share a common range of maximum auditory sensitivity of 1.0–3.0 kHz, with the long-tailed ducks and common eiders at the high end of that range (2.96 kHz), and surf scoters at the low end (1.0 kHz). In addition, our electrophysiological results from 4 surf scoters and 2 long-tailed ducks, while only tested at 0.5, 1 and 2 kHz, generally agree with the audiogram shape from our psychoacoustic testing. The results from this study are applicable to the development of effective acoustic deterrent devices or pingers in the 2–3 kHz range to deter sea ducks from anthropogenic threats.

Introduction: Multiple breath washout (MBW) is used for early detection of cystic fibrosis (CF) lung disease, with SF6MBW commonly viewed as the reference method. The use of N2MBW in infants and toddlers has been questioned for technical and physiological reasons, but a new correction of the N2signal has minimized the technical part. The present study aimed to assess the remaining differences and the contributing mechanisms for the differences between SF6 and N2MBW,corrected—such as tidal volume reduction during N2 washout with pure O2. Method: This was a longitudinal multicenter cohort study. SF6MBW and N2MBW were performed prospectively at three CF centers in the same visits on 154 test occasions across 62 children with CF (mean age: 22.7 months). Offline analysis using identical algorithms to the commercially available program provided outcomes of N2,original and N2,corrected for comparison with SF6MBW. Results: Mean functional residual capacity, FRCN2,corrected was 14.3% lower than FRCN2, original, and 1.0% different from FRCSF6. Lung clearance index, LCIN2,corrected was 25.2% lower than LCIN2,original, and 7.3% higher than LCISF6. Mean (SD) tidal volume decreased significantly during N2MBWcorrected, compared to SF6MBW (−13.1 ml [−30.7; 4.6], p < 0.0001, equal to −12.0% [−25.7; 1.73]), but this tidal volume reduction did not correlate to the differences between LCIN2,corrected and LCISF6. The absolute differences in LCI increased significantly with higher LCISF6 (0.63/LCISF6) and (0.23/LCISF6), respectively, for N2,original and N2,corrected, but the relative differences were stable across disease severity for N2,corrected, but not for N2,original. Conclusion: Only minor residual differences between FRCN2,corrected and FRCSF6 remained to show that the two methods measure gas volumes very similar in this age range. Small differences in LCI were found. Tidal volume reduction during N2MBW did not affect differences. The corrected N2MBW can now be used with confidence in young children with CF, although not interchangeably with SF6.

This work was part of PROVIDE (Protein valorization through informatics, hydrolysis, and separation) project, which is supported by Innovation Fund Denmark (Grant No.: 7045-00021B) . We acknowledge ISA, Centre for Storage Ring Facilities in Aarhus, Denmark, for granting the beam time (Grant No.: ISA-20-1005) . We thank Lis Berner for her help in the lab with the production and physicochemical characterization of the emulsions. We also acknowledge the companies involved and provided the original samples used as source materials: KMC Kartoffelmelcentralen amba (Brande, Denmark) , AKV Langholt amba (Langholt, Denmark) , CP Kelco (Lille Skensved, Denmark) , Unibio A/S (Odense, Denmark) , and Lihme Protein Solutions (Kgs. Lyngby, Denmark) ., In this study, we used a combination of quantitative proteomics and bioinformatic prediction for identifying novel antioxidant peptides. Thirty-five peptides from potato, seaweed, microbial, and spinach proteins were investigated. Based on high DPPH radical scavenging activity (IC50 ≤ 16 mg/mL), metal chelation activity, isoelectric point, and high relative abundance in the parent protein sources, 11 peptides were selected. Lipid oxidation retardation was evaluated in 5% fish oil-in-water emulsions stabilized with Tween 20, where emulsion physical stability was unaffected by peptide addition. The secondary structure of selected peptides was similar in the aqueous solution and emulsions, as confirmed by synchrotron radiation circular dichroism spectroscopy. The emulsions containing the selected peptides had lower levels of hydroperoxides and volatile compounds during storage compared to the control (without peptide). This study contributes to elucidating the effect of antioxidant peptides in emulsions and demonstrates the ability of quantitative proteomics and bioinformatics prediction to identify peptides with strong antioxidant properties., Innovation Fund Denmark 7045-00021B, ISA, Centre for Storage Ring Facilities in Aarhus, Denmark ISA-20-1005

Multiple breath washout (MBW) is used for early detection of cystic fibrosis (CF) lung disease, with SFThis was a longitudinal multicenter cohort study. SFMean functional residual capacity, FRCOnly minor residual differences between FRC

