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Boas argued that anthropologists should make historical comparisons within well-defined regional contexts. A century later, we have many improvements in the statistical methodologies for comparative research, yet most of our regional constructs remain without a valid empirical basis. We present a new method for developing and testing regions. The method takes into account older anthropological concerns with relationships between culture history and the environment, embodied in the culture-area concept, as well as contemporary concerns with historical linkages of societies into world systems. We develop nine new regions based on social structural data and test them using data on 351 societies. We compare the new regions with Murdock's regional constructs and find that our regional classification is a strong improvement over Murdock's. In so doing we obtain evidence for the cross-cultural importance of gender and descent systems, for the importance of constraint relationships upon sociocultural systems, for the historical importance of two precapitalist world systems, and for strikingly different geographical alignments of cultural systems in the Old World and the Americas. © 1996 by The Wenner-Gren Foundation for Anthropological Research. All rights reserved.

Background: The pathophysiology of sepsis is due in part to early systemic inflammation. Here we describe molecular and cellular responses, as well as survival, in A 2A adenosine receptor (AR) agonist treated and untreated animals during experimental sepsis.Methods: Sepsis was induced in mice by intraperitoneal inoculation of live bacteria (Escherichia coli or Staphylococcus aureus) or lipopolysaccharide (LPS). Mice inoculated with live bacteria were treated with an A 2A AR agonist (ATL313) or phosphate buffered saline (PBS), with or without the addition of a dose of ceftriaxone. LPS inoculated mice were treated with ATL313 or PBS. Serum cytokines and chemokines were measured sequentially at 1, 2, 4, 8, and 24 hours after LPS was administered. In survival studies, mice were followed until death or for 7 days.Results: There was a significant survival benefit in mice infected with live E. coli (100% vs. 20%, p = 0.013) or S. aureus (60% vs. 20%, p = 0.02) when treated with ATL313 in conjunction with an antibiotic versus antibiotic alone. ATL313 also improved survival from endotoxic shock when compared to PBS treatment (90% vs. 40%, p = 0.005). The serum concentrations of TNF-alpha, MIP-1 alpha, MCP-1, IFN-gamma, and IL-17 were decreased by ATL313 after LPS injection (p < 0.05). Additionally, ATL313 increased the concentration of IL-10 under the same conditions (p < 0.05). Circulating white blood cell concentrations were higher in ATL313 treated animals (p < 0.01).Conclusion: Further studies are warranted to determine the clinical utility of ATL313 as a novel treatment for sepsis. [ABSTRACT FROM AUTHOR]

Background: Patient disposition following total knee arthroplasty (TKA) has major implications for patient outcomes and costs. Current studies are limited in sample size and dates of data collection. We evaluated patient factors, outcomes, and costs associated with disposition to a facility following TKA., Methods: This was a retrospective cohort study including 1,906,670 patients undergoing TKA from a national wide database, from the years 2016 to 2020. Of these, 25,485 (1.34%) patients were transferred to a facility for rehabilitation. Demographic data, hospital-related outcomes, and postoperative complications were collected. Multivariate regression was performed to assess outcomes associated with facility transfer for rehabilitation., Results: Patients were more likely to be transferred if they were women (Odds Ratio (OR) = 1.10; P < 0.001), greater than 80 years old (OR = 2.25; P < 0.001), had an increased Elixhauser comorbidity index (OR = 1.38; P < 0.001), or were in the lowest income quartile (OR = 1.38; P < 0.001). Transferred patients were more likely to experience medical (OR = 1.92; P < 0.001) and surgical complications (OR = 2.74; P < 0.001), including vascular complications (OR = 2.07; P < 0.001), neurologic complications (OR = 5.72; P < 0.001), and dislocation (OR = 2.01; P < 0.001). They also had greater hospital lengths of stay (OR = 5.27; P < 0.001) and hospital charges (OR = 1.88; P < 0.001); however, they were less likely to undergo reoperation within 30 days (OR = 0.61; P = 0.002)., Conclusions: Elderly, lower-income patients who had more comorbidities are more likely to be transferred to a facility following TKA. While there are associated increased costs, complications, and hospital lengths of stay, there are lower rates of reoperation for those who transferred to a facility after TKA., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Sepsis is the leading cause of global death with the highest burden found in sub-Saharan Africa (sSA). The Universal Vital Assessment (UVA) score is a validated resource-appropriate clinical tool to identify hospitalized patients in sSA who are at risk of in-hospital mortality. Whether a decrease in the UVA score over 6 hours of resuscitation from sepsis is associated with improved outcomes is unknown. We aimed to determine (1) the association between 6-hour UVA score and in-hospital mortality, and (2) if a decrease in UVA score from admission to 6 hours was associated with improved in-hospital mortality. We analyzed data from participants with severe sepsis aged ≥14 years enrolled at the Mbarara Regional Referral Hospital in Uganda from October 2014 through May 2015. Among 197 participants, the median (interquartile range) age was 34 (27-47) years, 99 (50%) were female and 116 (59%) were living with HIV. At 6 hours, of the 65 participants in the high-risk group, 28 (43%) died compared to 28 (30%) of 94 in the medium-risk group (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.29,1.08, p = 0.086) and 3 (9%) of 33 in the low-risk group (OR 0.13, 95% CI 0.03, 0.42, p = 0.002). In a univariate analysis of the 85 participants who improved their UVA risk group at 6 hours, 20 (23%) died compared to 39 (36%) of 107 participants who did not improve (OR 0.54, 95% CI 0.27-1.06, p = 0.055). In the multivariable analysis, the UVA score at 6 hours (adjusted OR [aOR] 1.26, 95%CI 1.10-1.45, p<0.001) was associated with in-hospital mortality. When adjusted for age and sex, improvement in the UVA risk group over 6 hours was associated with a non-statistically significant 43% decrease in odds of mortality (aOR 0.57, 95%CI 0.29-1.07, p = 0.08). Targeting a decrease in UVA score over 6 hours from admission may be a useful clinical endpoint for sepsis resuscitation in sSA, but this would need to be proven in a clinical trial., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Null et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The Kohn-Sham exchange-correlation potential of a given system can be written exactly in terms of several quantities including the interacting and noninteracting kinetic energy densities of the electrons. Electronic kinetic energy densities are sharply discontinuous at the atomic nuclei in molecules, which implies that exact exchange-correlation potentials of molecules might also be discontinuous at the nuclear positions. This surprising possibility is made even more likely by the fact that molecular exchange-correlation potentials derived from wave functions within Slater-type basis sets do have jump discontinuities. We deduce analytically the exact behavior of the relevant quantities near atomic nuclei and conclude that, in the basis-set limit, all jump discontinuities cancel out nontrivially so that exact exchange-correlation potentials are continuous after all.

Background: Clinical severity scores can identify patients at risk of severe disease and death, and improve patient management. The modified early warning score (MEWS), the quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA), and the Universal Vital Assessment (UVA) were developed as risk-stratification tools, but they have not been fully validated in low-resource settings where fever and infectious diseases are frequent reasons for health care seeking. We assessed the performance of MEWS, qSOFA, and UVA in predicting mortality among febrile patients in the Lao PDR, Malawi, Mozambique, and Zimbabwe., Methods: We prospectively enrolled in- and outpatients aged ≥ 15 years who presented with fever (≥37.5 °C) from June 2018-March 2021. We collected clinical data to calculate each severity score. The primary outcome was mortality 28 days after enrolment. The predictive performance of each score was determined using area under the receiver operating curve (AUC)., Findings: A total of 2797 participants were included in this analysis. The median (IQR) age was 32 (24-43) years, 38% were inpatients, and 60% (1684/2797) were female. By the time of follow-up, 7% (185/2797) had died. The AUC (95% CI) for MEWS, qSOFA and UVA were 0.67 (0.63-0.71), 0.68 (0.64-0.72), and 0.82 (0.79-0.85), respectively. The AUC comparison found UVA outperformed both MEWS (p < 0.001) and qSOFA (p < 0.001)., Interpretation: We showed that the UVA score performed best in predicting mortality among febrile participants by the time follow-up compared with MEWS and qSOFA, across all four study sites. The UVA score could be a valuable tool for early identification, triage, and initial treatment guidance of high-risk patients in resource-limited clinical settings., Funding: FCDO., Competing Interests: HH reports royalties from Wolters Kluwer Health as the primary author and maintainer of the “Laboratory tools for diagnosis of malaria” clinical decision support tool., (© 2024 The Author(s).)

