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Parth Shah,1 Andrew McWilliams,2 Daniel Howard,3 Jason Roberge4 1UNC School of Medicine, Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, NC 28203, USA; 2Carolinas Hospitalist Group, Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, NC 28203, USA; 3Medical Group Division, Atrium Health, Charlotte, NC 28232, USA; 4Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, NC 28203, USA Background: COPD is a lung disease characterized by chronic, irreversible airway obstruction that can precipitate into acute exacerbations of COPD (AECOPD) often requiring hospitalization. Improving these outcomes will require proactive innovations in care delivery to at-risk populations. Data-driven models to identify patients with AECOPD on admission to the hospital are needed, but do not exist. Objective: This study aimed to compare the performance of several models designed to identify patients with AECOPD within 24 hours of hospital admission. Methods: Clinical factors associated with admissions for AECOPD that are available within 24 hours of an encounter were combined into six different models and then tested retrospectively to evaluate each model’s performance in predicting AECOPD. The data set incorporated billing and clinical data from patients who were older than 40 years of age with an inpatient or observation encounter in 2016 at one of the nine hospitals within a large integrated healthcare system. Results: Of the 116,329 encounters, 6,383 had a billing diagnosis for AECOPD. The models showed a wide range of sensitivity (0.473 vs 0.963) and positive predictive value (0.190 vs 0.827). Conclusion: It is possible to leverage clinical and administrative data to identify patients admitted with AECOPD in real-time for quality improvement or research purposes. Because models relied on clinical data, local variation in care delivery also likely contributed to performance variation across hospitals. These findings emphasize the importance of testing model performance on local data and choosing the model that best aligns with the specific goals of the targeted initiative. Keywords: quality improvement, outcomes research, AECOPD, model, validity

Keywords: allergen immunotherapy; bioparticle; food allergy; hypoallergenicity; peanut allergy; plant-based particle EN allergen immunotherapy bioparticle food allergy hypoallergenicity peanut allergy plant-based particle 577 581 5 05/10/23 20230501 NES 230501 Key messages Ara h 2 eBPs show reduced IgE binding, effector cell activation, and IgE-facilitated antigen presentation compared to nAra h 2 Ara h 2 eBPs are >10,000-fold hypoallergenic compared to nAra h 2 Ara h 2 eBPs are a promising candidate for peanut allergen immunotherapy To the Editor: Since the early nineties several approaches have been tested to develop safe and effective allergen immunotherapy (AIT) for the treatment of peanut allergy, starting with subcutaneous AIT with aqueous extract, followed by hypo-allergenic major allergens produced in bacteria that were administered rectally. For example, a virus-based particle expressing the peanut allergens Ara h 1 or 2, based on the Cucumber Mosaic Virus, was shown to be hypo-allergenic in a mouse model.[3] Here we report the ground-breaking hypo-allergenicity of a novel non-virus-based microparticle produced in plants, that is, enveloped bioparticles ( I e i BPs) expressing ~3000 copies of Ara h 2 on the surface of each particle. These results indicate that the I e i BPs have a > 10,000-fold reduced capacity to form IgE-Ara h 2 complexes and subsequently activate Th2 cell responses via IgE-facilitated allergen presentation by B cells. [Extracted from the article]

To assess the impact of bariatric surgery and an added supervised exercise training programme on heart rate variability (HRV) in patients with severe obesity. Fifty-nine patients who underwent bariatric surgery were randomised in the post-operative period to a 12-week supervised exercise training programme (moderate intensity combination aerobic/resistance exercise training programme) or a control group. Indices of HRV including time-domain, spectral-domain, and nonlinear parameters were measured preoperatively, and at 3, 6, and 12 months. After the surgical procedure, both groups improved anthropometric parameters. Type 2 diabetes, hypertension, and dyslipidemia resolutions were similar between groups. Total body weight loss at 6 and 12 months were also comparable between groups (6 months: 28 ± 6 vs. 30 ± 6%; 12 months: 38 ± 9 vs. 38 ± 10%; control vs. intervention group respectively). Bariatric surgery improved HRV parameters at 12 months compared to the pre-operative values in the intervention group: standard deviation of R-R interval (SDNN) (156.0 ± 46.4 vs. 122.6 ± 33.1 ms), low frequency (LF) (6.3 ± 0.8 vs. 5.8 ± 0.7 ms2), and high frequency (HF) (5.1 ± 0.8 vs. 4.7 ± 0.9 ms2) (all p<0.001). For the control patients, similar improvements in SDNN (150.0 ± 39.4 vs. 118.8 ± 20.1 ms), LF (6.1 ± 0.9 vs. 5.7 ± 0.8 ms2), and HF (5.0 ± 0.9 vs. 4.7 ± 0.9 ms2) were obtained (all p<0.001). However, there was no add-on impact of the supervised exercise training programme on HRV after 12 months (p>0.05 for all HRV parameters). Bariatric surgery is associated with an improvement in HRV. A supervised exercise training programme in the post-operative period did not modulate further the benefits of bariatric surgery regarding HRV parameters. [ABSTRACT FROM AUTHOR]