Aim: To investigate the efficacy and safety of a non-calorie–restricted low-carbohydrate diet (LCD) on glycaemic control, body composition, and cardiovascular risk factors in patients with type 2 diabetes (T2D) instructed to maintain their non-insulin antidiabetic medication and physical activity. Materials and Methods: In an open-label randomized controlled trial, patients with T2D were randomized 2:1 to either a LCD with a maximum of 20 E% (percentage of total energy intake) from carbohydrates (n = 49) or a control diet with 50-60 E% from carbohydrates (n = 22) for 6 months. Examinations at enrolment and after 3 and 6 months included blood sample analyses, anthropometrics, blood pressure, accelerometer-based assessment of physical activity, and food diaries. Total fat mass and lean mass were determined by dual-energy x-ray absorptiometry scan. The mean difference in change between groups from baseline are reported. Results: The LCD group decreased carbohydrate intake to 13.4 E% and increased fat intake to 63.2 E%, which was −30.5 ± 2.2 E% lower for carbohydrates and 30.6 ± 2.2 E% higher for fat, respectively, compared with the control group (all P 2), and waist circumference (−4.9 ± 1.3 cm) compared with the control diet (all P

Every year, hundreds of millions of people around the world travel to sacred places to worship and to learn. While the practice of pilgrimage has a long tradition and is an important part of many religious traditions and the spiritual development of individuals, some scholars have begun to question the sustainability of modern pilgrimage travel. Not only does pilgrimage, like other forms of mobility, contribute to the emission of greenhouse gases and waste accumulation, it also seems to be exempt from blame when it comes to the current environmental crisis. In addition, while mass religious gatherings have historically been tied to the transmission and spread of disease, the threat of pilgrims becoming infected while on pilgrimage has not historically been an inhibiter to religious mobility. Indeed, the demand for pilgrimage seems to increase during times of hardship and uncertainty. Given these inherent contradictions, the purpose of this conceptual paper is to question the notion of sustainability in the context of pilgrimage and religious tourism and discuss whether modern day pilgrimage and religious tourism can be structured and managed in a more sustainable manner. First, the authors discuss the existing academic literature on the positive and negative economics, socio-cultural, and environmental impacts of pilgrimage and religious tourism. The authors then question the validity of certain tourism-environment models, including the ‘Tourism Area Life Cycle’ and ‘Carrying Capacity’, in the context of pilgrimage and religious tourism, particularly as they apply to pilgrimage and religious tourism destinations that do not typically show a decline in their visitor numbers. The authors then expand upon a conceptual model that can help scholars analyze the impacts of pilgrimage and religious tourism on pilgrim-towns. The authors conclude by contending that future discussions regarding sustainability in the context of pilgrimage and religious tourism should include religious and cultural constructs of what constitutes the tangible and intangible forms of sacredness of a place.

Antibodies against SARS-CoV-2 decay but persist six months post-vaccination, with lower levels of neutralizing titers against Delta than wild-type. Only 2 of 227 vaccinated healthcare workers experienced outpatient symptomatic breakthrough infections despite 59 of 227 exhibiting serological evidence of exposure to SARS-CoV-2 as defined by development of anti-nucleocapsid protein antibodies.

The antibody repertoires of individuals and groups have been used to explore disease states, understand vaccine responses, and drive therapeutic development. The arrival of B‐cell receptor repertoire sequencing has enabled researchers to get a snapshot of these antibody repertoires, and as more data are generated, increasingly in‐depth studies are possible. However, most publicly available data only exist as raw FASTQ files, making the data hard to access, process, and compare. The Observed Antibody Space (OAS) database was created in 2018 to offer clean, annotated, and translated repertoire data. In this paper, we describe an update to OAS that has been driven by the increasing volume of data and the appearance of paired (VH/VL) sequence data. OAS is now accessible via a new web server, with standardized search parameters and a new sequence‐based search option. The new database provides both nucleotides and amino acids for every sequence, with additional sequence annotations to make the data Minimal Information about Adaptive Immune Receptor Repertoire compliant, and comments on potential problems with the sequence. OAS now contains 25 new studies, including severe acute respiratory syndrome coronavirus 2 data and paired sequencing data. The new database is accessible at http://opig.stats.ox.ac.uk/webapps/oas/, and all data are freely available for download.