The kinetic energy density of electrons and the gradient of the electron density have pronounced jump discontinuities at the positions of the atomic nuclei in molecules. Certain exact relations then imply that molecular Kohn-Sham exchange-correlation potentials may also be discontinuous at atomic nuclei. Here, we confirm that exchange-correlation potentials derived from Hartree-Fock and correlated wavefunctions within Slater-type basis sets do exhibit such discontinuities. Despite their persistence even in large basis sets, these discontinuities are almost certainly artifacts of basis set finiteness and are expected to disappear in the basis-set limit. The findings imply that imposing electron-nucleus cusp conditions in spherically averaged form may not always be appropriate., (© 2024 Author(s). Published under an exclusive license by AIP Publishing.)

The goals of the present study were to investigate links between changes in peer victimization from elementary to high school and adolescent reactive aggression (Goal 1), whether heightened autonomic nervous system (ANS) reactivity to social and nonsocial stress increases risk for adolescent reactive aggression (Goal 2), and whether increased ANS reactivity strengthens the association between changes in victimization and adolescent reactive aggression (Goal 3). Participants included 145 adolescents ( M age = 16; 54% female; 76% European American, 13% African American, 11% Latino American, 7% Asian American, 5% of mixed race or ethnicity; 60% with family incomes of $100,000 or greater). We collected self-report data in elementary (Time 1 [T1]); (Time 2 [T2]); middle (Time 3 [T3]); and high school (Time 4 [T4]) to assess victimization. At T4, we measured self-reported reactive and proactive aggression, and ANS reactivity (preejection period [PEP], respiratory sinus arrhythmia [RSA]) to peer rejection and nonsocial frustration. More positive victimization slope over time (meaning both less decreasing slopes and increasing slopes) predicted greater adolescent reactive, but not proactive aggression (Goal 1). Greater RSA augmentation to peer rejection and more PEP reactivity to nonsocial frustration predicted more reactive, but not proactive aggression (Goal 2). The link between victimization slope and reactive aggression emerged only for adolescents exhibiting RSA augmentation to peer rejection (marginal; Goal 3). (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: A number of tools exist to aid surgeons in risk assessment, including the Charlson Comorbidity Index (CCI), the Elixhauser Comorbidity Index (ECI), and various measures of frailty, such as the Hospital Frailty Risk Score (HFR). While all of these tools have been validated for general use, the best risk assessment tool is still debated. Risk assessment is particularly important in elective surgery, such as total joint arthroplasty. The aim of this study is to compare the predictive power of the CCI, ECI, and HFR in the setting of total knee arthroplasty (TKA)., Methods: All patients who underwent TKA were identified via International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code from the National Readmissions Database, years 2016 to 2019. Patient demographics, perioperative complications, and hospital-associated outcomes were recorded. Receiver operating characteristic (ROC) curves were created and area under the curves (AUCs) evaluated to gauge the predictive capabilities of each risk assessment tool (CCI, ECI, and HFR) across a range of outcomes., Results: A total of 1,930,803 patients undergoing TKA were included in our analysis. For mortality, ECI was most predictive (0.95 AUC), while HFR and CCI were 0.75 and 0.74 AUC, respectively. For periprosthetic fractures, ECI was 0.78 AUC, HFR was 0.68 AUC, and CCI was 0.66 AUC. For joint infections, the ECI was 0.78 AUC, the HFR was 0.63 AUC, and the CCI was 0.62 AUC. For 30-day readmission, ECI was 0.79 AUC, while HFR and CCI were 0.6 AUC. For 30-day reoperation, ECI was 0.69 AUC, while HFR was 0.58 AUC and CCI was 0.56 AUC., Conclusions: Our analysis shows that ECI is superior to CCI and HFR for predicting 30-day postoperative outcomes following TKA. Surgeons should consider assessing patients using ECI prior to TKA., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: Accumulating more steps/day is associated with a lower risk of cancer mortality and composite cancer outcomes. However, less is known about the relationship of steps/day with the risk of multiple site-specific cancers., Methods: This study included >22,000 women from the Women's Health Accelerometry Collaboration Cohort (2011-2022), comprised of women from the Women's Health Study and Women's Health Initiative Objective Physical Activity and Cardiovascular Health Study. Steps/day and step intensity were collected with accelerometry. Incident cancer cases and deaths were adjudicated. Stratified Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of the associations of steps/day and step intensity with incident breast, colon, endometrial, lung, and ovarian cancers, a composite of 13 physical activity-related cancers, total invasive cancer, and fatal cancer., Results: On average, women were 73.4 years old, accumulated 4993 steps/day, and had 7.9 years of follow-up. There were small nonsignificant inverse associations with the risks of colon cancer (HR = 0.94, 95% CI: 0.83, 1.05), endometrial cancer (HR = 0.91, 95% CI: 0.82, 1.01), and fatal cancer (HR = 0.95 95% CI: 0.90, 1.00) per 1000 steps/day. More minutes at ≥40 steps/min and a faster peak 10- and 30-min step cadence were associated with a lower risk of endometrial cancer, but findings were attenuated after adjustment for body mass index and steps/day., Conclusions: Among women 62-97 years, there were small nonsignificant inverse associations of colon, endometrial, and fatal cancer with more steps/day. Epidemiologic studies with longer follow-up and updated assessments are needed to further explore these associations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Although electron densities are always continuous, other ingredients of density-functional approximations can be sharply discontinuous at isolated points. In particular, the positive-definite, Weizsäcker, and Pauli kinetic energy densities expressed in terms of Slater-type orbitals all have discontinuities at the positions of the atomic nuclei in molecules. The first two of those quantities are similarly discontinuous even in the basis-set limit. These striking features are not as widely recognized as they deserve to be. We show in detail how discontinuities of kinetic energy densities arise from asymmetric electron-nucleus cusps of molecular wave functions and point out instances of their significance in electronic structure theory.

While the Plasmodium falciparum malaria parasite continues to cause severe disease globally, Mozambique is disproportionally represented in malaria case totals. Acquisition of copy number variations (CNVs) in the parasite genome contributes to antimalarial drug resistance through overexpression of drug targets. Of interest, piperaquine resistance is associated with plasmepsin 2 and 3 CNVs ( pfpmp2 and pfpmp3, respectively), while CNVs in the multidrug efflux pump, multidrug resistance-1 ( pfmdr1 ), increase resistance to amodiaquine and lumefantrine. These antimalarials are partner drugs in artemisinin combination therapies (ACTs) and therefore, CNV detection with accurate and efficient tools is necessary to track ACT resistance risk. Here, we evaluated ~300 clinically derived samples collected from three sites in Mozambique for resistance-associated CNVs. We developed a novel, medium-throughput, quadruplex droplet digital PCR (ddPCR) assay to simultaneously quantify the copy number of pfpmp3, pfpmp2 , and pfmdr1 loci in these clinical samples. By using DNA from laboratory parasite lines, we show that this nanodroplet-based method is capable of detecting picogram levels of parasite DNA, which facilitates its application for low yield and human host-contaminated clinical surveillance samples. Following ddPCR and the application of quality control standards, we detected CNVs in 13 of 229 high-quality samples (prevalence of 5.7%). Overall, our study revealed a low number of resistance CNVs present in the parasite population across all three collection sites, including various combinations of pfmdr1 , pfpmp2 , and pfpmp3 CNVs. The potential for future ACT resistance across Mozambique emphasizes the need for continued molecular surveillance across the region., Competing Interests: The authors declare no conflict of interest.

