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Objectives Individual risk factors for dementia are well known, but the influence of co-occurring chronic conditions has not been considered. We identified clusters of chronic conditions using an unsupervised machine learning approach and examined associations with incident dementia. Approach Using linked population-based administrative databases, we followed all community-dwelling adults aged 40-54 years in Ontario, Canada from April 2002 until March 2019 for incident dementia. We estimated the prevalence of 29 chronic conditions using validated algorithms and/or diagnosis codes. We reduced dataset dimensionality using multiple correspondence analysis and a fuzzy c-means clustering algorithm identified the optimal number of clusters (between 3-6 tested). Associations between clusters and incident dementia were examined using a cause-specific hazard model adjusted for sociodemographic characteristics and accounting for the competing risk of death. Results We identified 82,359 eligible individuals (random 3% sample of total eligible individuals; mean age 46.5 years; 50.4% female). Regression analyses were based on 5 comorbidity clusters (fuzzy silhouette index:0.69). Compared to the low comorbidity cluster, persons in the cerebrovascular disease/metabolic (HRadj=3.06, 95%CI[2.42,3.86]) and neuro-related/mental health clusters (HRadj=2.51, 95%CI[2.05,3.07]) had the highest rates of incident dementia, followed by the cardiovascular risk factor cluster (HRadj=1.66,95%CI[1.32,2.09]). Persons in the cancer cluster did not have an increased incidence of dementia (HRadj=0.96,95%CI[0.77,1.20]). Conclusions We found significant associations between machine learning-derived clusters of chronic conditions and dementia. Implications Unsupervised machine learning approaches to identify clusters of chronic conditions may be a useful tool for considering the impact of multimorbidity on dementia risk.

BackgroundSeveral social determinants of health and other structural factors drive racial and ethnic disparities in COVID-19 risk, morbidity, and mortality. Public-private collaborations with community pharmacies have been successful in expanding access to COVID-19 testing and reaching historically underserved communities. The objectives of this study were to describe individuals who sought testing for COVID-19 at a national community pharmacy chain and to understand potential racial and ethnic inequities in testing access, positivity, and infection with emerging variants of concern.MethodsWe conducted a cross-sectional study of individuals aged ≥18 who were tested for COVID-19 (SARS-CoV-2) at a Walgreens pharmacy or Walgreen-affiliated mass testing site between May 1, 2021 and February 28, 2022. Positivity was defined as the proportion of positive tests among all administered tests. A geographically balanced random subset of positive tests underwent whole genome sequencing to identify specific viral variants (alpha, delta, and omicron). Logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) to compare the likelihood of testing positive and testing positive with an emerging variant of concern across race and ethnicity groups.ResultsA total of 18,576,360 tests were analyzed (16.0% tests were positive for COVID-19; 59.5% of tests were from White individuals and 13.1% were from Black individuals). American Indian or Alaska Native (OR = 1.12; 95%CI = 1.10–1.13), Hispanic or Latino (1.20; 95%CI = 1.120, 1.21), and Black (1.12; 95%CI = 1.12, 1.13) individuals were more likely to test positive for COVID-19 compared to White individuals. Non-White individuals were also more likely to test positive for emerging variants of concern (e.g., Black individuals were 3.34 (95%CI = 3.14–3.56) times more likely to test positive for omicron compared to White individuals during the transition period from delta to omicron).DiscussionUsing a national database of testing data, we found racial and ethnic differences in the likelihood of testing positive for COVID-19 and testing positive for emerging viral strains. These results demonstrate the feasibility of public-private collaborations with local pharmacies and pharmacy chains to support pandemic response and reach harder to reach populations with important health services.

IntroductionCOVID-19 booster vaccines are highly effective at reducing severe illness and death from COVID-19. Research is needed to identify whether racial and ethnic disparities observed for the primary series of the COVID-19 vaccines persist for booster vaccinations and how those disparities may vary by other characteristics. We aimed to measure racial and ethnic differences in booster vaccine receipt among U.S. Medicare beneficiaries and characterize potential variation by demographic characteristics.MethodsWe conducted a cohort study using CVS Health and Walgreens pharmacy data linked to Medicare claims. We included community-dwelling Medicare beneficiaries aged ≥66 years who received two mRNA vaccine doses (BNT162b2 and mRNA-1273) as of 8/1/2021. We followed beneficiaries from 8/1/2021 until booster vaccine receipt, death, Medicare disenrollment, or end of follow-up (12/31/2021). Adjusted Poisson regression was used to estimate rate ratios (RRs) and 95% confidence intervals (CIs) comparing vaccine uptake between groups.ResultsWe identified 11,339,103 eligible beneficiaries (mean age 76 years, 60% female, 78% White). Overall, 67% received a booster vaccine (White = 68.5%; Asian = 67.0%; Black = 57.0%; Hispanic = 53.3%). Compared to White individuals, Black (RR = 0.78 [95%CI = 0.78–0.78]) and Hispanic individuals (RR = 0.72 [95% = CI 0.72–0.72]) had lower rates of booster vaccination. Disparities varied by geographic region, urbanicity, and Medicare plan/Medicaid eligibility. The relative magnitude of disparities was lesser in areas where vaccine uptake was lower in White individuals.DiscussionRacial and ethnic disparities in COVID-19 vaccination have persisted for booster vaccines. These findings highlight that interventions to improve vaccine uptake should be designed at the intersection of race and ethnicity and geographic location.