A U-shaped association between serum potassium (s-potassium) and short-term mortality has been reported for patients with hypertension. Less is known about the long-term prognostic implications of s-potassium and whether this relationship is modified by intensive blood pressure (BP) control. SPRINT (Systolic Blood Pressure Intervention Trial) was a randomized, controlled trial of 9361 high-risk patients aged ≥50 years without diabetes, who were allocated to intensive versus standard BP control. We investigated associations between baseline and on-treatment s-potassium and death, using Cox proportional hazards regression (including s-potassium as a time-dependent covariate) and restricted cubic splines. We further explored the effects of intensive BP control across the s-potassium spectrum. Baseline s-potassium was available in 9336 individuals, and 8473 had a measurement at 12 months. Mean baseline s-potassium was similar between the 2 treatment groups (intensive 4.21 mmol/L versus standard 4.20 mmol/L; P =0.74), but on-treatment s-potassium was lower in the intensive group (4.14 mmol/L versus 4.18 mmol/L; P =0.001). Median follow-up was 3.3 years, with 365 all-cause deaths (3.9%) and 102 cardiovascular deaths (1.1%). Baseline s-potassium had a linear association with both types of death events ( P P =0.04) but not with cardiovascular death ( P =0.13). None of the associations remained significant after multivariable adjustment ( P ≥0.05). S-potassium did not modify the effect of intensive BP control ( P ≥0.05). In SPRINT, neither baseline nor on-treatment s-potassium levels were independently associated with death, and the effect of intensive BP control was not modified by s-potassium. Careful monitoring of patients on antihypertensive medications may eliminate the risks associated with abnormal s-potassium. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01206062

Angiogenesis is crucial in tissue repair and prevents scar tissue formation following an ischemic event such as myocardial infarction. The ischemia induces formation of new capillaries, which have high expression of integrin αv β3 . [68 Ga]Ga-NODAGA-E[(cRGDyK)]2 ([68 Ga]Ga-RGD) is a promising PET-radiotracer reflecting angiogenesis by binding to integrin αv β3 . A Göttingen mini-pig underwent transient catheter-induced left anterior descending artery (LAD) occlusion for 120 min, and after 8 weeks was imaged on a Siemens mMR 3T PET/MR system. A large antero-septal infarction was evident by late gadolinium enhancement (LGE) on the short axis and 2–4 chamber views. The infarcted area corresponded to the area with high [68 Ga]Ga-RGD uptake on the fused PET/MR images, with no uptake in the healthy myocardium. To support the hypothesis that [68 Ga]Ga-RGD uptake reflects angiogenesis, biopsies were sampled from the infarct border and healthy myocardium. Expression of αv β3 was evaluated using immunohistochemistry. The staining showed higher αv β3 expression in the capillaries of the infarct border compared to those in the healthy myocardium. These initial data confirm in vivo detection of angiogenesis using [68 Ga]Ga-RGD PET in a translational model, which overall support the method applicability when evaluating novel cardio-protective therapies.

Background Married persons may have lower rates of mortality and cardiovascular disease (CV) than unmarried persons although data regarding potential differences between men and women are conflicting. The Systolic Blood Pressure Intervention Trial (SPRINT) found that intensive versus standard blood pressure (BP) control reduced CV morbidity and mortality in high-risk patients. We hypothesized that marital status would influence CV event risk and the impact of intensive BP control, and that these effects would vary according to sex. Purpose To assess the risks of CV events and mortality according to marital status in a high-risk population, and to assess if marital status modified the effect of intensive versus standard BP control. Methods SPRINT was a randomized, controlled, open-label trial of 9361 individuals at high CV risk, at least 50 years of age, without diabetes, and with a systolic BP 130–180 mmHg. Participants were randomized to either intensive or standard BP control and followed for median 3.2 years (range 0–4.8 years). The primary efficacy endpoint was the composite of acute coronary syndromes, stroke, heart failure, or CV death. Secondary efficacy endpoints included the individual components of the primary endpoint and all-cause death. Event risk according to marital status, including variation of the effects of intensive BP control, was evaluated using multivariable Cox proportional-hazards regression with interaction analyses. The group of subjects who were married or living in a marriage-like relationship served as baseline. Results Information on marital status was available for 8762 (93.6%) individuals. A total of 4863 (55.5%) were married or in a marriage-like relationship, 3149 (35.9%) were widowed, divorced, or separated, and 750 (8.6%) were never married. Marital status did not differ between patients randomized to intensive versus standard BP control (P=0.51). The risk of the primary endpoint was not significantly affected by marital status (P>0.05), in neither men nor women (P-interaction>0.05). The same was true for its individual components except the risk of CV death which was higher among never married men (adjusted hazard ratio [aHR], 3.29, 95% confidence interval [CI]: 1.34–8.09; P=0.009; P-sex-interaction=0.99). The risk of all-cause death was higher among widowed, divorced, or separated men (aHR, 1.90, 95% CI: 1.35–2.67; P0.05; P-sex-interaction=0.24) (Figure). Associations were not modified by age (P-interaction>0.05). Marital status did not modify the effect of intensive BP control for any of the endpoints (P-interaction>0.05). Conclusions In SPRINT, never married men had higher risks of both CV death and all-cause death while widowed, divorced, or separated men had a higher risk of all-cause death. The risks and benefits of intensive BP control were not affected by marital status. Funding Acknowledgement Type of funding sources: None. Figure 1