Importance: Current US physical activity (PA) guidelines prescribe moderate to vigorous PA (MVPA) time of at least 150 minutes per week for health. An analogous step-based recommendation has not been issued due to insufficient evidence., Objective: To examine the associations of MVPA time and step counts with all-cause mortality and cardiovascular disease (CVD)., Design, Setting, and Participants: This cohort study analyzed data from an ongoing follow-up study of surviving participants of the Women's Health Study, a randomized clinical trial conducted from 1992 to 2004 in the US to evaluate use of low-dose aspirin and vitamin E for preventing cancer and CVD. Participants were 62 years or older who were free from CVD and cancer, completed annual questionnaires, and agreed to measure their PA with an accelerometer as part of a 2011-2015 ancillary study. Participants were followed up through December 31, 2022., Exposures: Time spent in MVPA and step counts, measured with an accelerometer for 7 consecutive days., Main Outcomes and Measures: The associations of MVPA time and step counts with all-cause mortality and CVD (composite of myocardial infarction, stroke, and CVD mortality) adjusted for confounders. Cox proportional hazards regression models, restricted mean survival time differences, and area under the receiver operating characteristic curve (AUC) were used to evaluate the associations., Results: A total of 14 399 women (mean [SD] age, 71.8 [5.6] years) were included. The median (IQR) MVPA time and step counts were 62 (20-149) minutes per week and 5183 (3691-7001) steps per day, respectively. During a median (IQR) follow-up of 9.0 (8.0-9.9) years, the hazard ratios (HR) per SD for all-cause mortality were 0.82 (95% CI, 0.75-0.90) for MVPA time and 0.74 (95% CI, 0.69-0.80) for step counts. Greater MVPA time and step counts (top 3 quartiles vs bottom quartile) were associated with a longer period free from death: 2.22 (95% CI, 1.58-2.85) months and 2.36 (95% CI, 1.73-2.99) months at 9 years follow-up, respectively. The AUCs for all-cause mortality from MVPA time and step counts were similar: 0.55 (95% CI, 0.52-0.57) for both metrics. Similar associations of these 2 metrics with CVD were observed., Conclusion and Relevance: Results of this study suggest that among females 62 years or older, MVPA time and step counts were qualitatively similar in their associations with all-cause mortality and CVD. Step count-based goals should be considered for future guidelines along with time-based goals, allowing for the accommodation of personal preferences.

Objective: Situated in Children's National Hospital (CNH)'s Neuropsychology Division, the Gender and Autism Program (GAP) is the first clinical service dedicated to the needs of autistic gender-diverse/transgender youth. This study describes GAP clinical assessment profiles and presents a multi-perspective programmatic review of GAP evaluation services. Method: Seventy-five consecutive gender- and neuropsychologically-informed GAP evaluations were analyzed, including demographics, gender and autism characterization, and primary domains evaluated. Three program-based Delphi studies were conducted and identify: clinician priorities and challenges in providing care, program administrator lessons learned and ongoing barriers, and considerations adapting this model for a rural academic medical center. Results: Nearly two-thirds of referrals were transfeminine. Most youth had existing autism diagnoses; of those undiagnosed, three-quarters were found to be autistic. Five goals of evaluations were identified: Mental health was always assessed, and most evaluations also assessed gender-related needs in the context of autism neurodiversity. Neuropsychological characterization of strengths and challenges informed personalized accommodations to support youth gender-related self-advocacy. Clinicians emphasized frequent youth safety concerns. Administrators emphasized the need for specialized training for working with families. Components for adaptation of the GAP in a rural academic medical center were identified. Conclusions: Since its founding, the GAP has proven a sustainable neuropsychology-based service with consistent referral flow and insurance authorizations. Capturing staff perspectives through rigorous Delphi methods, and addressing the GAP's feasibility and replicability, this study provides a road map for replicating this service. We also highlight GAP training of specialist clinicians, fundamental to addressing the desperate shortage of providers in this field.

Background: Identification of bloodstream infection (BSI) in transplant recipients may be difficult due to immunosuppression. Accordingly, we aimed to compare responses to BSI in critically ill transplant and non-transplant recipients and to modify systemic inflammatory response syndrome (SIRS) criteria for transplant recipients., Methods: We analyzed univariate risks and developed multivariable models of BSI with 27 clinical variables from adult intensive care unit (ICU) patients at the University of Virginia (UVA) and at the University of Pittsburgh (Pitt). We used Bayesian inference to adjust SIRS criteria for transplant recipients., Results: We analyzed 38.7 million hourly measurements from 41 725 patients at UVA, including 1897 transplant recipients with 193 episodes of BSI and 53 608 patients at Pitt, including 1614 transplant recipients with 768 episodes of BSI. The univariate responses to BSI were comparable in transplant and non-transplant recipients. The area under the receiver operating characteristic curve (AUC) was 0.82 (95% confidence interval [CI], .80-.83) for the model using all UVA patient data and 0.80 (95% CI, .76-.83) when using only transplant recipient data. The UVA all-patient model had an AUC of 0.77 (95% CI, .76-.79) in non-transplant recipients and 0.75 (95% CI, .71-.79) in transplant recipients at Pitt. The relative importance of the 27 predictors was similar in transplant and non-transplant models. An upper temperature of 37.5°C in SIRS criteria improved reclassification performance in transplant recipients., Conclusions: Critically ill transplant and non-transplant recipients had similar responses to BSI. An upper temperature of 37.5°C in SIRS criteria improved BSI screening in transplant recipients., Competing Interests: Potential conflicts of interests. G. C. and S. R. report grants or contracts paid to their institution from the National Institutes of Health (NIH). C. C. M. reports grants or contracts paid to their institution from the NIH (U01 AI150508). P. C. reports consulting fees for statistical consulting unrelated to the current article from BioCore LLC. J. R. M. reports grants or contracts unrelated to this work from the NIH and royalties or licenses from the University of Virginia Licensing and Ventures Group, payments to the author; consulting fees paid to their institution from Nihon Kohden Digital Health Solutions; several unrelated patents planned, issued, or pending; and stock or stock options (no payments) from the Medical Predictive Sciences Corporation. N. R. N. reports a collaborative grant as co-principal investigator with Drs. Christopher Moore and Randall Moorman from the Global Infectious Diseases Institute at the University of Virginia. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Describing correlates of physical activity (PA) and sedentary behavior (SB) among postmenopausal cancer survivors can help identify risk profiles and can be used to support development of targeted interventions to improve PA and reduce SB in this population., Objective: To describe PA/SB and identify correlates of PA/SB among cancer and cancer-free post-menopausal women., Methods: Women from the Women's Health Study (N = 16,629) and Women's Health Initiative/Objective Physical Activity and Cardiovascular Health Study (N = 6,079) were asked to wear an accelerometer on the hip for 7 days. Multiple mixed-effects linear regression models were used to identify sociodemographic-, health-, and chronic condition-related correlates (independent variables) associated with PA and SB (dependent variables) among women with (n = 2,554) and without (n = 20,154) a history of cancer. All correlates were mutually adjusted for each other., Results: In unadjusted analyses, women with a history of cancer took fewer mean daily steps (4,572 (standard deviation 2557) vs 5,029 (2679) steps/day) and had lower mean moderate-to-vigorous PA (74.9 (45.0) vs. 81.6 (46.7) minutes/day) than cancer-free women. In adjusted analyses, for cancer and cancer-free women, age, diabetes, overweight, and obesity were inversely associated with all metrics of PA (average vector magnitude, time in moderate-to-vigorous PA, step volume, time at ≥40 steps/minutes, and peak 30-minute step cadence). In unadjusted analyses, mean SB was similar for those with and without cancer (529.7 (98.1) vs. 521.7 (101.2) minutes/day). In adjusted analyses, for cancer and cancer-free women, age, diabetes, cardiovascular disease, current smoking, overweight, and obesity were positive correlates of SB, while Black or Hispanic race/ethnicity, weekly/daily alcohol intake, and excellent/very good/good self-rated health were inverse correlates of SB., Conclusion: Several sociodemographic, health, and chronic conditions were correlates of PA/SB for postmenopausal women with and without cancer. Future studies should examine longitudinal relationships to gain insight into potential determinants of PA/SB., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Schilsky et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: In sub-Saharan Africa, the provision of infection prevention and control (IPC) measures are often limited by resource constraints., Aim: To determine the association of supportive supervision activities with the availability of the WHO core components for IPC at health facilities in Southwestern Uganda., Methods: We employed a before and after quality improvement study design. We conducted a baseline assessment of the availability of the WHO IPC core components and provided supportive supervision activities, which was followed by a second IPC assessment. We included health centers II-IV, which have increasing clinical care capacity, and regional hospitals., Findings: Of 244 regional health facilities, baseline assessment occurred at 111 (45%) of which 23 (21%) were reassessed. The number of facilities in the Red (<70%) category for each core component stayed the same or decreased at each facility type, but there was an increase from five to six health center III facilities scoring Red (<70%) for PPE. The number of facilities in the Green (>85%) category for each core component stayed the same or was increased at each facility type, but there was a decrease from four to two health center III facilities scoring Green (>85%) for instrument processing. There was an increase in the median (interquartile range [IQR]) overall score for all facilities (65 [54-72] vs 75 [68-83], P =0.0001)., Conclusion: Supportive supervision activities were associated with improved availability of the core components of IPC at health facilities in Southwestern Uganda. PPE should be prioritized in health care facilities in Southwestern Uganda., (© 2024 Published by Elsevier Ltd on behalf of The Healthcare Infection Society.)

