Search

Rice bodies secondary to synovial inflammation, typically occur in the shoulders and knees of individuals affected by either rheumatoid arthritis or tuberculosis. It is uncommon to encounter these in nontubercular mycobacterial tenosynovitis especially in wrist extensor compartment. Understanding this condition and its distinctive imaging features is crucial for both treating clinicians and radiologists. In this case study, we present the imaging findings of a rare occurrence of tenosynovitis of the fourth extensor compartment in the wrist with the formation of rice bodies due to Mycobacterium avium intracellulare. We have chosen to document this case to emphasize its importance in considering the differential diagnosis of extensor tenosynovitis with rice bodies.

Abstract Background Idiopathic intracranial hypertension (IIH) is a cause of chronic headaches that are probably driven by raised intracranial pressure (ICP). Cerebral venous sinus pressure is thought to play a role in the underlying pathology, but its relation with intracranial pressure requires further investigation. We aimed to evaluate the concordance between lumbar puncture opening pressure (LPOP) as indicator of the ICP and cerebral venous sinus pressure in patients investigated for IIH. Methods In this case-series replication study, all patients with IIH suspicion and who underwent cerebral venous sinus pressure measurement followed immediately by LP opening pressure (LPOP) measurement were retrospectively included. Pearson’s correlation and measurement agreement (Bland-Altman plots) between venous pressure and LPOP were analyzed. Results 52 consecutive patients (46 women; median age, 31 years [IQR = 25–42]) were included. The mean pressure in the superior sagittal sinus (SSS) and in the torcular were 20.9mmHg (SD ± 7.3) and 20.8 mmHg (SD ± 6.8), respectively. The mean LPOP was 22mmHg (SD ± 6.4). Pressure measured in the transverse venous sinus, the torcular, and the SSS correlated with LPOP (p

Background Heavy reliance on container shipping during the COVID-19 pandemic with lockdown implementation and air travel bans placed substantial pressure on shipping crews and ports. Long waiting times at ports, substantial economic losses and massive supply chain disruption of essential and medical goods were observed. To minimise this for future pandemic preparedness, we explore the use of quarantining and testing of crews preboarding instead of quarantining at port calls or during voyages.Methods Using a microsimulation model of 10 000 vessels and 300 000 crew, we examine the effectiveness of nine predeparture control strategies in reducing COVID-19 outbreak sizes, from no control to the use of 7-day and 14-day quarantining, and addition of polymerase chain reaction (PCR) or antigen rapid test (ART) testing. To assess different infection parameters, we explored three variants (Alpha, Delta and Omicron), four prevalences (0.1%, 0.5%, 1% and 2%) and three quarantine compliances (50%, 90% and 100%).Results Across the prevalences with no intervention, our modelled simulations estimate that approximately 3%, 15%, 28% and 47% of crews are infected, totalling around 9400, 44 900, 82 600 and 141 300 infections. At 2% prevalence, averaged across variants and compliances, when 7-day predeparture quarantining (7DQ) is introduced, 23 900 (range: 21 500–25 200) estimated cases are averted, rising up to 40 900 (40 200–41 600) for 14DQ. With additional predeparture PCR testing, this increases further to 102 100 (100 100–104 500) and 106 800 (106 100–108 100) respectively. Should ART testing be used instead, 92 600 (92 200–93 200) and 100 000 (98 900–101 100) estimated cases are averted. The use of predeparture PCR testing and PCR testing 1 week before departure has the greatest reduction at 108 200 (106 400–110 600) and 111 600 (110 500–113 000).Conclusion In our simulation model, we show that preboarding control measures can be effective in limiting outbreaks, reducing the number of active cases on marine vessels without access to adequate medical care while simultaneously reducing port congestion and facilitating for the greater global transport of essential goods.

The development of compact fiber-based light sources emitting over a wide wavelength range in the mid-infrared and their application to the detection of greenhouse gases and volatile organic compounds still remain of critical interest. In the present work, we make use of several dedicated infrared fibers for implementing a mid-infrared optical device pumped by a thulium doped-fiber laser around 1.965 μm that simultaneously enables a first nonlinear stage of frequency conversion and supercontinuum generation and a second linear stage of gas absorption spectroscopy. As a proof-of-principle, we carry out mid-infrared supercontinuum absorption spectroscopy of methane around 7.7 μm by means of a hollow-core fiber-based gas cell combined to a commercial Fourier-transform infrared spectrometer. Our all-fiber configuration operating in the femtosecond regime at megahertz repetition rate allows the detection of methane concentrations as low as 20 ppm.

Background: International vertical health financing programmes risk functioning in parallel with existing domestic funding in low- and middle-income countries (LMICs), leading to inefficient service delivery and concomitant poor health outcomes. Aim: We assessed the opportunities offered by digitalised diagnostics (ConnDx) to target and monitor health funds to those in need objectively and transparently. Setting: ConnDx was rolled out in five private health facilities in Kisumu, Kenya. Methods: The ConnDx process was codeveloped with the local Department of Health of Kisumu. We used the quantitative data generated by ConnDx. We also calculated the costs for ConnDx and standard care to assess potential cost reductions. Results: In total, 2199 malaria cases were detected among 11 689 patients with fever. ConnDx allowed for the identification of malaria hotspots, semi-real-time assessment of patient health seeking behaviour across facilities and insights in doctor’s prescription behaviours. Based on these insights, we estimated a 25% reduction in costs can be realised, while simultaneously better quality indicators can be monitored. Conclusion: The concept of ConnDx can be used for any medical condition that can be diagnosed in a digital manner and linked to mobile payment systems. The generated data can contribute to better quality services for individual patients while at the same time support local health policy makers and managers for more targeted interventions. Contribution: The ConnDx approach can help decision makers in LMICs to channel disease-specific funds to the right patients for the right disease at the right time, which can potentially accelerate the way to universal health coverage.

Grape (Vitis vinifera) composition is a weather-dependent determiner of wine quality. With changing climates, we can expect variation in wine-quality. To understand the extent of this we built path models to create a generalised Cabernet-Sauvignon grape quality model focusing on the total concentrations of six important molecular groups (sugar, pH, phenols, tannins, flavanols, anthocyanins). Path models statistically connect factors from input to output using a series of dependent models. As such, this modelling approach takes the output from one model and puts it into the next model as a chain. By varying climate inputs, we can simulate how changes in climate impact the final composition of the grapes throughout their ripening. We explore the impact of changes in composition under several climate change scenarios namely: changes in light, temperature, and rainfall by changing the climatic inputs to the path model. We find that, under moderate-projected climatic changes (a combination of RCP4.5 and SRES A2 and B2), we expect higher concentrations of sugars, lower acidity (a more neutral pH), and higher total concentrations of aromatic compounds (tannins, phenols, flavanols, and anthocyanins). We also find that an earlier start of ripening leads to the same result. These two results combined suggest the potential for stronger red wines in future, with more flavour-related compounds and in particular tannins which often give greater ageing potential.