Background The Systolic Blood Pressure Intervention Trial (SPRINT) found that intensive versus standard blood pressure (BP) control reduced cardiovascular (CV) morbidity and mortality in high-risk patients. Although antihypertensive therapies were provided at no cost to trial participants, patients were covered by various entities. Insurance coverage provides a unique dimension of risk assessment and may provide additional prognostic information in this setting. Purpose To assess the risks of incident CV events and safety events in a high CV risk population according to type of health insurance, and to assess if insurance type interacted with the effect of intensive versus standard BP control. Methods SPRINT was a randomized, controlled trial conducted across 102 US sites of 9,361 high-risk adults ≥50 years, without diabetes, and with a systolic BP 130–180 mmHg at screening. Study participants were randomized to intensive (target systolic BP Results Of 9361 participants, 3980 (42.5%) were covered by private/other insurance, 1483 (15.8%) by a Veterans Affairs (VA) health plan, 2691 (28.8%) by Medicare, 207 (2.2%) by Medicaid, and 1000 (10.7%) were uninsured. Insurance coverage distribution was well-balanced between the two study arms (P>0.05). Compared with patients who had private/other insurance, the risk of the primary endpoint was significantly higher among Medicaid beneficiaries (adj. hazard ratio [HR], 1.81, 95% confidence interval [CI], 1.09–3.00; P=0.02). The risk of death was similarly highest among Medicaid patients (adj. HR, 2.08, 95% CI, 1.08–4.02; P=0.03) and was also significantly higher among VA patients (adj. HR, 1.49, 95% CI, 1.11–2.99; P=0.008) (Figure). Serious adverse events were more common in the VA population (HR, 1.12, 95% CI, 1.01–1.23; P=0.03). Insurance type did not modify the efficacy and safety of intensive BP control (P>0.05 for all interactions). Conclusions In SPRINT, Medicaid beneficiaries were at significantly greater risk for experiencing a primary CV event. Medicaid patients and VA patients both had higher mortality than those covered by private/other insurance. The risks and benefits of intensive BP control were not affected by insurance type. Funding Acknowledgement Type of funding sources: None. Risk of death and health insurace type

Atherosclerosis - the pathophysiological mechanism shared by most cardiovascular diseases - can be directly or indirectly assessed by a variety of clinical tests including measurement of carotid intima-media thickness, carotid plaque, ankle-brachial index, pulse wave velocity, and coronary artery calcium. the Prospective Studies of Atherosclerosis (Proof-ATHERO) consortium (https://clinicalepi.i-med.ac.at/research/proof-athero/) collates de-identified individual-participant data of studies with information on atherosclerosis measures, risk factors for cardiovascular disease, and incidence of cardiovascular diseases. It currently comprises 74 studies that involve 106,846 participants from 25 countries and over 40 cities. in summary, 21 studies recruited participants from the general population (n = 67,784), 16 from high-risk populations (n = 22,677), and 37 as part of clinical trials (n = 16,385). Baseline years of contributing studies range from April 1980 to July 2014; the latest follow-up was until June 2019. Mean age at baseline was 59 years (standard deviation: 10) and 50% were female. Over a total of 830,619 person-years of follow-up, 17,270 incident cardiovascular events (including coronary heart disease and stroke) and 13,270 deaths were recorded, corresponding to cumulative incidences of 2.1% and 1.6% per annum, respectively. the consortium is coordinated by the Clinical Epidemiology Team at the Medical University of Innsbruck, Austria. Contributing studies undergo a detailed data cleaning and harmonisation procedure before being incorporated in the Proof-ATHERO central database. Statistical analyses are being conducted according to pre-defined analysis plans and use established methods for individual-participant data meta-analysis. Capitalising on its large sample size, the multi-institutional collaborative Proof-ATHERO consortium aims to better characterise, understand, and predict the development of atherosclerosis and its clinical consequences. (c) 2020 S. Karger AG, Basel, Austrian Science Fund (FWF)Austrian Science Fund (FWF) [P 32488]; Dr.-Johannes-and-Hertha-Tuba Foundation, This work was funded by the Austrian Science Fund (FWF) (P 32488) and the Dr.-Johannes-and-Hertha-Tuba Foundation. Funders of individual studies contributing to the present analysis arelisted onthe Proof-ATHERO webpage(https://clinicalepi.i-med.ac.at/research/proof-athero/studies/).

