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There are only a few models developed for risk-stratifying COVID-19 patients with suspected pneumonia in the emergency department (ED). We aimed to develop and validate a model, the COVID-19 ED pneumonia mortality index (CoV-ED-PMI), for predicting mortality in this population. We retrospectively included adult COVID-19 patients who visited EDs of five study hospitals in Texas and who were diagnosed with suspected pneumonia between March and November 2020. The primary outcome was 1-month mortality after the index ED visit. In the derivation cohort, multivariable logistic regression was used to develop the CoV-ED-PMI model. In the chronologically split validation cohort, the discriminative performance of the CoV-ED-PMI was assessed by the area under the receiver operating characteristic curve (AUC) and compared with other existing models. A total of 1678 adult ED records were included for analysis. Of them, 180 patients sustained 1-month mortality. There were 1174 and 504 patients in the derivation and validation cohorts, respectively. Age, body mass index, chronic kidney disease, congestive heart failure, hepatitis, history of transplant, neutrophil-to-lymphocyte ratio, lactate dehydrogenase, and national early warning score were included in the CoV-ED-PMI. The model was validated with good discriminative performance (AUC: 0.83, 95% confidence interval [CI]: 0.79–0.87), which was significantly better than the CURB-65 (AUC: 0.74, 95% CI: 0.69–0.79, p-value

Introduction: Diverse coronavirus disease 2019 (COVID-19) mortalities have been reported but focused on identifying susceptible patients at risk of more severe disease or death. This study aims to investigate the mortality variations of COVID-19 from different hospital settings during different pandemic phases. Methods: We retrospectively included adult (≥18 years) patients who visited emergency departments (ED) of five hospitals in the state of Texas and who were diagnosed with COVID-19 between March–November 2020. The included hospitals were dichotomized into urban and suburban based on their geographic location. The primary outcome was mortality that occurred either during hospital admission or within 30 days after the index ED visit. We used multivariable logistic regression to investigate the associations between independent variables and outcome. Generalized additive models were employed to explore the mortality variation during different pandemic phases. Results: A total of 1,788 adult patients who tested positive for COVID-19 were included in the study. The median patient age was 54.6 years, and 897 (50%) patients were male. Urban hospitals saw approximately 59.5% of the total patients. A total of 197 patients died after the index ED visit. The analysis indicated visits to the urban hospitals (odds ratio [OR] 2.14, 95% confidence interval [CI], 1.41, 3.23), from March to April (OR 2.04, 95% CI, 1.08, 3.86), and from August to November (OR 2.15, 95% CI, 1.37, 3.38) were positively associated with mortality. Conclusion: Visits to the urban hospitals were associated with a higher risk of mortality in patients with COVID-19 when compared to visits to the suburban hospitals. The mortality risk rebounded and showed significant difference between urban and suburban hospitals since August 2020. Optimal allocation of medical resources may be necessary to bridge this gap in the foreseeable future.

Conservation strategies are rarely systematically evaluated, which reduces transparency, hinders the cost-effective deployment of resources, and hides what works best in different contexts. Using data on the iconic and critically endangered orangutan (Pongo spp.), we developed a novel spatiotemporal framework for evaluating conservation investments. We show that around USD 1 billion was invested between 2000 and 2019 into orangutan conservation by governments, nongovernmental organizations, companies, and communities. Broken down by allocation to different conservation strategies, we find that habitat protection, patrolling, and public outreach had the greatest return on investment for maintaining orangutan populations. Given the variability in threats, land-use opportunity costs, and baseline remunerations in different regions, there were differential benefits per dollar invested across conservation activities and regions. We show that although challenging from a data and analysis perspective, it is possible to fully understand the relationships between conservation investments and outcomes and the external factors that influence these outcomes. Such analyses can provide improved guidance toward a more effective biodiversity conservation. Insights into the spatiotemporal interplays between the costs and benefits driving effectiveness can inform decisions about the most suitable orangutan conservation strategies for halting population declines. Although our study focuses on the three extant orangutan species of Sumatra and Borneo, our findings have broad application for evidence-based conservation science and practice worldwide.