We report a case of tibial osteochondroma in a 25-year-old female who presented with a palpable calf mass. This mass was associated with a thick cartilaginous cap on cross-sectional imaging, suggesting chondrosarcoma. A CT-guided biopsy was performed, and histology, however, was consistent with osteochondroma. Orthopedic oncology recommended surgical excision due to the potential high sampling error with chondroid lesions. The patient underwent surgical resection, resulting in a final diagnosis of osteochondroma. No post-surgical complications occurred, and a 12-month follow-up showed no evidence of local recurrence. This case highlights the atypical imaging feature of a thick cartilaginous cap in a benign etiology without malignant transformation.

Introduction: The transmission dynamics of the recent mpox outbreak highlights the lack of infrastructure available to rapidly respond to novel STI outbreaks, of which Asia and Oceania remains particularly susceptible. Here, we simulate outbreaks in this setting and propose the use of pre-emptive vaccination within the men who have sex with men (MSM) community before the arrival and establishment of the virus. Materials and methods: Using data driven heterogeneous sexual contact networks, we simulated outbreaks of mpox in Singapore, Hong Kong, and Sydney. An individual based SEIR compartmental model was used to simulate epidemic trajectories and the impact of different vaccination uptakes was assessed in their ability to avert or suppress outbreaks upon the arrival of mpox within the MSM populations. Results: The highly dense sexual networks of Singapore and Sydney experience rapid outbreaks, with infection peaks occurring at day 41 and 23 respectively, compared to Hong Kong which occurs at day 77. Across the simulations with no vaccination, 68.2%–89.7% of the MSM community will become infected with mpox across the different cities, over a simulation period of 1 year. By implementing vaccination strategies, the infection rate across the cities can be reduced to as low as 3.1% of the population (range: 3.1%–82.2%) depending on the implementation and uptake of the vaccine. Vaccination is also extremely effective in slowing the start of the epidemic, delaying the epidemic peak by 36–50 days in Hong Kong, or even preventing the outbreak of mpox. Discussion: With extremely dense and well-connected sexual contact networks, where 65.2%–83.2% of the population are connected to a super-spreader in the different contact networks, pre-emptive or immediate vaccination upon identification of the first case is strongly recommended to help better manage the outbreak of mpox and prevent potential straining of healthcare systems.

Satellite remote sensing enables monitoring of regenerative agriculture practices, such as crop rotation, cover cropping, and conservation tillage to allow tracking and quantification at unprecedented scales. The Monitor system presented here capitalizes on the scope and scale of these data by integrating crop identification, cover cropping, and tillage intensity estimations annually at field scales across the contiguous United States (CONUS) from 2014 to 2023. The results provide the first ever mapping of these practices at this temporal fidelity and spatial scale, unlocking valuable insights for sustainable agricultural management. Monitor incorporates three datasets: CropID, a deep learning transformer model using Sentinel-2 and USDA Cropland Data Layer (CDL) data from 2018 to 2023 to predict annual crop types; the living root data, which use Normalized Difference Vegetation Index (NDVI) data to determine cover crop presence through regional parameterization; and residue cover (RC) data, which uses the Normalized Difference Tillage Index (NDTI) and crop residue cover (CRC) index to assess tillage intensity. The system calculates field-scale statistics and integrates these components to compile a comprehensive field management history. Results are validated with 35,184 ground-truth data points from 19 U.S. states, showing an overall accuracy of 80% for crop identification, 78% for cover crop detection, and 63% for tillage intensity. Also, comparisons with USDA NASS Ag Census data indicate that cover crop adoption rates were within 20% of estimates for 90% of states in 2017 and 81% in 2022, while for conventional tillage, 52% and 25% of states were within 20% of estimates, increasing to 75% and 67% for conservation tillage. Monitor provides a comprehensive view of regenerative practices by crop season for all of CONUS across a decade, supporting decision-making for sustainable agricultural management including associated outcomes such as reductions in emissions, long term yield resiliency, and supply chain stability.

Abstract Adaptative objects based on shape-memory materials are expected to significantly impact numerous technological sectors including optics and photonics. In this work, we demonstrate the manufacturing of shape-memory optical fibers from the thermal stretching of additively manufactured preforms. First, we show how standard commercially-available thermoplastics can be used to produce long continuously-structured microfilaments with shape-memory abilities. Shape recovery as well as programmability performances of such elongated objects are assessed. Next, we open the way for light-guiding multicomponent fiber architectures that are able to switch from temporary configurations back to user-defined programmed shapes. In particular, we show that distinct designs of fabricated optical fibers can maintain efficient light transmission upon completion of multiple temperature-triggered bending/straightening cycles. Such fibers are also programmed into more complex shapes including coils or near 180 ° curvatures for delivering laser light around obstacles. Finally, a shape-memory exposed-core fiber is employed in fiber evanescent wave spectroscopy experiments to optimize the performance of the sensing scheme. We strongly expect that such actuatable fibers with light-guiding abilities will trigger exciting progress of unprecedented smart devices in the areas of photonics, electronics, or robotics.

Malawi has the potential to explore the utilization of biogas technology. The technology has existed in the country for decades. However, the uptake has been lower than expected. Further, there has been a high rate of dis-adoption of the installed systems. To deal with the problem, this study explored the opportunities and barriers to biogas technology to enhance biogas adoption and utilization in Malawi. Qualitative research methods using key informant interviews were employed to collect the data from biogas adopters, dis-adopters, potential adopters, and experts. A total of 22 households and 6 experts were interviewed. The findings of the study show that the country has opportunities for biogas adoption and utilization. The most mentioned opportunities were livestock farming practices, constraints to access to reliable energy sources, associated benefits of biogas technology, and land holding. However, the adoption of the technology has faced several challenges. Commonly cited barriers were the high installation and maintenance costs, inadequate feedstock, inappropriate dissemination approaches, lack of training after installation services and expertise, lack of reliable water sources, absence of ownership, lack of cooperation amongst institutions involved in biogas promotion, lack of a coordinating body for institutions involved in biogas dissemination, lack of standards, and socio-cultural factors. To overcome the challenges, strategies were identified, and these include the provision of incentives, loans and subsidies, provision of technical support services, having demonstration sites, employing suitable dissemination approaches, co-digestion or diversification of raw materials, awareness campaigns, and collaboration amongst sectors involved in biogas dissemination.