Aims The aim of this study was to examine whether high-sensitivity C-reactive protein (hs-CRP), N-terminal pro-brain natriuretic peptide (NT-proBNP), and soluble urokinase plasminogen activator receptor (suPAR) carried incremental prognostic value in predicting cardiovascular morbidity and mortality beyond traditional risk factors in apparently healthy individuals. Methods and results This was a prospective population-based cohort study comprising 1951 subjects included in the 10-year follow-up of the MONItoring of trends and determinants in CArdiovascular disease (MONICA) study, between 1993 and 1994. The principal endpoint was death from cardiovascular causes. Secondary endpoints were death from any cause, coronary artery disease, heart failure, and cerebrovascular disease. Predictive capabilities of each of the three biomarkers were tested using Cox proportional-hazards regression, Harrell’s concordance index (C-index), and net reclassification improvement (NRI). Study participants were aged 41, 51, 61, or 71 years, and equally distributed between the two sexes. During a median follow-up of 18.5 years (interquartile range: 18.1–19.0), 177 (9.1%) subjects died from a cardiovascular cause. Hs-CRP (adjusted standardized hazard ratio (HR): 1.37, 95% confidence interval (CI): 1.17–1.60), NT-proBNP (HR: 1.90, 95% CI: 1.58–2.29), and suPAR (HR: 1.35, 95% CI: 1.17–1.57) were all significantly associated with cardiovascular deaths after adjustment for age, sex, smoking status, systolic blood pressure, and total cholesterol ( p Conclusions Hs-CRP, suPAR, and particularly NT-proBNP predicted cardiovascular death and may enhance prognostication beyond traditional risk factors in apparently healthy individuals.

Objective Parental military deployment can lead to stress in the family system due to concerns about the deployed service-member's safety and increased responsibilities for those not deployed. Parent-related stress can impact adolescent disordered eating. Given the important role that stress plays in disordered eating and obesity, it is crucial to understand the impacts of unique stressors to which vulnerable populations are exposed. Method We studied 126 adolescent (14.3 ± 1.6 years; 59.5% girls; 44.4% non-Hispanic White; BMI-z, 1.91 ± .39) military dependents prior to entering an obesity and binge-eating disorder prevention trial. The Eating Disorder Examination was used to assess adolescent disordered eating. Parents self-reported their own distress and family deployment history that occurred during the adolescent's lifetime. Results Parental distress interacted with frequency of parental deployments such that for those with high parental distress, more frequent deployment was associated with greater adolescent shape and weight concerns (β = .21, p = .012) and global eating pathology (β = .18, p = .024). Discussion In this hypothesis-generating study, the combination of number of deployments and parental distress may be associated with disordered eating among adolescent military dependents seeking prevention of binge-eating disorder and adult obesity. If these preliminary findings are supported longitudinally, interventions to reduce parental stress related to deployment may be warranted to reduce disordered eating in adolescent dependents.

High blood pressure (BP) is a highly prevalent modifiable cause of cardiovascular disease, stroke, and death. Accurate BP measurement is critical, given that a 5-mmHg measurement error may lead to incorrect hypertension status classification in 84 million individuals worldwide. This position statement summarizes procedures for optimizing observer performance in clinic BP measurement, with special attention given to low-to-middle-income settings, where resource limitations, heavy workloads, time constraints, and lack of electrical power make measurement more challenging. Many measurement errors can be minimized by appropriate patient preparation and standardized techniques. Validated semi-automated/automated upper arm cuff devices should be used instead of auscultation to simplify measurement and prevent observer error. Task sharing, creating a dedicated measurement workstation, and using semi-automated or solar-charged devices may help. Ensuring observer training, and periodic re-training, is critical. Low-cost, easily accessible certification programs should be considered to facilitate best BP measurement practice.

Objective Depression is linked to excess weight, insulin resistance, and type 2 diabetes (T2D). We previously reported that in adolescent girls at-risk for T2D with moderately elevated depression, randomization to cognitive-behavioral therapy (CBT) produced greater decreases in depression at post-treament and greater decreases in fasting/2-h insulin at 1 year, compared to health education (HE). The current study is a secondary analysis of this parallel-group randomized controlled trial. We examined whether decreasing depression explained intervention effects on body composition and insulin outcomes. We hypothesized that decreases in depression would be an explanatory mediator and that indirect effects would be strongest at higher levels of baseline depression. Methods Participants were 12–17 years girls with overweight/obesity and family history of T2D randomized to 6-week group CBT (n = 58) or HE (n = 61). Procedures took place at an outpatient pediatric clinic. At baseline, post-treatment, and 1 year, adolescents completed the Center for Epidemiologic Studies-Depression Scale to assess depression symptoms; body mass index (BMI [kg/m2]) was measured from height/fasting weight; insulin resistance was derived from 2-h oral glucose testing. Adiposity was assessed with dual-energy X-ray absorptiometry at baseline and 1 year. Indirect effects of intervention were tested on 1-year changes in BMI, adiposity, and insulin through decreases in depression. Baseline depression was tested as a moderator of mediation. Results There was an indirect effect of CBT on decreased 1-year fasting insulin via decreases in depression during treatment, among adolescents with more elevated baseline depression. Conclusions Decreasing elevated depression may be one mechanism in the targeted prevention of T2D in at-risk adolescents.