The current study investigated in-the-moment links between adolescents' autonomic nervous system activity and susceptibility to three types of peer influence (indirect, direct, continuing) on two types of behavior (antisocial, prosocial). The sample included 144 racially ethnically diverse adolescents (46% male, 53% female, 1% other; M age  = 16.02 years). We assessed susceptibility to peer influence behaviorally using the Public Goods Game (PGG) while measuring adolescents' mean heart rate (MHR) and pre-ejection period (PEP). Three key findings emerged from bivariate dual latent change score modeling: (1) adolescents whose MHR increased more as they transitioned from playing the PGG alone (pre-influence) to playing while simply observed by peers (indirect influence) displayed more prosocial behavior; (2) adolescents whose PEP activity increased more (greater PEP activity = shorter PEP latency) as they transitioned from indirect influence to being encouraged by peers to engage in antisocial behavior (direct influence) engaged in more antisocial behavior; and (3) adolescents whose PEP activity decreased less as they transitioned from direct influence on prosocial behavior to playing the PGG alone again (continuing influence) displayed more continuing prosocial behavior (marginal effect). The discussion focuses on the role of psychophysiology in understanding adolescents' susceptibility to peer influence.

Although children display strong individual differences in emotion expression, they also engage in emotional synchrony or reciprocity with interaction partners. To understand this paradox between trait-like and dyadic influences, the goal of the current study was to investigate children's emotion expression using a Social Relations Model (SRM) approach. Playgroups consisting typically of four same-sex unfamiliar nine-year-old children ( N = 202) interacted in a round-robin format (6 dyads per group). Each dyad completed two 5-minute tasks, a challenging frustration task and a cooperative planning task. Observers coded children's emotions during the tasks (happy, sad, angry, anxious, neutral) on a second-by-second basis. SRM analyses provided substantial evidence of both the trait-like nature of children's emotion expression (through significant effects for actor variance, multivariate actor-actor correlations, and multivariate intrapersonal correlations) and the dyadic nature of their emotion expression (through significant effects for partner variance, relationship variance, dyadic reciprocity correlations, and multivariate interpersonal correlations)., Competing Interests: No authors have any conflicts of interest to report.

Background: We previously demonstrated that a heuristic (i.e., evidence-based, rounded yet practical) cadence threshold of ≥ 100 steps/min was associated with absolutely-defined moderate intensity physical activity (i.e., ≥ 3 metabolic equivalents [METs]) in older adults 61-85 years of age. Although it was difficult to ascertain achievement of absolutely-defined vigorous (6 METs) intensity, ≥ 130 steps/min was identified as a defensible threshold for this population. However, little evidence exists regarding cadence thresholds and relatively-defined moderate intensity indicators, including ≥ 64% heart rate [HR] maximum [HR max = 220-age], ≥ 40% HR reserve [HRR = HR max -HR resting ], and ≥ 12 Borg Scale Rating of Perceived Exertion [RPE]; or vigorous intensity indicators including ≥ 77%HR max , ≥ 60%HRR, and ≥ 14 RPE., Purpose: To analyze the relationship between cadence and relatively-defined physical activity intensity and identify relatively-defined moderate and vigorous heuristic cadence thresholds for older adults 61-85 years of age., Methods: Ninety-seven ostensibly healthy adults (72.7 ± 6.9 years; 49.5% women) completed up to nine 5-min treadmill walking bouts beginning at 0.5 mph (0.8 km/h) and progressing by 0.5 mph speed increments (with 2-min rest between bouts). Directly-observed (and video-recorded) steps were hand-counted, HR was measured using a chest-strapped monitor, and in the final minute of each bout, participants self-reported RPE. Segmented mixed model regression and Receiver Operating Characteristic (ROC) curve analyses identified optimal cadence thresholds associated with relatively-defined moderate (≥ 64%HR max , ≥ 40%HRR, and ≥ 12 RPE) and vigorous (≥ 77%HR max , ≥ 60%HRR, and ≥ 14 RPE) intensities. A compromise between the two analytical methods, including Youden's Index (a sum of sensitivity and specificity), positive and negative predictive values, and overall accuracy, yielded final heuristic cadences., Results: Across all relatively-defined moderate intensity indicators, segmented regression models and ROC curve analyses identified optimal cadence thresholds ranging from 105.9 to 112.8 steps/min and 102.0-104.3 steps/min, respectively. Comparable values for vigorous intensity indicators ranged between126.1-132.1 steps/min and 106.7-116.0 steps/min, respectively. Regardless of the relatively-defined intensity indicator, the overall best heuristic cadence threshold aligned with moderate intensity was ≥ 105 steps/min. Vigorous intensity varied between ≥ 115 (greater sensitivity) or ≥ 120 (greater specificity) steps/min., Conclusions: Heuristic cadence thresholds align with relatively-defined intensity indicators and can be useful for studying and prescribing older adults' physiological response to, and/or perceived experience of, ambulatory physical activity., Trial Registration: Clinicaltrials.gov NCT02650258. Registered 24 December 2015., (© 2023. The Author(s).)