Since the publication of the landmark thrombectomy trials in 2015, the field of endovascular therapy for ischemic stroke has been rapidly growing. The very low number needed to treat to provide functional benefits shown by the initial randomized trials has led clinicians and investigators to seek to translate the benefits of endovascular therapy to other patient subgroups. Even if the treatment effect is diminished, currently available data has provided sufficient information to extend endovascular therapy to large infarct core patients. Recently, published data have also shown that sophisticated imaging is not necessary for late time- window patients. As a result, further research into patient selection and the stroke pathway now focuses on dramatically reducing door-to-groin times and improving outcomes by circumventing classical imaging paradigms altogether and employing a direct-to-angio suite approach for selected large vessel occlusion patients in the early time window. While the results of this approach mainly concern patients with severe deficits, there are further struggles to provide evidence of the efficacy and safety of endovascular treatment in minor stroke and large vessel occlusion, as well as in patients with middle vessel occlusions. The current lack of good quality data regarding these patients provides significant challenges for accurately selecting potential candidates for endovascular treatment. However, current and future randomized trials will probably elucidate the efficacy of endovascular treatment in these patient populations.

BackgroundTransmission intensity for mosquito-borne diseases are highly heterogenous and multi-factorial. Understanding risk factors associated to disease transmission allow the optimization of vector control. This study sets out to understand and compare the combined anthropogenic and environmental risk factors of four major mosquito-borne diseases, dengue, malaria, chikungunya and Japanese encephalitis in Thailand.MethodsAn integrated analysis of mosquito-borne diseases, meteorological and ambient air pollutants of 76 provinces of Thailand was conducted over 2003-2021. We explored the use of generalized linear models and generalized additive models to consider both linear and non-linear associations between meteorological factors, ambient air pollutants and mosquito-borne disease incidence. Different assumptions on spatio-temporal dependence and nonlinearity were considered through province-specific and panel models, as well as different spline functions. Disease-specific model evidence was assessed to select best-fit models for epidemiological inference downstream.ResultsAnalyses indicated several findings which can be generally applied to all diseases explored: (1) higher AH above mean values was positively associated with disease case counts (2) higher total precipitation above mean values was positively associated with disease case counts (3) extremely high temperatures were negatively associated with disease case counts (4) higher SO2 and PM2.5 surface concentrations were negatively associated with disease case counts. However, the relationships between disease and RH, non-extreme temperatures and CO surface concentration were more mixed, with directions of associations changing across the different diseases considered.ConclusionsThis study found protective and enhancing effects of meteorological and ambient air pollutant factors on mosquito-borne diseases burdens in Thailand. Further studies should employ these factors to understand and predict risk factors associated with mosquito-borne disease transmission.

Rolla (2021) argumentou que a prática de avaliar teorias epistemológicas com base em intuições geradas pela consideração de certos casos, como os cenários hipotéticos envolvendo cérebros encubados, clarividentes e anjos da guarda epistêmicos, é um erro. Um erro que, uma vez reconhecido, faria com que os problemas e métodos que ocupam a epistemologia mudassem significativamente. Neste artigo, defendo que a argumentação de Rolla não se sustenta: há falhas no modo como Rolla caracteriza o uso das intuições, as suposições de Rolla podem gerar consequências implausíveis e há um contraexemplo para as alegações dele. Portanto, epistemólogos podem manter os problemas e a metodologia que Rolla critica.

Background: Increasing use prevalence of waterpipe tobacco products raises concerns about environmental impacts from waterpipe waste disposal. The U.S. Food and Drug Administration (FDA) is required to assess the environmental impact of its tobacco regulatory actions per the National Environmental Policy Act. This study builds on FDA’s efforts characterizing the aquatic toxicity of waterpipe wastewater chemicals. Methods: We compiled a comprehensive list of waterpipe wastewater chemical concentrations from literature. We then selected chemicals for risk assessment by estimating persistence, bioaccumulation, and aquatic toxicity (PBT) characteristics (U.S. Environmental Protection Agency), and hazardous concentration values (concentration affecting specific proportion of species). Results: Of 38 chemicals in waterpipe wastewater with concentration data, 20 are listed as harmful or potentially harmful constituents (HPHCs) in tobacco smoke and tobacco products by FDA, and 15 are hazardous waste per U. S. Environmental Protection Agency. Among metals, six (cadmium, chromium, lead, mercury, nickel and selenium) are included in both HPHC and hazardous waste lists and were selected for future risk assessments. Among non-metals, nicotine, and 4-methylnitrosamino-1-(3-pyridyl)− 1-butanone (NNK) were shortlisted, as they are classified as persistent and toxic. Further, N-nitrosonornicotine (NNN), with a low hazardous concentration value (HC50; concentration affecting 50 % of aquatic species) for chronic aquatic toxicity, had high aquatic toxicity concern and is selected. Conclusions: The presence of multiple hazardous compounds in waterpipe wastewater highlights the importance of awareness on the proper disposal of waterpipe wastewater in residential and retail settings. Future studies can build on the hazard characterization provided in this study through fate and transport modeling, exposure characterization and risk assessments of waterpipe wastewater chemicals.

Abstract Among the different fundamental aspects that govern the design and development of elongated multimaterial structures via the preform-to-fiber technique, material association methodologies hold a crucial role. They greatly impact the number, complexity and possible combinations of functions that can be integrated within single fibers, thus defining their applicability. In this work, a co-drawing strategy to produce monofilament microfibers from unique glass-polymer associations is investigated. In particular, the molten core-method (MCM) is applied to several amorphous and semi-crystalline thermoplastics for their integration within larger glass architectures. General conditions in which the MCM can be employed are established. It is demonstrated that the classical glass transition temperature compatibility requirements for glass-polymer associations can be overcome, and that other glass compositions than chalcogenides can be thermally stretched with thermoplastics, here oxide glasses are considered. Composite fibers with various geometries and compositional profiles are then presented to illustrate the versatility of the proposed methodology. Finally, investigations are focused on fibers produced from the association of poly ether ether ketone (PEEK) with tellurite and phosphate glasses. It is demonstrated that upon appropriate elongation conditions, the crystallization kinetics of PEEK can be controlled during the thermal stretching and crystallinities of the polymer as low as 9 mass. % are reached in the final fiber. It is believed such novel material associations as well as the ability to tailor material properties within fibers could inspire the development of a new class of hybrid elongated objects with unprecedented functionalities.