Objective: The present study, adhering to Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) guidelines, is the first systematic review and meta-analysis of the Test of Memory Malingering (TOMM) to examine traditional and alternative cutoffs across Trial 1, Trial 2, and Retention.Method: Search criteria identified 539 articles published from 1997 to 2017. After application of selection criteria, 60 articles were retained for meta-analysis. Classification accuracy statistics were calculated using fixed- and random-effects models.Results: For Trial 1, a cutoff of 0.90 specificity across most samples of examinees for whom English is not the primary language, but well-below acceptable levels in individuals with dementia.Conclusions: The TOMM is highly specific when interpreted per traditional cutoffs. In individuals not suspected of significant impairment, findings indicate that a less conservative TOMM Trial 2 or Retention cutoff of

Background and aims The advantage of combining molecular and morphological imaging, e.g. positron emission tomography and magnetic resonance imaging (PET/MRI), is reflected in the increased use of these modalities as surrogate end-points in clinical trials. This study aimed at evaluating plaque inflammation using 18F-fluorodeoxyglucose (18F-FDG)-PET/MRI, and gene expression in a minipig model of atherosclerosis. Methods Gottingen Minipigs were fed for 60 weeks with fat/fructose/cholesterol-rich diet (FFC), chow (Control) or FFC-diet changed to chow midway (diet normalization group; DNO). In all groups, 18F-FDG-PET/MRI of the abdominal aorta was assessed midway and at study-end. The aorta was analyzed using histology and gene expression. Results At study-end, FFC had significantly higher FDG-uptake compared to Control (target-to-background maximal uptake, TBRMax (95% confidence interval) CITBRMax: 0.092; 7.32) and DNO showed significantly decreased uptake compared to FFC (CITBRMax: -5.94;-0.07). No difference was observed between DNO and Control (CITBRMax: −2.71; 4.11). FFC displayed increased atherosclerosis and gene expression of inflammatory markers, including vascular cell adhesion molecule 1 (VCAM-1), cluster of differentiation 68 (CD68), matrix metalloproteinase 9 (MMP9), cathepsin K (CTSK) and secreted phosphoprotein 1 (SPP1) compared to Control and DNO (all, p Conclusions In a model of atherosclerosis, 18F-FDG-PET/MRI technology allows for detection of inflammation in atherosclerotic plaques, consistent with increased inflammatory gene expression. Our findings corroborate clinical data and are important in pre-clinical drug development targeting plaque inflammation.

Objective: This study investigated sensitivity and specificity rates of four Test of Memory Malingering (TOMM) indices (Trial 1, Trial 2, Retention, and Albany Consistency Index (ACI)) and ...

Plasmodium sexual differentiation is required for malaria transmission, yet much remains unknown about its regulation. Here, we quantify early gametocyte-committed ring (gc-ring) stage, P. falciparum parasites in 260 uncomplicated malaria patient blood samples 10 days before maturation to transmissible stage V gametocytes using a gametocyte conversion assay (GCA). Seventy six percent of the samples have gc-rings, but the ratio of gametocyte to asexual-committed rings (GCR) varies widely (0–78%). GCR correlates positively with parasitemia and is negatively influenced by fever, not hematocrit, age or leukocyte counts. Higher expression levels of GDV1-dependent genes, ap2-g, msrp1 and gexp5, as well as a gdv1 allele encoding H217 are associated with high GCR, while high plasma lysophosphatidylcholine levels are associated with low GCR in the second study year. The results provide a view of sexual differentiation in the field and suggest key regulatory roles for clinical factors and gdv1 in gametocytogenesis in vivo., Here, the authors quantify early gametocyte-committed ring (gc-ring) stage Plasmodium falciparum parasites in 260 malaria patients 10 days before maturation to transmissible stage V gametocytes, and show that the ratio of circulating gc-rings is positively correlated with parasitemia and negatively correlated with body temperature.