Background: Little is known about the microbiology and outcomes of chemotherapy-associated febrile illness among patients in sub-Saharan Africa. Understanding the microbiology of febrile illness could improve antibiotic selection and infection-related outcomes., Methods: From September 2019 through June 2022, we prospectively enrolled adult inpatients at the Uganda Cancer Institute who had solid tumors and developed fever within 30 days of receiving chemotherapy. Evaluation included blood cultures, malaria rapid diagnostic tests, and urinary lipoarabinomannan testing for tuberculosis. Serum cryptococcal antigen was evaluated in participants with human immunodeficiency virus (HIV). The primary outcome was the mortality rate 40 days after fever onset, which we estimated using Cox proportional hazards models., Results: A total of 104 febrile episodes occurred among 99 participants. Thirty febrile episodes (29%) had ≥1 positive microbiologic result. The most frequently identified causes of infection were tuberculosis (19%) and bacteremia (12%). The prevalence of tuberculosis did not differ by HIV status. The 40-day case fatality ratio was 25%. There was no difference in all-cause mortality based on HIV serostatus, presence of neutropenia, or positive microbiologic results. A universal vital assessment score of >4 was associated with all-cause mortality (hazard ratio, 14.5 [95% confidence interval, 5-42.7])., Conclusions: The 40-day mortality rate among Ugandan patients with solid tumors who developed chemotherapy-associated febrile illness was high, and few had an identified source of infection. Tuberculosis and bacterial bloodstream infections were the leading diagnoses associated with fever. Tuberculosis should be included in the differential diagnosis for patients who develop fever after receiving chemotherapy in tuberculosis-endemic settings, regardless of HIV serostatus., Competing Interests: Potential conflicts of interest. All authors: No reported conflicts., (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Background: Humans naturally transition from walking to running at a point known as the walk-to-run transition (WRT). The WRT commonly occurs at a speed of ∼2.1 m/s (m/s) or a Froude number (dimensionless value considering leg length) of 0.5. Emerging evidence suggests the WRT can also be classified using a cadence of 140 steps/min. An accurate cadence-based WRT metric would aid in classifying wearable technology minute-level step metrics as walking vs. running., Purpose: To evaluate performance of 1) WRT predictors directly identified from a treadmill-based dataset of sequentially faster bouts, and 2) accepted WRT predictors compiled from previous literature., Methods: Twenty-eight adults (71.4% men; age = 36.6 ± 12.8 years, BMI = 26.2 ± 4.7 kg/m 2 ) completed a series of five-minute treadmill walking bouts increasing in 0.2 m/s increments until they freely chose to run. Optimal WRT values for speed, Froude number, and cadence were identified using receiver operating characteristic (ROC) curve analyses. WRT value performance was evaluated via classification accuracy metrics., Results: Overall accuracies (metric, percent) according to WRT predictors from previous literature were: speed (2.1 m/s, 55.0%), Froude number (0.5, 76.8%), and cadence (140 steps/min, 91.1%), and those from the dataset herein were: speed (1.9 and 2.0 m/s, 78.6%), Froude number (0.68, 77.3%), and cadence (134, 139, and 141 steps/min, 92.9%). The three equally accurate cadence values support a heuristic range of cadence-based WRT values in young and middle-aged adults: 135-140 steps/min., Significance: A tight range of cadence values performed better as WRT predictors compared to either previously reported or directly identified speed or Froude number values. These findings have important implications for gait classification, especially considering cadence is a simple metric which can be readily assessed across settings using direct observation or wearable technologies., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Purpose: In a cross-sectional sample of US Hispanic/Latino adults, we aimed to describe step-based metric distributions, estimate their associations with activity counts and self-report, and calibrate step-based translations of current (2018) US physical activity (PA) guidelines, that is, ≥150 min·wk -1 moderate-to-vigorous PA (MVPA) from accelerometer counts and self-report., Methods: The Hispanic Community Health Study/Study of Latinos enrolled 16,415 Hispanic/Latino adults 18-74 yr from four US cities (2008-2011). Participants completed the Global PA Questionnaire and 1 wk of Actical accelerometer wear ( n = 12,528). Weighted medians were used to describe step-based metrics, and Spearman correlations estimated their relationships with count-based and self-reported PA indicators. Receiver operator characteristic curve analyses were used to examine the ability of each step-based metric to classify participants meeting PA guidelines., Results: Overall, US Hispanic/Latino adults accumulated medians of 6770 steps per day and 6, 18, 236, and 630 min·d -1 at ≥100, ≥70, 1-69, and 0 steps per minute, respectively. Count-based time in MVPA, light PA, and sedentary behavior were most strongly correlated ( rs = 0.79-0.85) with times ≥70, 1-69, and 0 steps per minute, respectively, whereas self-reported MVPA had similar correlations with steps per day and times ≥40 and ≥70 steps per minute ( rs = 0.28-0.29). Time ≥70 steps per minute had the greatest capacity to classify participants meeting PA guidelines with both measures of MVPA., Conclusions: This study provides the first normative values (based on percentiles) of step-based metrics for US Hispanic/Latino adults, which can facilitate surveillance, program planning, research, and data interpretation. Our finding that PA guidelines corresponded to 6000-7000 steps per day or ~20 min·d -1 at ≥70 steps per minute with an Actical accelerometer can be considered alongside dose-response relationships with health outcomes to develop step-based recommendations that are consistent with and better communicate PA guidelines., (Copyright © 2023 by the American College of Sports Medicine.)

This study investigated emotion transmission among peers during middle childhood. Participants included 202 children (111 males; race: 58% African American, 20% European American, 16% Mixed race, 1% Asian American, and 5% Other; ethnicity: 23% Latino(a) and 77% Not Latino(a); M income  = $42,183, SD income  = $43,889; M age  = 9.49; English-speaking; from urban and suburban areas of a mid-Atlantic state in the United States). Groups of four same-sex children interacted in round-robin dyads in 5-min tasks during 2015-2017. Emotions (happy, sad, angry, anxious, and neutral) were coded and represented as percentages of 30-s intervals. Analyses assessed whether children's emotion expression in one interval predicted change in partners' emotion expression in the next interval. Findings suggested: (a) escalation of positive and negative emotion [children's positive (negative) emotion predicts an increase in partners' positive (negative) emotion], and (b) de-escalation of positive and negative emotion (children's neutral emotion predicts a decrease in partners' positive or negative emotion). Importantly, de-escalation involved children's display of neutral emotion and not oppositely valenced emotion., (© 2023 The Authors. Child Development © 2023 Society for Research in Child Development.)

Purpose: The purpose of this study was to develop 60-second epoch accelerometer intensity cutpoints for vertical axis count and vector magnitude (VM) output from hip-worn tri-axial accelerometers among women 60-91 years. We also compared these cutpoints against cutpoints derived by multiplying 15-second epoch cutpoints by four., Methods: Two hundred apparently healthy women wore an ActiGraph GT3X+ accelerometer on their hip while performing a variety of laboratory-based activities that were sedentary (watching television, assembling a puzzle), low light (washing/drying dishes), high light (laundry, dust mopping), or MVPA (400-meter walk) intensity. Oxygen uptake was measured using an Oxycon ™ portable calorimeter. Sedentary behavior and physical activity intensity cutpoints for vertical axis and VM counts were derived for 60-second epochs from receiver operating characteristic (ROC) and by multiplying the 15-second cutpoints by four); both were compared to oxygen uptake., Results: The median age was 74.5 years (interquartile range 70-83). The 60-second epoch cutpoints for vertical counts were 0 sedentary, 1-73 low light, 74-578 high light, and >=579 MVPA. The 60-second epoch cutpoints for VM were 0-88 sedentary, 89-663 low light, 664-1730 high light, and >=1731 MVPA. For both sets of cutpoints, the ROC approach yielded more accurate estimates than the multiplication approach., Conclusion: The derived 60-second epoch cutpoints for vertical counts and VM can be applied to epidemiologic studies to define sedentary behavior and physical activity intensities in older adult populations., Competing Interests: CONFLICT OF INTEREST The authors have no conflicts of interest.