Abstract Introduction Telehealth (TH) utilization in cancer care prior to COVID‐19 was variable. Research highlights disparities in access determined by socioeconomic factors including education, income, race, and age. In response to COVID‐19 and these disparities, we assessed the impact of a personalized digital support structure, the Telehealth Task Force (TTF), to reduce disparities in TH. Methods We performed a retrospective review of cohorts between January 1, 2020 and August 30, 2020: Pre (TH use with basic telephone support), Intervention (TH access with TTF), and Post (TH access after TTF initiation and educational material dissemination). Data collected included successful TH access, health literacy (HL), and Area Deprivation Index, a ranking of neighborhoods by socioeconomic disadvantage (ADI). The data were analyzed in univariate ordinary least squares model and adjacent categories ratio model using statistical software R to understand the relationship between TTF, HL, ADI, and TH access. Results We included 555 patients from January 1, 2020 to August 30, 2020 (90 preintervention, 194 intervention, and 271 postintervention), excluding patients without ADI/HL. TTF support successfully engaged older, racially, and socioeconomically diverse patients in TH; ADI is significantly higher in the postintervention group vs. preintervention (mean difference = 7.66, 95% CI 1.00–4.32, p = 0.024) and more patients had low HL during intervention compared with preintervention (adjacent categories ratio = 0.62, 95% CI 0.41–0.93, p = 0.021). Discussion COVID‐19 created an immediate need for TH. Implementation of the TTF helped close the digital divide, increasing TH access for vulnerable patients. Attention to digital readiness can mitigate disparities in access to care. Future research should explore the implementation of widespread routine digital support initiatives.

Background: Available surveys that evaluate shoulder strength and pain often combine rotator cuff muscles making the test unable to differentiate subscapularis tears from other pathology including concomitant supraspinatus, infraspinatus tears. The purpose of this study was to validate a subscapularis-specific shoulder survey (Baltimore Orthopedic Subscapularis Score) as a viable clinical outcome assessment through analysis of psychometric properties. Methods: A 5-question survey was given to a study population of 390 patients, 136 of whom had full thickness rotator cuff tears with a minimum score of 5 (better) and a maximum score of 25 (worse). Surveys were given during the initial consultation, preoperative visit, and postoperative visit. Content validity, construct validity, test-retest reliability, responsiveness to change, internal consistency, and minimal clinically important difference using distribution and anchor-based methods were determined for our subscapularis function survey. Results: A high correlation was reported on test-retest reliability (intraclass correlation coefficient = 0.89). An acceptable internal consistency was reported for all patients surveyed (Cronbach alpha = 0.91). Floor and ceiling effects for patients with rotator cuff pathology were minimized (1% for both). Patients with an isolated subscapularis tear scored worse than supraspinatus/infraspinatus tears and exhibited similar dysfunction as patients with a supraspinatus/infraspinatus/subscapularis tear. An acceptable construct validity was reported with subscapularis-involved tears demonstrating higher scores with significance (P 0.8). The minimal clinically important difference using a distribution and anchor-based method was 4.1 and 4.6, respectively. Among patients with rotator cuff tears in this population, a score of 22 or higher predicts a subscapularis tear 75% of the time, in spite of its low overall prevalence. Conclusion: The subscapularis shoulder score demonstrated acceptable psychometric performance for outcomes assessment in patients with rotator cuff disease. This survey can be used as an effective clinical tool to assess subscapularis function.

Abstract Suicide prevention is a complex and context‐dependent challenge. About 75% of deaths by suicide occur in low‐ and middle‐income countries; yet, most current suicide prevention strategies build upon data from high‐income countries (HIC). The Kisumu County Government (KCG) in Kenya recognized the need for a suicide prevention action plan. In the absence of a Kenyan national suicide strategy, it also did not solely depend on recommendations from HIC. The KCG therefore convened a multidisciplinary workgroup with stakeholders from various sectors that led the development of the Kisumu County Suicide Prevention Action Plan (KCSPAP). The team utilized a mixed‐method approach (literature review, a desk review of mental health indicators and death certificates, focus group discussions, and key informant interviews) identifying the following: (a) magnitude and variations of suicide cases (higher number of suicide completions compared to attempts; the leading method was organophosphate poisoning though the suicide method often was not specified); (b) protective and risk factors (male gender, being between 19 and 45 years of age, and being married); (c) community perceptions of suicide (taboo topic; associated with negative spirits; community members were divided on suicide decriminalization); (d) potential solutions (need for data collection, awareness creation; scale‐up of traditional and nontraditional mental health approaches). Given the importance of a public health perspective on suicide prevention, the data in the KCSPAP are organized in a public health prevention framework that builds on a data collection framework. The KCSPAP was handed over to the KCG in mid‐2020; different recommendations have been implemented since. The KCSPAP is an example of policymaking based on local knowledge. This homegrown policymaking approach has multiple benefits and can be used by stakeholders locally and in other countries.

The question of building a local diff-invariant effective gravitational action for the trace anomaly is reconsidered. General Relativity (GR) combined with the existing action for the trace anomaly is an inconsistent low energy effective field theory. This issue is addressed by extending GR into a certain scalar-tensor theory, which preserves the GR trace anomaly equation, up to higher order corrections. The extension introduces a new mass scale – assumed to be below the Planck scale – that governs four high dimensional terms in a local diff-invariant trace anomaly action. Such terms can be kept, while an infinite number of Planck-suppressed invariants are neglected. The resulting theory maintains two derivative equations of motion. In a certain approximation it reduces to the conformal Gallileon, which could have physical consequences.

Abstract Pharmacovigilance (PV) systems in many countries in sub-Saharan Africa (SSA) are not fully functional. The spontaneous adverse events (AE) reporting rate in SSA is lower than in any other region of the world, and healthcare professionals (HCPs) in SSA countries have limited awareness of AE surveillance and reporting procedures. The GSK PV enhancement pilot initiative, in collaboration with PATH and national PV stakeholders, aimed to strengthen passive safety surveillance through a training and mentoring program of HCPs in healthcare facilities in three SSA countries: Malawi, Côte d’Ivoire, and Democratic Republic of Congo (DRC). Project implementation was country-driven, led by the Ministry of Health via the national PV center or department, and was adapted to each country’s needs. The implementation phase for each country was scheduled to last 18 months. At project start, low AE reporting rates reflected that awareness of PV practices was very low among HCPs in all three countries, even if a national PV center already existed. Malawi did not have a functional PV system nor a national PV center prior to the start of the initiative. After 18 months of PV training and mentoring of HCPs, passive safety surveillance was enhanced significantly as shown by the increased number of AE reports: from 22 during 2000–2016 to 228 in 18 months to 511 in 30 months in Malawi, and ~ 80% of AE reports from trained healthcare facilities in Côte d’Ivoire. In DRC, project implementation ended after 7 months because of the SARS-CoV-2 pandemic. Main challenges encountered were delayed AE report transmission (1–2 months, due mainly to remoteness of healthcare facilities and complex procedures for transmitting reports to the national PV center), delayed or no causality assessment due to lack of expertise and/or funding, negative perceptions among HCPs toward AE reporting, and difficulties in engaging public health programs with the centralized AE reporting processes. This pilot project has enabled the countries to train more HCPs, increased reporting of AEs and identified KPIs that could be flexibly replicated in each country. Country ownership and empowerment is essential to sustain these improvements and build a stronger AE reporting culture.