To investigate the origin of compositional zonation in the Bishop Tuff magma body, we have analyzed trace elements in the matrix glass of pumice clasts and in quartz-hosted melt inclusions. Our results show contrasting patterns for quartz in different parts of the Bishop Tuff. In all samples from the early part of the eruption, trace element compositions of matrix glasses are similar to but slightly more evolved than quartz-hosted melt inclusions. This indicates a cogenetic relationship between quartz crystals and their surrounding matrix glass, consistent with in situ crystallization. The range of incompatible element concentrations in melt inclusions and matrix glass from single pumice clasts requires 16-20 wt% in situ crystallization. This is greater than the actual crystal content of the pumices ( Keywords Bishop Tuff * Melt inclusions * Trace element * Matrix glass * C[O.sub.2] * [H.sub.2]O, Introduction Studying large silicic ignimbrites like the Bishop Tuff in California provides valuable insight into the evolution and differentiation processes occurring within silicic magma bodies and plutons. At the time [...]

Through the lens of bulk-rock and matrix glass geochemistry, we investigated the magmatic evolution and pre-eruptive architecture of the siliceous magma complex beneath the Cerro Blanco volcanic complex, a Crater Lake--type caldera complex in the southern Puna Plateau of the Central Andes of Argentina. The Cerro Blanco volcanic complex has been the site of two caldera-forming eruptions with volcanic explosivity index (VEI) 6+ that emplaced the ca. 54 ka Campo Piedra Pomez ignimbrite and the ca. 4.2 ka Cerro Blanco ignimbrite. As such, it is the most productive recent explosive volcano in the Central Andes. The most recent eruptions (younger than 4.2 ka) are dominantly postcaldera effusions of crystal-rich domes and associated small explosive pulses. Previous work has demonstrated that andesitic recharge of and mixing with rhyolitic magma occurred at the base of the magma complex, at ~10 km depth. New isotopic data (Sr, Nd, Pb, and O) confirm that the Cerro Blanco volcanic complex rhyolite suite is part of a regional southern Puna, arc-related ignimbrite group. The suite defines a tight group of consanguineous siliceous magmas that serves as a model for the evolution of arc-related, caldera- forming silicic magma systems in the region and elsewhere. These data indicate that the rhyolites originated through limited assimilation of and mixing with upper-crustal lithologies by regional basaltic andesite parent materials, followed by extensive fractional crystallization. Least squares models of major elements in tandem with Rayleigh fractionation models for trace elements reveal that the internal variations among the rhyolites through time can be derived by extensive fractionation of a quartz--two feldspar (granitic minimum) assemblage with limited assimilation. The rare earth element character of local volumes of melt in some samples of the Campo Piedra Pomez ignimbrite basal fallout requires significant fractionation of amphibole. The distinctive major- and trace-element characteristics of bulk rock and matrix of the Campo Piedra Pomez and Cerro Blanco tephras provide useful geochemical fingerprints to facilitate regional tephrochronology. Available data indicate that rhyolites from other neighborhood centers, such as Cueros de Purulla, share bulk chemical characteristics with the Campo Piedra Pomez ignimbrite rhyolites, but they appear to be isotopically distinct. Pre-eruptive storage and final equilibration of the rhyolitic melts were estimated from matrix glass compositions projected onto the haplogranitic system (quartz-albite-orthoclase-H2O) and using rhyolite-MELTS models. These revealed equilibration pressures between 360 and 60 MPa (~10-2 km depth) with lowest pressures in the Holocene eruptions. Model temperatures for the suite ranged from 695 to 790 °C. Integrated together, our results reveal that the Cerro Blanco volcanic complex is a steady-state (low-magmatic-flux), arc-related complex, standing in contrast to the flare-up (high-magmatic-flux) supervolcanoes that dominate the Neogene volcanic stratigraphy. The silicic magmas of the Cerro Blanco volcanic complex were derived more directly from mafic and intermediate precursors through extensive fractional crystallization, albeit with some mixing and assimilation of local basement. Geochemical models and pressure-temperature estimates indicate that significant volumes of remnant cumulates of felsic and intermediate composition should dominate the polybaric magma complex beneath the Cerro Blanco volcanic complex, which gradually shallowed through time. Evolution to the most silicic compositions and final equilibration of some of the postcaldera domes occurred during ascent and decompression at depths less than 2 km. Our work connotes an incrementally accumulated (over at least 54 k.y.), upper-crustal pluton beneath the Cerro Blanco volcanic complex between 2 and 10 km depth. The composition of this pluton is predicted to be dominantly granitic, with deeper parts being granodioritic to tonalitic. The progressive solidification and eventual contraction of the magma complex may account for the decades of deflation that has characterized Cerro Blanco. The presently active geothermal anomaly and hydrothermal springs indicate the Cerro Blanco volcanic complex remains potentially active. [ABSTRACT FROM AUTHOR]