The goal of the current study was to investigate whether children's social information processing (SIP) predicts their conversations with peers, including both their remarks to peers and peers' remarks to them. When children ( N = 156; 55% male; United States; Representation by Race: 60% African American, 18% Mixed race, 15% European American, 7% Other; Representation by Latino/a Ethnicity: 22% Latino/a, 78% Not Latino/a; M income = $39,419) were 8 years old, we assessed their aggressive and prosocial SIP using the Social Information Processing Application (SIP-AP). When children were 9 years old, they participated in playgroups typically consisting of four same-sex unfamiliar children who interacted in a round-robin format. Each dyad completed a five-minute frustration task and a five-minute planning task. Observers coded children's verbalizations into six prosocial categories (Suggest, Agree, Solicit Input, Ask, Encourage, State Personal) and four antisocial categories (Command, Disagree, Discourage, Aggress). Children with higher aggressive SIP made more antisocial and fewer prosocial statements, whereas children with higher prosocial SIP made more prosocial and fewer antisocial statements. Furthermore, children with higher aggressive SIP elicited more antisocial and fewer prosocial statements from peers, whereas children with higher prosocial SIP elicited more prosocial and fewer antisocial statements from peers. Children's antisocial and prosocial remarks mediated relations between their aggressive SIP and peers' subsequent antisocial and prosocial remarks. Findings are discussed in terms of: (a) the use of SIP to predict more subtle social behaviors in children's social interaction, and (b) cycles of social interactions that maintain and reinforce children's SIP patterns. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Infectious Diseases Society of America (IDSA) has set clear priorities in recent years to promote inclusion, diversity, access, and equity (IDA&E) in infectious disease (ID) clinical practice, medical education, and research. The IDSA IDA&E Task Force was launched in 2018 to ensure implementation of these principles. The IDSA Training Program Directors Committee met in 2021 and discussed IDA&E best practices as they pertain to the education of ID fellows. Committee members sought to develop specific goals and strategies related to recruitment, clinical training, didactics, and faculty development. This article represents a presentation of ideas brought forth at the meeting in those spheres and is meant to serve as a reference document for ID training program directors seeking guidance in this area., Competing Interests: Potential conflicts of interest. All authors: No reported conflicts., (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Current experiments only provide low-resolution information on gaseous protein ions generated by electrospray ionization (ESI). Molecular dynamics (MD) simulations can yield complementary insights. Unfortunately, conventional MD does not capture the mobile nature of protons in gaseous proteins. Mobile-proton MD (MPMD) overcomes this limitation. Earlier MPMD data at 300 K indicated that protein ions generated by "native" ESI retain solution-like structures with a hydrophobic core and zwitterionic exterior [Bakhtiari, M.; Konermann, L. J. Phys. Chem. B 2019, 123, 1784-1796]. MPMD redistributes protons using electrostatic and proton affinity calculations. The robustness of this approach has never been scrutinized. Here, we close this gap by benchmarking MPMD against density functional theory (DFT) at the B3LYP/6-31G* level, which is well suited for predicting proton affinities. The computational cost of DFT necessitated the use of small peptides. The MPMD energetic ranking of proton configurations was found to be consistent with DFT single-point energies, implying that MPMD can reliably identify favorable protonation sites. Peptide MPMD runs converged to DFT-optimized structures only when applying 300-500 K temperature cycling, which was necessary to prevent trapping in local minima. Temperature cycling MPMD was then applied to gaseous protein ions. Native ubiquitin converted to slightly expanded structures with a zwitterionic core and a nonpolar exterior. Our data suggest that such inside-out protein structures are intrinsically preferred in the gas phase, and that they form in ESI experiments after moderate collisional excitation. This is in contrast to native ESI (with minimal collisional excitation, simulated by MPMD at 300 K), where kinetic trapping promotes the survival of solution-like structures. In summary, this work validates the MPMD approach for simulations on gaseous peptides and proteins.

The US Environmental Protection Agency (EPA) uses a water quality index (WQI) to estimate benefits of proposed Clean Water Act regulations. The WQI is relevant to human use value, such as recreation, but may not fully capture aspects of nonuse value, such as existence value. Here, we identify an index of biological integrity to supplement the WQI in a forthcoming national stated preference survey that seeks to capture existence value of streams and lakes more accurately within the conterminous United States (CONUS). We used literature and focus group research to evaluate aquatic indices regularly reported by the EPA's National Aquatic Resource Surveys. We chose an index that quantifies loss in biodiversity as the observed-to-expected (O/E) ratio of taxonomic composition because focus group participants easily understood its meaning and the environmental changes that would result in incremental improvements. However, available datasets of this index do not provide the spatial coverage to account for how conditions near survey respondents affect their willingness to pay for its improvement. Therefore, we modeled and interpolated the values of this index from sampled sites to 1.1 million stream segments and 297,071 lakes across the CONUS to provide the required coverage. The models explained 13 to 36% of the variation in O/E scores and demonstrate how modeling can provide data at the required density for benefits estimation. We close by discussing future work to improve performance of the models and to link biological condition with water quality and habitat models that will allow us to forecast changes resulting from regulatory options.

Background: Saudi Arabia is experiencing rapid development of the built environment and implementing policy changes to promote physical activity (PA) and reduce sedentary behavior (SB) among its population. In light of these developments, this scoping review systematically summarized population levels of PA/SB in Saudi Arabia., Methods: The authors searched 6 databases on December 13, 2021, for articles published in English or Arabic from 2018 to the search date. Studies using population-based sampling in Saudi Arabia and measuring PA/SB were included., Results: Of the 1272 records found, 797 were screened, and 19 studies (9 on children/adolescents age 6-19 y and 10 on adults age 15-75 y) were included. All studies were cross-sectional in design, and 18 studies collected data at only one point in time, ranging from 2009 to 2020. A total of 18 studies relied on self-reporting to assess PA/SB using a variety of questionnaires. Among children/adolescents, approximately 80% to 90% did not attain at least 60 minutes per day of moderate to vigorous PA and 50% to 80% engaged in ≥2 hours per day of screen time or SB. Among adults, approximately 50% to 95% had low or insufficient PA (eg, less than meeting PA guidelines) and about half had a sitting time of ≥5 hours per day. Population-based studies were not found among children <10 years and adults >75 years., Conclusions: A high proportion of participants in the reviewed studies did not meet PA recommendations and spent excessive time in SB. Ongoing surveillance efforts for all ages may help identify target populations for interventions and prioritize the national strategy on PA/SB in Saudi Arabia.