Arthroscopic shoulder surgery can be performed for retrieval of bullets and retained metallic fragments in the glenohumeral and subacromial spaces. Previous case reports and case series have demonstrated the effectiveness of an arthroscopic approach over an open procedure, as it is less invasive, allows for improved inspection and documentation of the joint surfaces and periarticular structures, and potentially leads to a faster recovery. An arthroscopic approach for extracting foreign bodies from both the quadrilateral space and the posterior extra-articular space by first accessing the glenohumeral space has yet to be described. This inside-out technique may afford surgeons the potential for improved visualization and less morbidity compared with a traditional open posterior approach. We report a technique for an arthroscopic inside-out approach for removal of extra-articular foreign bodies retained in either the quadrilateral space or the posterior extra-articular space.

Referência do artigo comentado: CID, R. R. L. Uma visão de mundo filosófica. Trans/Form/Ação: Revista de Filosofia da Unesp, v. 46, n. esp. “Filosofia Autoral Brasileira”, p. 571-596, 2023.

Background: The Neer classification is among the most widely used systems to describe proximal humerus fractures (PHF) despite the poor interobserver agreement. The purpose of this study was to verify whether or not blinded shoulder surgeons and trainees agree with the authors of articles published in the highest impact-factor orthopedic journals. Methods: All articles regarding PHF published between 2017 and 2019 in the top 10 orthopedic journals as rated by impact factor were searched. Articles were included if the authors used the Neer classification to describe at least 1 PHF in the figures. Figures were extracted without the legend, and X-rays ± computed tomography scan images were included when available. An international survey was conducted among 138 shoulder surgeons who were asked to record the Neer classification for each de-identified radiograph in the publications. The type of fracture mentioned in the legend of the published figure was considered as the gold standard. Results: Survey participants agreed with the published article authors in 55% of cases overall (range 6%-96%, n = 35). The most common response disagreed with the article authors in 13 cases (37%), underestimating the number of parts in 11 of 13 cases. The interobserver agreement between the 138 responders was fair (k = 0.296). There was an association between the percentage of concordant answers and greater experience (number of years of shoulder surgery practice) of the responders (P = .0023). The number of parts, the number or type of available imaging modalities, and the geographic origin of participants did not influence the agreement between responders and authors. Discussion: In more than one-third of cases, specialized shoulder surgeons disagree with article authors when interpreting the Neer classification of de-identified images of PHF in published manuscripts. Morphologic classification of PHF as the sole basis for treatment algorithms and surgical success should be scrutinized.

Granting a short-term loan is a critical decision. A great deal of research has concerned the prediction of credit default, notably through Machine Learning (ML) algorithms. However, given that their black-box nature has sometimes led to unwanted outcomes, comprehensibility in ML guided decision-making strategies has become more important. In many domains, transparency and accountability are no longer optional. In this article, instead of opposing white-box against black-box models, we use a multi-step procedure that combines the Fast and Frugal Tree (FFT) methodology of Martignon et al. (2005) and Phillips et al. (2017) with the extraction of post-hoc explainable information from ensemble ML models. New interpretable models are then built thanks to the inclusion of explainable ML outputs chosen by human intervention. Our methodology improves significantly the accuracy of the FFT predictions while preserving their explainable nature. We apply our approach to a dataset of short-term loans granted to borrowers in the UK, and show how complex machine learning can challenge simpler machines and help decision makers.

Over the last 15 years, optogenetics has changed fundamental research in neuroscience and is now reaching toward therapeutic applications. Vision restoration strategies using optogenetics are now at the forefront of these new clinical opportunities. But applications to human patients suffering from retinal diseases leading to blindness raise important concerns on the long-term functional expression of optogenes and the efficient signal transmission to higher visual centers. Here, we demonstrate in non-human primates continued expression and functionality at the retina level ∼20 months after delivery of our construct. We also performed in vivo recordings of visually evoked potentials in the primary visual cortex of anesthetized animals. Using synaptic blockers, we isolated the in vivo cortical activation resulting from the direct optogenetic stimulation of primate retina. In conclusion, our work indicates long-term transgene expression and transmission of the signal generated in the macaque retina to the visual cortex, two important features for future clinical applications.

PURPOSENearly half of Kenyan women with breast cancer present with advanced disease—owing partially to limited patient education and screening limitations in low- and middle-income countries. With increasing access to nurse-led cervical cancer screening (CCS) in government clinics in Kenya, we investigated provider-perceived barriers and facilitators to integrating clinical breast examinations (CBEs) with ongoing CCS programs in Kisumu County, Kenya.METHODSCCS providers within the Ministry of Health Clinics in Kisumu County, Kenya, were recruited to participate in a two-phase, sequential, mixed methods study. Knowledge of CBE guidelines was assessed with a questionnaire. Providers with significant CCS and CBE experience then completed a one-on-one interview discussing barriers and facilitators to integration.RESULTSSixty-nine providers from 20 randomly selected facilities participated in the survey. Providers all agreed that breast cancer screening was very important. Although 93% said that they routinely offered CBEs, only 22% of these providers screened at least eight of their last 10 patients. Forty-four percent identified four or more of five signs and symptoms of breast cancer, and 33% identified four to five risk factors. Although providers showed enthusiasm for integration of CBEs into their practices, barriers were identified and grouped into four themes: (1) fragmentation of services, (2) staffing shortage and inadequate on-the-job training, (3) limited space and referral system challenges, and (4) limited patient awareness on need for cancer screening.CONCLUSIONAddressing providers' concerns by providing routine on-the-job clinical training, improving staffing shortages, strengthening the diagnostic and treatment referral pathway, and increasing patient education are some of the first steps in facilitating integration of CBEs with CCS services in primary care clinics in Kenya.

IntroductionIn Africa almost half of healthcare services are delivered through private sector providers. These are often underused in national public health responses. To support and accelerate the public sector's COVID-19 response, we facilitated recruitment of additional private sector capacity by initiating a public-private partnership (PPP) in Kisumu County, Kenya. In this manuscript we demonstrate this PPP's performance.MethodsCOVID-19 diagnostic testing formed the basis for a PPP between Kenyan Medical Research Institute (KEMRI), Department of Health Kisumu County, PharmAccess Foundation, and local faith-based and private healthcare facilities: COVID-Dx. First phase COVID-Dx was implemented from June 01, 2020, to March 31, 2021 in Kisumu County, Kenya. Trained laboratory technologists in participating healthcare facilities collected nasopharyngeal and oropharyngeal samples from patients meeting the Kenyan MoH COVID-19 case definition. Healthcare workers in participating facilities collected patient clinical data using a digitized MoH COVID-19 Case Identification Form. We shared aggregated results from these data via (semi-) live dashboards with all relevant stakeholders through their mobile phones and tablets. Statistical analyses were performed using Stata 16 to inform project processes.ResultsNine private facilities participated in the project. A patient trajectory was developed from case identification to result reporting, all steps supported by a semi-real time digital dashboard. A total of 4,324 PCR tests for SARS-CoV-2 were added to the public response, identifying 425 positives, accounting for 16% of all COVID-19 tests performed in the County over the given time-period. Geo-mapped and time-tagged information on incident cases was depicted on Google maps through PowerBI-dashboards and fed back to policymakers for informed rapid decision making. Preferential COVID-19 testing was performed on health workers at risk, with 1,009 tests performed (up to 43% of all County health workforce).ConclusionWe demonstrate feasibility of rapidly increasing the public health sector COVID-19 response through coordinated private sector efforts in an African setting. Our PPP intervention in Kisumu, Kenya was based on a joint testing strategy and demonstrated that semi-real time digitalization of patient trajectories can gain significant efficiencies, linking public and private healthcare efforts, increasing transparency, support better quality health services and informing policy makers to target interventions.