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BackgroundHerd immunity or community immunity refers to the reduced risk of infection among susceptible individuals in a population through the presence and proximity of immune individuals. Recent studies suggest that improving the understanding of community immunity may increase intentions to get vaccinated. ObjectiveThis study aims to design a web application about community immunity and optimize it based on users’ cognitive and emotional responses. MethodsOur multidisciplinary team developed a web application about community immunity to communicate epidemiological evidence in a personalized way. In our application, people build their own community by creating an avatar representing themselves and 8 other avatars representing people around them, for example, their family or coworkers. The application integrates these avatars in a 2-min visualization showing how different parameters (eg, vaccine coverage, and contact within communities) influence community immunity. We predefined communication goals, created prototype visualizations, and tested four iterative versions of our visualization in a university-based human-computer interaction laboratory and community-based settings (a cafeteria, two shopping malls, and a public library). Data included psychophysiological measures (eye tracking, galvanic skin response, facial emotion recognition, and electroencephalogram) to assess participants’ cognitive and affective responses to the visualization and verbal feedback to assess their interpretations of the visualization’s content and messaging. ResultsAmong 110 participants across all four cycles, 68 (61.8%) were women and 38 (34.5%) were men (4/110, 3.6%; not reported), with a mean age of 38 (SD 17) years. More than half (65/110, 59.0%) of participants reported having a university-level education. Iterative changes across the cycles included adding the ability for users to create their own avatars, specific signals about who was represented by the different avatars, using color and movement to indicate protection or lack of protection from infectious disease, and changes to terminology to ensure clarity for people with varying educational backgrounds. Overall, we observed 3 generalizable findings. First, visualization does indeed appear to be a promising medium for conveying what community immunity is and how it works. Second, by involving multiple users in an iterative design process, it is possible to create a short and simple visualization that clearly conveys a complex topic. Finally, evaluating users’ emotional responses during the design process, in addition to their cognitive responses, offers insights that help inform the final design of an intervention. ConclusionsVisualization with personalized avatars may help people understand their individual roles in population health. Our app showed promise as a method of communicating the relationship between individual behavior and community health. The next steps will include assessing the effects of the application on risk perception, knowledge, and vaccination intentions in a randomized controlled trial. This study offers a potential road map for designing health communication materials for complex topics such as community immunity.

Abstract: The explosive activity of Popocatépetl Volcano is a threat to the surrounding densely populated areas and it is therefore important to recognize indicators of change in eruptive style (explosive to dome building) within a short period of time. In this study we present results of vesicle size distributions (VSDs) and compositional analysis of matrix glass from juvenile clasts from five of the main plinian eruptions of Popocatépetl (ca. 23–1.2ka), the 2001 small eruption during partial dome collapse and four eruptions during 1997 (May 11th and June 14th, 15th and 30th). Major element analysis of matrix glass (WDS-EPMA) allows the estimation of the depth from which the erupted magma went into disequilibrium (between crystals and melt), by calculating the equilibrium pressure using the quartz–albite–orthoclase ternary system of Blundy and Cashman (2001). Quantitative interpretation of texture in juvenile (pumice or scoria) clasts via VSD analysis using CSD software was used to link physical changes experienced by magma during ascent, with conditions responsible for eruptions. The extent and style of vesiculation in juvenile clasts is also related to eruption style and duration and has specifically allowed the recognition of changes in vesicular texture that represent variations from explosive to dome building activity (Mangan and Sisson, 2000; Adams et al., 2006). This study highlights a more complicated story in terms of magma storage, than that previously accepted for the Popocatépetl volcanic system and is an important contribution to ongoing research at the volcano. [Copyright &y& Elsevier]