Background Few studies have investigated associations of acclerometer-based assessments of physical activity (PA) and sedentary behavior (SB) with incidence of cardiovascular disease (CVD) and its components. This prospective cohort study assessed the associations of accelerometer-measured PA and SB with total CVD, myocardial infarction, and ischemic stroke (IS). Methods and Results The authors included 16 031 women aged 62 years and older, free of CVD, with adherent accelerometer wear (≥10 hours/day for ≥4 days) from the Women's Health Study (mean age, 71.4 years [SD, 5.6 years]). Hip-worn ActiGraph GT3X+ accelerometers measured total volume of PA (total average daily vector magnitude), minutes per day of high-light PA and moderate to vigorous PA (MVPA), and SB. Women reported diagnoses of CVD, which were adjudicated using medical records and death certificates. Hazard ratios (HRs) were estimated for each exposure, and 95% CIs using Cox proportional hazards models were adjusted for accelerometer wear time, age, self-reported general health, postmenopausal hormone therapy, smoking status, and alcohol use. The hypothetical effect of replacing 10 minutes/day of SB or high-light PA with MVPA on CVD incidence was assessed using adjusted isotemporal substitution Cox models. Over a mean of 7.1 years (SD, 1.6 years) of follow-up, 482 total CVD cases, 107 myocardial infarction cases, and 181 IS cases were diagnosed. Compared with the lowest quartiles of total average daily vector magnitude and MVPA (≤60 minutes), women who were in the highest quartiles (>120 minutes of MVPA) had a 43% (95% CI, 24%-58%) and 38% (95% CI, 18%-54%) lower hazard of total CVD, respectively. Estimates were similar for total average daily vector magnitude and MVPA with IS, but PA was not associated with myocardial infarction overall. High-light PA was not associated with any CVD outcomes. Women who spent <7.4 hours sedentary per day had a 33% (95% CI, 11%-49%) lower hazard of total CVD compared with those who spent ≥9.5 hours sedentary. Replacing 10 minutes of SB with MVPA was associated with a 4% lower incidence of total CVD (HR, 0.96 [95% CI, 0.93-0.99]). Conclusions Accelerometer-assessed total PA and MVPA were inversely associated with total CVD and IS incidence, and SB was directly associated with total CVD; high-light PA was not related to CVD.

Background: Walking cadence (steps/min) has emerged as a valid proxy of physical activity intensity, with consensus across numerous laboratory-based treadmill studies that ≥100 steps/min approximates absolutely defined moderate intensity (≥3 metabolic equivalents; METs). We recently reported that this cadence threshold had a classification accuracy of 73.3% for identifying moderate intensity during preferred pace overground walking in young adults. The purpose of this study was to evaluate and compare the performance of a cadence threshold of ≥100 steps/min for correctly classifying moderate intensity during overground walking in middle- and older-aged adults., Methods: Participants (N = 174, 48.3% female, 41-85 years of age) completed laboratory-based cross-sectional study involving an indoor 5-min overground walking trial at their preferred pace. Steps were manually counted and converted to cadence (total steps/5 min). Intensity was measured using indirect calorimetry and expressed as METs. Classification accuracy (sensitivity, specificity, accuracy) of a cadence threshold of ≥100 steps/min to identify individuals walking at ≥3 METs was calculated., Results: The ≥100 steps/min threshold demonstrated accuracy of 74.7% for classifying moderate intensity. When comparing middle- vs. older-aged adults, similar accuracy (73.4% vs. 75.8%, respectively) and specificity (33.3% vs. 34.5%) were observed. Sensitivity was high, but was lower for middle- vs. older-aged adults (85.2% vs. 93.9%, respectively)., Conclusion: A cadence threshold of ≥100 steps/min accurately identified moderate-intensity overground walking. Furthermore, accuracy was similar when comparing middle- and older-aged adults. These findings extend our previous analysis in younger adults and confirm the appropriateness of applying this cadence threshold across the adult lifespan., (© 2022 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.)

Background: In Saudi Arabia, stay-at-home orders to address the coronavirus disease 2019 (COVID-19) pandemic between March 15 and 23, 2020 and eased on May 28, 2020. We conducted a scoping review to systematically describe physical activity and sedentary behavior in Saudi Arabia associated with the timing of the lockdown., Methods: We searched six databases on December 13, 2021 for articles published in English or Arabic from 2018 to the search date. Studies must have reported data from Saudi Arabia for any age and measured physical activity or sedentary behavior., Results: Overall, 286 records were found; after excluding duplicates, 209 records were screened, and 19 studies were included in the review. Overall, 15 studies were cross-sectional, and 4 studies were prospective cohorts. Three studies included children and adolescents (age: 2-18 years), and 16 studies included adults (age: 15-99 years). Data collection periods were <  = 5 months, with 17 studies collecting data in 2020 only, one study in 2020-2021, and one study in 2021. The median analytic sample size was 363 (interquartile range 262-640). Three studies of children/adolescents collected behaviors online at one time using parental reporting, with one also allowing self-reporting. All three studies found that physical activity was lower during and/or following the lockdown than before the lockdown. Two studies found screen time, television watching, and playing video games were higher during or following the lockdown than before the lockdown. Sixteen adult studies assessed physical activity, with 15 utilizing self-reporting and one using accelerometry. Physical activity, exercise, walking, and park visits were all lower during or following the lockdown than before the lockdown. Six adult studies assessed sedentary behavior using self-report. Sitting time (4 studies) and screen time (2 studies) were higher during or following the lockdown than before the lockdown., Conclusions: Among children, adolescents, and adults, studies consistently indicated that in the short-term, physical activity decreased and sedentary behavior increased in conjunction with the movement restrictions. Given the widespread impact of the pandemic on other health behaviors, it would be important to continue tracking behaviors post-lockdown and identify subpopulations that may not have returned to their physical activity and sedentary behavior to pre-pandemic levels to focus on intervention efforts., (© 2023. The Author(s).)

Sepsis is a significant cause of mortality among people living with human immunodeficiency virus (HIV) in sub-Saharan Africa. In the planning period prior to the start of a large multi-country clinical trial studying the efficacy of the immediate empiric addition of anti-tuberculosis therapy to standard-of-care antibiotics for sepsis in people living with HIV, we used decision analysis to assess the costs and potential health outcome impacts of the clinical trial design based on preliminary data and epidemiological parameter estimates. The purpose of this analysis was to highlight this approach as a case example where decision analysis can estimate the cost effectiveness of a proposed clinical trial design. In this case, we estimated the impact of immediate empiric anti-tuberculosis (TB) therapy versus the diagnosis-dependent standard of care using three different TB diagnostics: urine TB-LAM, sputum Xpert-MTB/RIF, and the combination of LAM/Xpert. We constructed decision analytic models comparing the two treatment strategies for each of the three diagnostic approaches. Immediate empiric-therapy demonstrated favorable cost-effectiveness compared with all three diagnosis-dependent standard of care models. In our methodological case exemplar, the proposed randomized clinical trial intervention demonstrated the most favorable outcome within this decision simulation framework. Applying the principles of decision analysis and economic evaluation can have significant impacts on study design and clinical trial planning.

Metagenomic sequencing is a promising new method for pathogen detection. We aimed to detect pathogens from archived plasma using metagenomic sequencing in a previously well-characterized cohort of 254 predominantly HIV-infected patients with sepsis in Uganda. We used Illumina sequencing and the Chan Zuckerberg ID metagenomics platform to sequence and identify pathogens. On average, each plasma sample yielded 3,404,737 ± 2,201,997 reads (mean ± standard deviation), of which 220,032 ± 416,691 (6.3% ± 8.6%) were identified as nonhuman reads. Using a background model filter, 414 genus-specific pathogen identifications were found in the 254 samples. Nineteen pathogens were previously detected positive by quantitative PCR (qPCR), compared to sequencing, which demonstrated 30.2% sensitivity and 99.5% specificity. Sensitivity was higher for viral pathogens than nonviral pathogens (37% versus 5%). For example, HIV viremia was detected in 69% of samples using qPCR, and sequencing revealed 70% sensitivity and 92% specificity. There were 75 genus-specific potential pathogens identified by sequencing in this cohort, including hepatitis B and Epstein-Barr virus (EBV), among several others. qPCR showed a prevalence of hepatitis B and EBV viremia of 17% and 45%, respectively. In-hospital mortality was associated with a lower qPCR threshold cycle value for EBV (adjusted odds ratio, 0.85; P  < .001) but not for hepatitis B or HIV. In conclusion, a broad range of potential pathogens were identified by metagenomic sequencing in patients with sepsis in Uganda. Unexpectedly high rates of hepatitis B and EBV viremia were found. Whether these viral infections in HIV patients with sepsis are clinically important requires further study. IMPORTANCE The use of next-generation sequencing (NGS) in blood samples is an emerging technology for clinical microbiology labs. In this work, we performed NGS on plasma samples from a well-characterized cohort, where all samples had been previously tested by PCR for 43 pathogens. Therefore, we could compare sequencing performance against that of PCR and identify clinical correlates. A broad range of potential pathogens were identified by metagenomic sequencing in patients with sepsis in Uganda, particularly viruses, which we confirmed by PCR. In addition to HIV viremia, unexpectedly high rates of hepatitis B and EBV viremia were found, which may have important clinical implications.