Multimaterial optical fibers combining tellurite with chalcogenide glasses and featuring thin polymer structures are fabricated via the thermal drawing process. It is demonstrated that micrometric polyethersulfone films can be embedded within larger elongated tellurite/chalcogenide glass architectures. Taking advantage of the strong chemical reactivity contrasts which exist in the considered fiber geometries, a quasi‐exposed‐core waveguide is obtained by selective etching of the glass cladding. The potential of the postprocessed fiber structure is then assessed through evanescent‐wave probing of liquids and numerical investigations are carried out to establish the device performances as function of selected optogeometric parameters. Those results open the way for the development of evolutive photonic objects benefiting from postdrawing processing of multimaterial fibers.

This study examines the relationship between land use and the landscape on the Lil'Ô site managed by the Halage association on the island of Saint-Denis. The transformation of the Lil'Ô landscape and adjacent land by land use since the 20th century is studied using in situ observations, interviews, archives and the integration of aerial images in a geographic information system (GIS). A temporal landscape in motion is described in the course of a century following an inventory of current land use in the presence of pollution. As the landscape has changed soils from past activities have sedimented. These polluted soils are those of a site in a neglected outlying flood plain. Following decades during which industrial activities left the area, the relationship to nature and soil evolved from recreational use to ecological conservation and finally to ecological reconciliation. This site is now developed according to practices that break with those of the past and include an awareness of the need to consider the soil as a living organism.

The integrated stress response is a signaling network comprising four branches, each sensing different cellular stressors, converging on the phosphorylation of eIF2α to downregulate global translation and initiate recovery. One of these branches includes GCN2, which senses cellular amino acid insufficiency and participates in maintaining amino acid homeostasis. Previous studies have shown that GCN2 is a viable cancer target when amino acid stress is induced by inhibiting an additional target. In this light, we screened numerous drugs for their potential to synergize with the GCN2 inhibitor TAP20. The drug sensitivity of six cancer cell lines to a panel of 25 compounds was assessed. Each compound was then combined with TAP20 at concentrations below their IC50, and the impact on cell growth was evaluated. The strongly synergistic combinations were further characterized using synergy analyses and matrix-dependent invasion assays. Inhibitors of proteostasis and the MEK–ERK pathway, as well as the pan-CDK inhibitors, flavopiridol, and seliciclib, were potently synergistic with TAP20 in two cell lines. Among their common CDK targets was CDK7, which was more selectively targeted by THZ-1 and synergized with TAP20. Moreover, these combinations were partially synergistic when assessed using matrix-dependent invasion assays. However, TAP20 alone was sufficient to restrict invasion at concentrations well below its growth-inhibitory IC50. We conclude that GCN2 inhibition can be further explored in vivo as a cancer target.

Complete congenital stationary night blindness (cCSNB) due to mutations in TRPM1, GRM6, GPR179, NYX, or leucine-rich repeat immunoglobulin-like transmembrane domain 3 (LRIT3) is an incurable inherited retinal disorder characterized by an ON-bipolar cell (ON-BC) defect. Since the disease is non-degenerative and stable, treatment could theoretically be administrated at any time in life, making it a promising target for gene therapy. Until now, adeno-associated virus (AAV)-mediated therapies lead to significant functional improvements only in newborn cCSNB mice. Here we aimed to restore protein localization and function in adult Lrit3−/− mice. LRIT3 localizes in the outer plexiform layer and is crucial for TRPM1 localization at the dendritic tips of ON-BCs and the electroretinogram (ERG)-b-wave. AAV2-7m8-Lrit3 intravitreal injections were performed targeting either ON-BCs, photoreceptors (PRs), or both. Protein localization of LRIT3 and TRPM1 at the rod-to-rod BC synapse, functional rescue of scotopic responses, and ON-responses detection at the ganglion cell level were achieved in a few mice when ON-BCs alone or both PRs and ON-BCs, were targeted. More importantly, a significant number of treated adult Lrit3−/− mice revealed an ERG b-wave recovery under scotopic conditions, improved optomotor responses, and on-time ON-responses at the ganglion cell level when PRs were targeted. Functional rescue was maintained for at least 4 months after treatment.

Cytosolic amino acid concentrations are carefully maintained, but how homeostasis occurs is unclear. Here, the authors show that amino acid transporters primarily determine intracellular amino acid levels and develop a model that predicts a perturbation response similar to experimental data.

SNAT2 (SLC38A2) is a sodium-dependent neutral amino acid transporter, which is important for the accumulation of amino acids as nutrients, the maintenance of cellular osmolarity, and the activation of mTORC1. It also provides net glutamine for glutaminolysis and consequently presents as a potential target to treat cancer. A high-throughput screening assay was developed to identify new inhibitors of SNAT2 making use of the inducible nature of SNAT2 and its electrogenic mechanism. Using an optimized FLIPR membrane potential (FMP) assay, a curated scaffold library of 33934 compounds was screened to identify 3-(N-methyl (4-methylphenyl)sulfonamido)-N-(2-trifluoromethylbenzyl)thiophene-2-carboxamide as a potent inhibitor of SNAT2. In two different assays an IC50 of 0.8–3 µM was determined. The compound discriminated against the close transporter homologue SNAT1. MDA-MB-231 breast cancer and HPAFII pancreatic cancer cell lines tolerated the SNAT2 inhibitor up to a concentration of 100 µM but in combination with tolerable doses of the glucose transport inhibitor Bay-876, proliferative growth of both cell lines was halted. This points to synergy between inhibition of glycolysis and glutaminolysis in cancer cells.