Stressors unique to military families may place dependents of military service members of both sexes at high-risk for disordered-eating. Yet, there are no data examining sex-related differences in eating pathology and distress among this population. Therefore, we examined disordered-eating attitudes and associated psychosocial characteristics in adolescent military dependents at high-risk for both eating disorders and adult obesity (i.e., BMI ≥ 85th percentile and elevated anxiety symptoms and/or loss-of-control eating). One-hundred-twenty-five (55.2% female) adolescent (12–17 y) military dependents were studied prior to entry in an eating disorder and obesity prevention trial. Youth were administered the Eating Disorder Examination interview to determine disordered-eating attitudes, and completed questionnaires to assess self-esteem, social functioning, and depression. Girls and boys did not differ in BMIz (p = .66) or race/ethnicity (p = .997/p = .55). Adjusting for relevant covariates, girls and boys did not differ significantly with regard to disordered-eating global scores (p = .38), self-esteem (p = .23), or social functioning (p = .19). By contrast, girls reported significantly more symptoms of depression (p = .001). Adolescent male and female dependents at high-risk for eating disorders and adult obesity reported comparable levels of eating-related and psychosocial stress. Data are needed to elucidate how adolescent military dependents respond to intervention and whether sex moderates outcome.

High-performance 4H-SiC MOSFETs have been fabricated, having a peak effective mobility of 265 cm2/ $\text{V}\,\cdot $ s, and a peak field effect mobility of 154 cm2/V s, in 2- $\mu $ m gate length MOSFETs. The gate-stack was designed to minimize interface states and comprised a 0.7-nm thermally grown SiO2 on 4H-SiC, followed by Al2O3 and a metal gate contact. In this way, carbon remaining following SiC oxidation is significantly reduced. A density of interface traps in the range of $6 \times 10^{11} - 5 \times 10^{10}$ cm−2eV−1 is also obtained. Temperature-dependent electrical data reveal that the high mobility results from conduction being phonon-limited, rather than Coulomb-limited. Furthermore, universal mobility in these 4H-SiC MOSFETs is shown to be up to 50% of that observed in the Si devices. Expressions for electric field-dependent contributions to mobility are presented. A steep subthreshold slope of 127 mV/decade indicates low electrical defect density. A temperature coefficient of −4.6 mV/K in threshold voltage is similar to that in the Si MOSFETs.

Background The challenge of managing age-related diseases is increasing; routine checks by the general practitioner do not reduce cardiovascular mortality. The aim here was to reduce cardiovascular mortality by advanced population-based cardiovascular screening. The present article reports the organization of the study, the acceptability of the screening offer, and the relevance of multifaceted screening for prevention and management of cardiovascular disease. Methods Danish men aged 65–74 years were invited randomly (1 : 2) to a cardiovascular screening examination using low-dose non-contrast CT, ankle and brachial BP measurements, and blood tests. Results In all, 16 768 of 47 322 men aged 65–74 years were invited and 10 471 attended (uptake 62·4 per cent). Of these, 3481 (33·2 per cent) had a coronary artery calcium score above 400 units. Thoracic aortic aneurysm was diagnosed in the ascending aorta (diameter 45 mm or greater) in 468 men (4·5 per cent), in the arch (at least 40 mm) in 48 (0·5 per cent) and in the descending aorta (35 mm or more) in 233 (2·2 per cent). Abdominal aortic aneurysm (at least 30 mm) and iliac aneurysm (20 mm or greater) were diagnosed in 533 (5·1 per cent) and 239 (2·3 per cent) men respectively. Peripheral artery disease was diagnosed in 1147 men (11·0 per cent), potentially uncontrolled hypertension (at least 160/100 mmHg) in 835 (8·0 per cent), previously unknown atrial fibrillation confirmed by ECG in 50 (0·5 per cent), previously unknown diabetes mellitus in 180 (1·7 per cent) and isolated severe hyperlipidaemia in 48 men (0·5 per cent). In all, 4387 men (41·9 per cent), excluding those with potentially uncontrolled hypertension, were referred for additional cardiovascular prevention. Of these, 3712 (35·5 per cent of all screened men, but 84·6 per cent of those referred) consented and were started on medication. Conclusion Multifaceted cardiovascular screening is feasible and may optimize cardiovascular disease prevention in men aged 65–74 years. Uptake is lower than in aortic aneurysm screening.

Children in developing countries often lack sufficient support for early learning skills prior to beginning school. This research evaluates an educational media intervention using an animated cartoon program, Akili and Me. The program was originally created in Tanzania to teach early learning skills. This program was adapted in content and language use in this study in Rwanda. The two-week intervention involved primary school students (mean age = 7.1 years) who were randomized into two groups (intervention and comparison group). The intervention group viewed one Akili and Me episode a day for five days. This viewing was repeated the following week. Similarly, the comparison watched the same amount of television but the content consisted of local popular programs. Baseline and follow-up assessments evaluated 10 areas of early learning, using an adaptation of the International Development and Early Learning Assessment (IDELA), and also children’s media receptivity. At follow-up, children in the intervention program, Akili and Me, had significantly higher scores for counting, number recognition, shape knowledge, letter identification, color identification, body part recognition, health knowledge, and vocabulary. The analyses provide promising evidence that locally produced educational media interventions can impact early learning skills, even among children living in resource-poor communities.