Progressive hypoxemia is the predominant mode of deterioration in COVID-19. Among hypoxemia measures, the ratio of the Pao 2 to the Fio 2 (P/F ratio) has optimal construct validity but poor availability because it requires arterial blood sampling. Pulse oximetry reports oxygenation continuously (ratio of the Spo 2 to the Fio 2 [S/F ratio]), but it is affected by skin color and occult hypoxemia can occur in Black patients. Oxygen dissociation curves allow noninvasive estimation of P/F ratios (ePFRs) but remain unproven., Objectives: Measure overt and occult hypoxemia using ePFR., Design Setting and Participants: We retrospectively studied COVID-19 hospital encounters ( n = 5,319) at two academic centers (University of Virginia [UVA] and Emory University)., Main Outcomes and Measures: We measured primary outcomes (death or ICU transfer within 24 hr), ePFR, conventional hypoxemia measures, baseline predictors (age, sex, race, comorbidity), and acute predictors (National Early Warning Score [NEWS] and Sequential Organ Failure Assessment [SOFA]). We updated predictors every 15 minutes. We assessed predictive validity using adjusted odds ratios (AORs) and area under the receiver operating characteristic curves (AUROCs). We quantified disparities (Black vs non-Black) in empirical cumulative distributions using the Kolmogorov-Smirnov (K-S) two-sample test., Results: Overt hypoxemia (low ePFR) predicted bad outcomes (AOR for a 100-point ePFR drop: 2.7 [UVA]; 1.7 [Emory]; p < 0.01) with better discrimination (AUROC: 0.76 [UVA]; 0.71 [Emory]) than NEWS (0.70 [both sites]) or SOFA (0.68 [UVA]; 0.65 [Emory]) and similar to S/F ratio (0.76 [UVA]; 0.70 [Emory]). We found racial differences consistent with occult hypoxemia. Black patients had better apparent oxygenation (K-S distance: 0.17 [both sites]; p < 0.01) but, for comparable ePFRs, worse outcomes than other patients (AOR: 2.2 [UVA]; 1.2 [Emory]; p < 0.01)., Conclusions and Relevance: The ePFR was a valid measure of overt hypoxemia. In COVID-19, it may outperform multi-organ dysfunction models. By accounting for biased oximetry as well as clinicians' real-time responses to it (supplemental oxygen adjustment), ePFRs may reveal racial disparities attributable to occult hypoxemia., Competing Interests: Dr. Moore is supported by the National Institutes of Health (U01AI150508). Dr. Holder is supported by the National Institutes of Health (K23GM37182), and he has received speaker and consulting fees from Baxter International and Philips, respectively. Dr. Kamaleswaran was supported by the National Institutes of Health (R01GM139967). Dr. Clark is an employee of Nihon Kohden Digital Health Solutions (Irvine, CA). Dr. Moorman has equity in Medical Predictive Science Corporation, Charlottesville, VA, and consults for Nihon Kohden Digital Health Solutions, Irvine, CA, with proceeds donated to the University of Virginia Medical Foundation. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)

There is much evidence showing that physical activity is related to optimal health, including physical and mental function, and quality of life. Additionally, data are accumulating with regards to the detrimental health impacts of sedentary behavior. Much of the evidence related to long-term health outcomes, such as cardiovascular disease and cancer - the two leading causes of death in the United States and worldwide, comes from observational epidemiologic studies and, in particular, prospective cohort studies. Few data on these outcomes are derived from randomized controlled trials, conventionally regarded as the "gold standard" of research designs. Why is there a paucity of data from randomized trials on physical activity or sedentary behavior and long-term health outcomes? A further issue to consider is that prospective cohort studies investigating these outcomes can take a long time to accrue sufficient numbers of endpoints for robust and meaningful findings. This contrasts with the rapid pace at which technology advances. Thus, while the use of devices for measuring physical behaviors has been an important development in large-scale epidemiologic studies over the past decade, cohorts that are now publishing results on health outcomes related to accelerometer-assessed physical activity and sedentary behavior may have been initiated years ago, using "dated" technology. This paper, based on a keynote presentation at ICAMPAM 2022, discusses the issues of study design and slow pace of discovery in prospective cohort studies and suggests some possible ways to maximize the utility and comparability of "dated" device data from prospective cohort studies for research investigations, using the Women's Health Study as an example.

The idea that we can detect subacute potentially catastrophic illness earlier by using statistical models trained on clinical data is now well-established. We review evidence that supports the role of continuous cardiorespiratory monitoring in these predictive analytics monitoring tools. In particular, we review how continuous ECG monitoring reflects the patient and not the clinician, is less likely to be biased, is unaffected by changes in practice patterns, captures signatures of illnesses that are interpretable by clinicians, and is an underappreciated and underutilized source of detailed information for new mathematical methods to reveal., (Copyright © 2022. Published by Elsevier Inc.)

Purpose: Our study evaluated the agreement of mean daily step counts, peak 1-min cadence, and peak 30-min cadence between the hip-worn ActiGraph GT3X+ accelerometer, using the normal filter (AG N ) and the low frequency extension (AG LFE ), and the thigh-worn activPAL3 micro (AP) accelerometer among older adults., Methods: Nine-hundred and fifty-three older adults (≥65 years) were recruited to wear the ActiGraph device concurrently with the AP for 4-7 days beginning in 2016. Using the AP as the reference measure, device agreement for each step-based metric was assessed using mean differences (AG N - AP and AG LFE - AP), mean absolute percentage error (MAPE), and Pearson and concordance correlation coefficients., Results: For AG N - AP, the mean differences and MAPE were: daily steps -1,851 steps/day and 27.2%, peak 1-min cadence -16.2 steps/min and 16.3%, and peak 30-min cadence -17.7 steps/min and 24.0%. Pearson coefficients were .94, .85, and .91 and concordance coefficients were .81, .65, and .73, respectively. For AG LFE - AP, the mean differences and MAPE were: daily steps 4,968 steps/day and 72.7%, peak 1-min cadence -1.4 steps/min and 4.7%, and peak 30-min cadence 1.4 steps/min and 7.0%. Pearson coefficients were .91, .91, and .95 and concordance coefficients were .49, .91, and .94, respectively., Conclusions: Compared with estimates from the AP, the AG N underestimated daily step counts by approximately 1,800 steps/day, while the AG LFE overestimated by approximately 5,000 steps/day. However, peak step cadence estimates generated from the AG LFE and AP had high agreement (MAPE ≤ 7.0%). Additional convergent validation studies of step-based metrics from concurrently worn accelerometers are needed for improved understanding of between-device agreement.