This case involves a patient with severe COVID-19 pneumonia and massive pulmonary embolism requiring mechanical ventilation. His clinical course was complicated by delirium likely triggered by his critical illness and failed initial extubation, isolation from family, and escalating fear and desperation. In hopeful preparation for subsequent successful extubation, a unique approach was taken to decrease the risk of panic, delirium, and decompensation leading to reintubation. As a means of orienting him to his treatment pathway and to provide encouragement for continued recovery, an impromptu patient-directed checklist was constructed. The recovery checklist, written in simplified language, outlined the stages of severe illness that the patient had overcome after his emergent intubation. The list also outlined the tasks he needed to complete prior to hospital discharge. Unexpectedly, the checklist received a great deal of engagement from both the patient and medical team and played an important role in this patient’s successful recovery and rehabilitation.

Abstract Background To evaluate the initial experience and clinical utility of first-line adjuvant intensity-modulated whole abdominal radiation therapy (WART) in women with ovarian clear cell cancer (OCCC) referred to an academic center. Methods Progression-free and overall survival was analyzed in a pragmatic observational cohort study of histologically pure OCCC patients over-expressing HNF-1ß treated between 2013 and end-December 2018. An in-house intensity-modulated WART program was developed from a published pre-clinical model. Radiation dose-volume data was curated to American Association of Physics in Medicine (AAPM) Task Group 263 recommendations. A dedicated database prospectively recorded presenting characteristics and outcomes in a standardized fashion. Results Five women with FIGO (2018) stage IA to IIIA2 OCCC were treated with first-line WART. Median age was 58 years (range 47–68 years). At diagnosis CA-125 was elevated in 4 cases (median 56 kU/L: range 18.4–370 kU/L) before primary de-bulking surgery. Severe premorbid endometriosis was documented in 3 patients. At a median follow-up of 77 months (range 16–83 mo.), all patients remain alive and progression-free on clinical, biochemical (CA-125), and 18Fluoro-deoxyglucose (FDG) PET/CT re-evaluation. Late radiation toxicity was significant (G3) in 1 case who required a limited bowel resection and chronic nutritional support at 9 months post-WART; 2 further patients had asymptomatic (G2) osteoporotic fragility fractures of axial skeleton at 12 months post-radiation treated with anti-resorptive agents (denosumab). Conclusions The clinical utility of intensity-modulated WART in OCCC over-expressing HNF-1β was suggested in this small observational cohort study. The hypothesis that HNF-1β is a portent of platinum-resistance and an important predictive biomarker in OCCC needs further confirmation. Curating multi-institutional cohort studies utilizing WART by means of “Big Data” may improve OCCC care standards in the future.

Commented Article: FREITAS, A. M. B. de; SANTOS, F. R. L. A brief discussion of the empirical plausibility of the Reflective Epistemic Agency. Trans/Form/Ação: Unesp journal of philosophy, v. 44, Special issue in honor of Ernest Sosa, p. 173-184, 2021.

In wine growing regions around the world, climate change has the potential to affect vine transpiration and overall vineyard water use due to related changes in daily atmospheric conditions and soil water deficits. Grapevines control their transpiration in response to such changes by regulating conductance of water through the soil-plant-atmosphere continuum. The response of bulk stomatal conductance, the vine canopy equivalent of stomatal conductance, to such changes were studied on Cabernet-Sauvignon, Merlot, Tempranillo, Ugni blanc, and Semillon vines in a non-irrigated vineyard in Bordeaux France. Whole-vine sap flow, temperature and humidity in the vine canopy, and net radiation absorbed by the vine canopy were measured on 15-minute intervals from early July through mid-September 2020, together with periodic measurements of leaf area, canopy porosity, and predawn leaf water potential. From these data, bulk stomatal conductance was calculated on 15-minute intervals, and multiple linear regression analysis was performed to identify key variables and their relative effect on conductance. For the regression analysis, attention was focused on addressing non-linearity and collinearity in the explanatory variables and developing a model that was readily interpretable. Variability of vapour pressure deficit in the vine canopy over the day and predawn water potential over the season explained much of the variability in bulk stomatal conductance overall, with relative differences between varieties appearing to be driven in large part by differences in conductance response to predawn water potential between the varieties. Transpiration simulations based on the regression equations found similar differences between varieties in terms of daily and seasonal transpiration. These simulations also compared well with those from an accepted vineyard water balance model, although there appeared to be differences between the two approaches in the rate at which conductance, and hence transpiration is reduced as a function of decreasing soil water content (i.e., increasing water deficit stress). By better characterizing the response of bulk stomatal conductance, the dynamics of vine transpiration can be better parameterized in vineyard water use modeling of current and future climate scenarios.

On April 1, 2022, the Government of Alberta stopped collecting the provincial fuel tax in an effort to support Albertans dealing with high fuel prices. The “tax holiday” applies to gasoline and diesel and will last until West Texas Intermediate prices fall below $80 US per barrel. A recent Energy & Environmental Policy Trends quantifies how much Alberta families could benefit from the tax holiday and the cost to the Government of Alberta. This note examines how retail fuel prices have historically responded to changes in fuel taxes and assesses how drivers in Alberta are benefitting from the holiday.

Gauvain et al demonstrate that optogenetic therapy using the AAV2.7m8- ChR-tdT construct can partially restore vision in non-human primates to levels above those considered legally-blind. This study enables the identification of the most suitable construct for ongoing clinical trials attempting vision restoration in patients with retinitis pigmentosa.

Abstract Background Cervical cancer screening is slowly transitioning from Pappanicolaou cytologic screening to primary Visual Inspection with Acetic Acid (VIA) or HPV testing as an effort to enhance early detection and treatment. However, an effective triage tests needed to decide who among the VIA or HPV positive women should receive further diagnostic evaluation to avoid unnecessary colposcopy referrals is still lacking. Evidence from experimental studies have shown potential usefulness of Squamous Cell Carcinoma Antigen (SCC Ag), Macrophage Colony Stimulating Factor (M-CSF), Vascular Endothelial Growth Factor (VEGF), MicroRNA, p16INKa / ki-67, HPV E6/E7/mRNA, and DNA methylation biomarkers in detecting premalignant cervical neoplasia. Given the variation in performance, and scanty review studies in this field, this systematic review described the diagnostic performance of some selected assays to detect high-grade cervical intraepithelial neoplasia (CIN2+) with histology as gold standard. Methods We systematically searched articles published in English between 2012 and 2020 using key words from PubMed/Medline and SCOPUS with two reviewers assessing study eligibility, and risk of bias. We performed a descriptive presentation of the performance of each of the selected assays for the detection of CIN2 + . Results Out of 298 citations retrieved, 58 articles were included. Participants with cervical histology yielded CIN2+ proportion range of 13.7–88.4%. The diagnostic performance of the assays to detect CIN2+ was; 1) SCC-Ag: range sensitivity of 78.6–81.2%, specificity 74–100%. 2) M-CSF: sensitivity of 68–87.7%, specificity 64.7–94% 3) VEGF: sensitivity of 56–83.5%, specificity 74.6–96%. 4) MicroRNA: sensitivity of 52.9–67.3%, specificity 76.4–94.4%. 5) p16INKa / ki-67: sensitivity of 50–100%, specificity 39–90.4%. 6) HPV E6/E7/mRNA: sensitivity of 65–100%, specificity 42.7–90.2%, and 7) DNA methylation: sensitivity of 59.7–92.9%, specificity 67–98%. Conclusion Overall, the reported test performance and the receiving operating characteristics curves implies that implementation of p16ink4a/ki-67 assay as a triage for HPV positive women to be used at one visit with subsequent cryotherapy treatment is feasible. For the rest of assays, more robust clinical translation studies with larger consecutive cohorts of women participants is recommended.