A principal factor analysis was performed on a matrix of correlations amoung measures of field independence, intelligence, and achievement in reading and mathematics. Factors of general intelligence and verbal ability were identified. Field independence shared a substantial amount of variance with general intellectual ability. (Author/SJL)

In recent years, the popularity of metal hydrides has increased considerably for hydrogen storage and their applications in hydrogen fuel cells. Their potential applications for clean energy are promissory. However, the temperatures required for adsorption and desorption are extremely high, which range between 500 and 700 K, making their use impractical. To overcome these difficulties, the following work considers using three hydride alloys: magnesium-aluminum (MgAl), magnesium-nickel (MgNi), and magnesium-zinc (MgZn). The Mg concentrations were set to be between 80 and 100 wt% in order to reduce the temperatures of adsorption and desorption in contrast with the temperatures of pure magnesium. The chemisorption and repulsion energies of the hydrogen molecule on the surface (110) of the different metallic alloys were studied at 0, 200, 400, 600, and 700 K, respectively. The study was based on the density functional theory (DFT), with the module DMol3 of the molecular simulation program Materials Studio, which was used to obtain these energy values. The results confirm that adding aluminum, nickel, or zinc into magnesium matrix increases the chemisorption and decreases the energy repulsion values on surfaces of the metallic alloys, improving the effectiveness of the hydrogen storage. [ABSTRACT FROM AUTHOR]

Swedish forest and environmental policies imply that forests should be managed so that all naturally occurring species are maintained in viable populations. This requires maintenance of functional networks of representative natural forest and cultural woodland habitats. We first review the policy implementation process regarding protected areas in Sweden 1991â2010, how ecological knowledge was used to formulate interim short-term and strategic long-term biodiversity conservation goals, and the development of a hierarchical spatial planning approach. Second, we present data about the amount of formally protected and voluntarily set aside forest stands, and evaluate how much remains in terms of additional forest protection, conservation management and habitat restoration to achieve forest and environmental policy objectives in the long-term. Third, a case study in central Sweden was made to estimate the functionality of old Scots pine, Norway spruce and deciduous forest habitats, as well as cultural woodland, in different forest regions. Finally, we assess operational biodiversity conservation planning processes. We conclude that Swedish policy pronouncements capture the contemporary knowledge about biodiversity and conservation planning well. However, the existing area of protected and set-aside forests is presently too small and with too poor connectivity. To bridge this gap, spatial planning, management and restoration of habitat, as well as collaboration among forest and conservation planners need to be improved.

Anthropogenic climate change is altering the management of production forests. These changes are motivated by the need to adapt to the uncertainties and risks of climate change, and by the need to enlist their carbon storage and sequestration capacity as part of global mitigation efforts. These changes do however raise concerns regarding the potential implications for forest biodiversity. Here we evaluate these concerns by assessing the biodiversity implications of climate change adaptation and mitigation strategies (CCAMS) being implemented in the production forests of Sweden. We do so by identifying biodiversity goals aimed specifically at closing the existing gap between the habitat requirements of forest-dependent species, and the conditions provided by production forests, in terms of tree species composition, forest structures, and spatio-temporal forest patterns. We then use the existing literature to determine whether and by which pathway each CCAMS is likely to bridge or extend this gap. Our results indicate that CCAMS will often come into direct or partial conflict with Swedish biodiversity goals in production forests. Furthermore, some CCAMS which are inconsistent with biodiversity goals, such as logging residue removal, are being implemented more extensively than those which were most consistent with biodiversity goals. We nevertheless challenge the necessity of setting the preservation of forest biodiversity against climate change mitigation and adaptation. We clarify how CCAMS with negative biodiversity implications may still be implemented without adverse outcomes, if coupled with conservation interventions, or combined with other CCAMS deemed complementary in habitat provision. [ABSTRACT FROM AUTHOR]