Objectives Adolescent military-dependents experience distinct risk and protective factors, which may necessitate additional clinical considerations. In civilian youth, overweight/obesity is associated with eating, internalizing, and externalizing difficulties, with some studies reporting more difficulties among non-Hispanic White (vs. non-Hispanic Black) youth. It is unknown if these disparities exist among adolescent military-dependents, or between civilian and military-dependent youth. Methods Non-Hispanic Black (187 civilian, 38 military-dependent) and non-Hispanic White (205 civilian, 84 military-dependent) adolescents with overweight/obesity (14.7 ± 1.6 years; 73.9% girls; body mass index adjusted for age and sex 1.9 ± 0.5) completed a disordered-eating interview; parents completed a measure assessing their child’s internalizing and externalizing difficulties. Multiple linear regressions examined parental military-status as a moderator of the relationship of participant race with eating, internalizing, and externalizing difficulties. Results White civilian youth with overweight/obesity reported significantly greater disordered-eating than their Black peers (p < .001); there were no other significant racial differences. In all regressions, parental military-status significantly moderated the association between race and each dependent variable (ps < .047). Black military-dependents (vs. civilians) reported more disordered-eating and internalizing difficulties (ps = .01). White military-dependents (vs. civilians) reported fewer externalizing difficulties (p = .01). Conclusions Black adolescent military-dependents with overweight/obesity may experience more eating and internalizing difficulties (vs. civilians), a pattern not observed among White participants. Future work should examine if being a military-dependent and a historically marginalized racial group member accounts for these findings. Such data may inform providers of youth with intersecting minority identities.

On the wintering grounds, wetland selection by waterfowl is influenced by spatiotemporal resource distribution. The ring-necked duck (Aythya collaris) winters in the southeastern United States where a disproportionate amount of Atlantic Flyway ring-necked duck harvest occurs. We quantified female ring-necked duck selection for wetland characteristics during and after the 2017–2018 and 2018–2019 waterfowl hunting seasons using discrete choice modeling under a Bayesian framework. Relative probability of selection was primarily influenced by characteristics at the local wetland scale. Relative probability of selection was higher for flooded agriculture and vegetated wetlands than open water and was positively influenced by wetland area during the winter. After the hunting season, the relative probability of selection decreased for flooded agriculture but increased for vegetated wetlands, and the effect of wetland area decreased in magnitude. We attribute changes in selection during and after the hunting season to dietary shifts related to migratory preparation, resource depletion, and reproductive pairing. Understanding the wetland characteristics that wintering waterfowl select, and the spatial scale at which selection occurs, is important for informing effective wetland management and waterfowl harvest practices.

Background The relationship between postvaccination symptoms and strength of antibody responses is unclear. The goal of this study was to determine whether adverse effects caused by vaccination with the Pfizer/BioNTech BNT162b2 vaccine are associated with the magnitude of vaccine-induced antibody levels. Methods We conducted a single-center, observational cohort study consisting of generally healthy adult participants that were not severely immunocompromised, had no history of coronavirus disease 2019, and were seronegative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein before vaccination. Severity of vaccine-associated symptoms was obtained through participant-completed questionnaires. Testing for immunoglobulin G antibodies against SARS-CoV-2 spike protein and receptor-binding domain was conducted using microsphere-based multiplex immunoassays performed on serum samples collected at monthly visits. Neutralizing antibody titers were determined by microneutralization assays. Results Two hundred six participants were evaluated (69.4% female, median age 41.5 years old). We found no correlation between vaccine-associated symptom severity scores and vaccine-induced antibody titers 1 month after vaccination. We also observed that (1) postvaccination symptoms were inversely correlated with age and weight and more common in women, (2) systemic symptoms were more frequent after the second vaccination, (3) high symptom scores after first vaccination were predictive of high symptom scores after second vaccination, and (4) older age was associated with lower titers. Conclusions Lack of postvaccination symptoms after receipt of the BNT162b2 vaccine does not equate to lack of vaccine-induced antibodies 1 month after vaccination., We found no correlation between BNT162b2-associated symptom severity and vaccine-induced antibody titers 1 month after vaccination. Adverse effects inversely correlated with age and weight, whereas symptom severity after first vaccination was predictive of that after second vaccination.