Signaling of IL-33 via its receptor, ST2, has been implicated in macrophage function in tissue repair. Here the authors show, using genetic mouse models and single-cell transcriptomic data, that the IL-33/ST2 axis regulates both ILC2-derived IL-13 and macrophage differentiation/reparative function required for club cell regeneration.

In response to changes in their environments, grapevines regulate transpiration using various physiological mechanisms that alter conductance of water through the soil-plant-atmosphere continuum. Expressed as bulk stomatal conductance at the canopy scale, it varies diurnally in response to changes in vapor pressure deficit and net radiation, and over the season to changes in soil water deficits and hydraulic conductivity of both the soil and plant. To help with future characterization of this dynamic response, a simplified method is presented for determining bulk stomatal conductance based on the crop canopy energy flux model by Shuttleworth and Wallace using measurements of individual vine sap flow, temperature and humidity within the vine canopy, and estimates of net radiation absorbed by the vine canopy. The methodology presented respects the energy flux dynamics of vineyards with open canopies, while avoiding problematic measurements of soil heat flux and boundary layer conductance needed by other methods, which might otherwise interfere with ongoing vineyard management practices. Based on this method and measurements taken on several vines in a non-irrigated vineyard in Bordeaux France, bulk stomatal conductance was estimated on 15-minute intervals from July to mid-September 2020 producing values similar to those presented for vineyards in the literature. Time-series plots of this conductance show significant diurnal variation and seasonal decreases in conductance associated with increased vine water stress as measured by predawn leaf water potential. Global sensitivity analysis using non-parametric regression found transpiration flux and vapor pressure deficit to be the most important input variables to the calculation of bulk stomatal conductance, with absorbed net radiation and bulk boundary layer conductance being much less important. Conversely, bulk stomatal conductance was one of the most important inputs when calculating vine transpiration, emphasizing the usefulness of characterizing its dynamic response for the purpose of estimating vine canopy transpiration in water use models.

Amino acid antiporters mediate the 1:1 exchange of groups of amino acids. Whether substrate specificity can be different for the inward and outward facing conformation has not been investigated systematically, although examples of asymmetric transport have been reported. Here we used LC–MS to detect the movement of 12C- and 13C-labelled amino acid mixtures across the plasma membrane of Xenopus laevis oocytes expressing a variety of amino acid antiporters. Differences of substrate specificity between transporter paralogs were readily observed using this method. Our results suggest that antiporters are largely symmetric, equalizing the pools of their substrate amino acids. Exceptions are the antiporters y+LAT1 and y+LAT2 where neutral amino acids are co-transported with Na+ ions, favouring their import. For the antiporters ASCT1 and ASCT2 glycine acted as a selective influx substrate, while proline was a selective influx substrate of ASCT1. These data show that antiporters can display non-canonical modes of transport.

Wholesale gasoline prices are dependent on two primary factors: crude oil prices, and refining and transportation margins. Retail prices are dependent on wholesale prices and two additional factors: taxes, and marketing margins.

The price of gasoline has returned to pre-pandemic levels and the U.S. Energy Information Administration’s October Short-term Energy Outlook (STEO) suggests prices could remain at these levels for the rest of 2021 and throughout 2022.

ABSTRACT Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in 2019 and has become a major global pathogen in an astonishingly short period of time. The emergence of SARS-CoV-2 has been notable due to its impacts on residents in long-term care facilities (LTCFs). LTCF residents tend to possess several risk factors for severe outcomes of SARS-CoV-2 infection, including advanced age and the presence of comorbidities. Indeed, residents of LTCFs represent approximately 40% of SARS-CoV-2 deaths in the United States. Few studies have focused on the prevalence and transmission dynamics of SARS-CoV-2 among LTCF staff during the early months of the pandemic, prior to mandated surveillance testing. To assess the prevalence and incidence of SARS-CoV-2 among LTCF staff, characterize the extent of asymptomatic infections, and investigate the genomic epidemiology of the virus within these settings, we sampled staff for 8 to 11 weeks at six LTCFs with nasopharyngeal swabs from March through June of 2020. We determined the presence and levels of viral RNA and infectious virus and sequenced 54 nearly complete genomes. Our data revealed that over 50% of infections were asymptomatic/mildly symptomatic and that there was a strongly significant relationship between viral RNA (vRNA) and infectious virus, prolonged infections, and persistent vRNA (4+ weeks) in a subset of individuals, and declining incidence over time. Our data suggest that asymptomatic SARS-CoV-2-infected LTCF staff contributed to virus persistence and transmission within the workplace during the early pandemic period. Genetic epidemiology data generated from samples collected during this period support that SARS-CoV-2 was commonly spread between staff within an LTCF and that multiple-introduction events were less common. IMPORTANCE Our work comprises unique data on the characteristics of SARS-CoV-2 dynamics among staff working at LTCFs in the early months of the SARS-CoV-2 pandemic prior to mandated staff surveillance testing. During this time period, LTCF residents were largely sheltering-in-place. Given that staff were able to leave and return daily and could therefore be a continued source of imported or exported infection, we performed weekly SARS-CoV-2 PCR on nasal swab samples collected from this population. There are limited data from the early months of the pandemic comprising longitudinal surveillance of staff at LTCFs. Our data reveal the surprisingly high level of asymptomatic/presymptomatic infections within this cohort during the early months of the pandemic and show genetic epidemiological analyses that add novel insights into both the origin and transmission of SARS-CoV-2 within LTCFs.

Wine grapes are one of the most lucrative crops in the world and this value is founded heavily on traditional winegrowing regions established over hundreds of years. These regions are now experiencing marked changes in climate. People speculate that global warming could reshape the distribution of premium wine-growing regions, pushing regions to higher latitudes and elevations with cooler temperatures. A major redistribution of this kind would be catastrophic for numerous regional economies. Here we examine relationships between warming, fruit ripening, and wine quality in two renowned red wine regions; Napa Valley, California, USA, and Bordeaux, France. We show that both regions have warmed substantially over the past 60+ years and that until now this warming has contributed to increases in the average wine quality. However, ripening relationships revealed that we are reaching a plateau and raise concerns that we may be approaching a tipping point in traditional wine-growing regions.