Holistic and ecological approaches to mental health support have been identified by many as best-practice approaches for creating and sustaining well-being. Those who experience mental health challenges including, for example, Borderline Personality Disorder (BPD), often struggle to find adequate, sustainable and ongoing care from clinical settings, and recent research shows that additional strategies such as peer support programs, arts approaches, and holistic school-based collaboration work effectively. More generally, the mainstream population continues to suffer from outdated, overly medicalised and frequently inaccurate notions of the experience of poor mental health and the effective support of those who suffer, and peer- and school-integrated approaches go some way toward better education about mental ill-health. This article uses a creative ecologies model (Harris, 2016) to help schools implement student- and family-led support programs for students experiencing mental health challenges in school settings.

This article considers the related concepts of 'rehearsal' [Harney, Stefano, and Fred Moten. 2013. "The Undercommons: Fugitive Planning & Black Study." Brooklyn: Minor Compositions] and 'catastrophe' [Stengers, Isabelle. 2015. "In Catastrophic Times: Resisting the Coming Barbarism." Translated by Andrew Goffey. London: Open Humanities Press] as activism, focussing upon eco-somatic drama processes engaged through "In Your Arms" (IYA). This participatory arts project for babies and their primary caregivers was co-created in Naarm (Melbourne), Australia, by a four-person artist ensemble, ten pre-crawling babies, and their mothers. Multi-modalities were used, including improvisatory movement scores, natural props, sound-making and listening practices. The article suggests new ways to consider drama activity at a micro-sensorial scale, offering practices that cultivate environmental attunement and care from the very first months of life.

One source of information we glean from everyday experience, which guides social interaction, is assessing the emotional state of others. Emotional state can be expressed through several modalities: body posture or movements, body odor, touch, facial expression, or the intonation in a voice. Much research has examined emotional processing within one sensory modality or the transfer of emotional processing from one modality to another. Yet, less is known regarding interactions across different modalities when perceiving emotions, despite our common experience of seeing emotion in a face while hearing the corresponding emotion in a voice. Our study examined if visual and auditory emotions of matched valence (congruent) conferred stronger perceptual and physiological effects compared to visual and auditory emotions of unmatched valence (incongruent). We quantified how exposure to emotional faces and/or voices altered perception using psychophysics and how it altered a physiological proxy for stress or arousal using salivary cortisol. While we found no significant advantage of congruent over incongruent emotions, we found that changes in cortisol were associated with perceptual changes. Following exposure to negative emotional content, larger decreases in cortisol, indicative of less stress, correlated with more positive perceptual after-effects, indicative of stronger biases to see neutral faces as happier.

Introduction: Stay-at-home orders during the COVID-19 pandemic decreased population mobility to reduce SARS-CoV-2 infection rates. We empirically tested the hypothesis that this public health measure was associated with a higher likelihood of opioid- and stimulant-involved deaths occurring in homes located in Cook County, Illinois. Methods: The stay-at-home period was from March 21, 2020 to May 30, 2020. We analyzed overdose data from the Cook County Medical Examiner's Office using a death location description from case investigations categorized as home, medical, motel, scene, and other. Two groups of decedents were defined as either having an opioid or stimulant listed in the primary cause of death field. We modeled a weekly time series to detect changes in deaths (number) and trends during segmented time periods. Chi-square or Fisher's exact and adjusted logistic regression was used for testing the differences between the stay-at-home and a 13-week preceding period. Results: There were 4,169 and 2,012 opioid- and stimulant-involved deaths, respectively, from 2018 to 2020. Both groups were demographically similar: 75% male, 52% White, and aged 45 years (mean). In the 13 weeks before stay-at-home orders, 51% of opioid-involved deaths occurred in homes, which increased to 59% (p

Mechanical vibrations appear across a diverse range of applications, but nevertheless are unified by a core set of principles and phenomena. In this article, we describe a reconfigurable laboratory kit that is designed to be used as part of a first undergraduate course in mechanical vibrations. The kit was designed to be low cost and allow for a series of laboratory experiments to be performed remotely. Using a common set of core hardware and software, five laboratory experiments are detailed and can be performed to supplement many of the major topics traditionally encountered in a first vibrations course. This accessible platform will readily enable further technical improvements and expansions, as well as the development of additional experiments and assignments. Metadata Overview Main design files: https://doi.org/10.5281/zenodo.5888554 Target group: undergraduate students in engineering, physics. Skills required: 3D printing – easy; laser cutting – easy; metal shear and hole punch – easy. Replication: Kit has been constructed and tested by authors, as well as students at Brown University. See section “Build Details” for more detail.

Aggregation of matter, common in stratified fluid systems, is essential to the carbon cycle and ocean ecology. Although the current understanding of aggregation involves only collision and adhesion, here Camassa et al. reveal a self-assembly phenomenon arising solely from diffusion-induced flows.

In the past twenty years, the consumption of opioid medications has reached significant proportions, leading to a rise in drug misuse and abuse and increased opioid dependence and related fatalities. Thus, the purpose of this study was to determine whether there are pharmacovigilance signals of abuse, misuse, and dependence and their nature for the following prescription opioids: codeine, dihydrocodeine, fentanyl, oxycodone, pentazocine, and tramadol. Both the pharmacovigilance datasets EudraVigilance (EV) and the FDA Adverse Events Reporting System (FAERS) were analyzed to identify and describe possible misuse-/abuse-/dependence-related issues. A descriptive analysis of the selected Adverse Drug Reactions (ADRs) was performed, and pharmacovigilance signal measures (i.e., reporting odds ratio, proportional reporting ratio, information component, and empirical Bayesian geometric mean) were computed for preferred terms (PTs) of abuse, misuse, dependence, and withdrawal, as well as PTs eventually related to them (e.g., aggression). From 2003 to 2018, there was an increase in ADR reports for the selected opioids in both datasets. Overall, 16,506 and 130,293 individual ADRs for the selected opioids were submitted to EV and FAERS, respectively. Compared with other opioids, abuse concerns were mostly recorded in relation to fentanyl and oxycodone, while tramadol and oxycodone were more strongly associated with drug dependence and withdrawal. Benzodiazepines, antidepressants, other opioids, antihistamines, recreational drugs (e.g., cocaine and alcohol), and several new psychoactive substances, including mitragynine and cathinones, were the most commonly reported concomitant drugs. ADRs reports in pharmacovigilance databases confirmed the availability of data on the abuse and dependence of prescription opioids and should be considered a resource for monitoring and preventing such issues. Psychiatrists and clinicians prescribing opioids should be aware of their misuse and dependence liability and effects that may accompany their use, especially together with concomitant drugs.

Research and catalytic testing of platinum group transition metal carbides have been extremely limited due to a lack of reliable, simple synthetic approaches. Powder samples have been reported to phase separately above 1%, and only thin-film samples have been reported to have appreciable amounts of precious metal doping. Herein, we demonstrated, through the simple co-precipitation of Pd and W or Mo precursors and their subsequent annealing, the possibility to readily form ternary carbide powders. During the investigation of the Pd-W ternary system, we discovered a new hexagonal phase, (PdW)2C, which represents the first non-cubic Pd ternary carbide. Additionally, the solubility of Pd in the Pd-W-C and Pd-Mo-C systems was increased to 24 and 32%, respectively. As a potential application, these new materials show an enhanced activity for the methanol oxidation reaction (MOR) compared to industrial Pd/C.

Liquid lithography represents a robust technique for fabricating three-dimensional (3D) microstructures on a two-dimensional template. Silanization of a surface is often a key step in the liquid lithography process and is used to alter the surface energy of the substrate and, consequently, the shape of the 3D microfeatures produced. In this work, we present a passive technique that allows for the generation of silane gradients along the length of a substrate. The technique relies on a secondary diffusion chamber with a single opening, leading to a directional introduction of silane to the substrate via passive diffusion. The secondary chamber geometry influences the deposited gradient, which is shown to be well captured by Monte Carlo simulations that incorporate the passive diffusion and grafting processes. The technique ultimately allows the user to generate a range of substrate wettabilities on a single chip, enhancing throughput for organ-on-a-chip applications by mimicking the spatial variability of tissue topographies present in vivo.

Background Early discontinuation of P2Y12 antagonists post–percutaneous coronary intervention may increase risk of stent thrombosis or nonstent recurrent myocardial infarction. Our aims were to (1) analyze the early discontinuation rate of P2Y12 antagonists post–percutaneous coronary intervention, (2) explore factors associated with early discontinuation, and (3) analyze the risk of major adverse cardiovascular events (death, acute coronary syndrome, revascularization, or stroke) associated with discontinuation from a prespecified prescribing instruction of 1 year. Method and Results We studied 2090 patients (2011–2015) who were recommended for clopidogrel for 12 months (+aspirin) post–percutaneous coronary intervention within a retrospective observational population cohort. Relationships between clopidogrel discontinuation and major adverse cardiac events were evaluated over 18‐month follow‐up. Discontinuation of clopidogrel in the first 4 quarters was low at 1.1%, 2.6%, 3.7%, and 6.1%, respectively. Previous revascularization, previous ischemic stroke, and age >80 years were independent predictors of early discontinuation. In a time‐dependent multiple regression model, clopidogrel discontinuation and bleeding (hazard ratio=1.82 [1.01–3.30] and hazard ratio=5.30 [3.14–8.94], respectively) were independent predictors of major adverse cardiac events as were age

Indium arsenide quantum dots are promising materials for short-wavelength infrared emissive applications. Here, the authors investigate the kinetics of indium arsenide nanocrystal growth and design large quantum dots with narrow emission wavelengths which can be used for through-skull fluorescence imaging.