Los ajuares funerarios del grupo arqueologico argarico constituyen una fuente excepcional para conocer la organizacion sociopolitica de esta sociedad de inicios de la Edad del Bronce. El presente articulo se centra en el analisis de las tumbas que incluyen hachas metalicas como parte de las ofrendas, una practica datada en la ultima fase de desarrollo argarico (1800/1750 – 1550 cal ANE). El analisis de los datos disponibles permite confirmar algunas de las hipotesis sociologicas planteadas al respecto por nuestro equipo, y avanzar nuevas perspectivas de conocimiento. En sintesis, la similitud estructural entre los ajuares funerarios con hacha y los previos con alabarda refuerza la clasificacion de las primeras como armas. Sin embargo, en terminos sociales sus portadores pertenecieron a una clase social distinta a la de los alabarderos, en el cuadro de disimetrias propio de los ultimos siglos argaricos. Finalmente, la excepcional concentracion de tumbas con hacha en el yacimiento de El Argar vincula el ejercicio de la violencia fisica a nuevas formas de dominio politico a escala regional.

The south-east of the Iberian Peninsula saw deep social and political changes at the dawn of the second millennium bce. The emergence of important economic asymmetries inside communities was apparently based to a large extent on control of the secondary metallurgical production process; namely, forging. In this sense, the recently excavated architectural complex at the Argaric site of Tira del Lienzo constitutes an exceptional finding. At this site a series of macrolithic artefacts were recorded, which were related to the forging of metals and, more specifically, to the working of silver, according to morpho-technological and functional studies (use-wear and residue analysis).

Evan Shipman, a writer and poet, met Hemingway in Paris in 1924 and eventually became the subject of one of the few chapters in A Moveable Feast where the protagonist is treated kindly. From the legendary 1920s to and through several wars and then home again over terrain more often rocky than not, the two men affected each other's lives. Different in many ways, they shared an enviable grace in the face of danger and a love of literature, art, and Paris. Hemingway, who may have lost as many friendships as he found, went all 15 rounds with this one. The relationship is traced through Shipman's letters to Hemingway from 1927 to 1950.

Objective To evaluate the accuracy of the Brugada algorithm for analysis of wide-complex tachycardia (WCT) when applied by board-certified emergency physicians and board-certified cardiologists. Methods A database consisting of 157 electrocardiograms of WCTs were evaluated in a blinded fashion using the Brugada criteria to determine the presence of ventricular tachycardia (VT) or supraventricular tachycardia with aberrancy. These results were then compared with the electrophysiologically proven diagnosis for each tracing. Sensitivity and specificity of the Brugada criteria for diagnosis of VT were calculated. Two board-certified emergency physicians and two board-certified cardiologists analyzed each tracing, and interobserver agreement was determined using the kappa statistic. Results Sensitivity and specificity for the determination of VT using the Brugada algorithm were 85% [95% confidence interval (95% CI) = 79% to 91%] and 60% (95% CI = 43% to 78%) for cardiologist 1 (C 1) and 91% (95% CI = 86% to 96%) and 55% (95% CI = 37% to 72%) for C 2. Emergency physician (EP 1) achieved a sensitivity of 83% (95% CI = 78% to 91%) and a specificity of 43% (95% CI = 25% to 59%), while EP 2 attained 79% (95% CI = 73% to 87%) and 70% (95% CI = 51% to 84%), respectively. The original authors achieved a sensitivity of 98.7% and specificity of 96.5% when determining VT in their study population. Interobserver agreement for the emergency physicians and the cardiologists in determining VT was 82% and 81%, respectively. Conclusions Neither the emergency physicians nor the cardiologists were able to achieve a sensitivity or specificity as high as that reported by the original investigators when using the Brugada algorithm to determine the presence of VT.

Evidence for prehistoric stone axe production is extremely scarce in the Iberian Peninsula in comparison to other parts of western Europe. This paper addresses this issue through the study of the manufacture and distribution of hornfels tools in the Northeast of the Iberian Peninsula. The combination of petrographic and geomorphological analyses, as well as the examination of archaeological materials, which so far have deserved little attention, allows the identification of procurement areas and blank production strategies. The next step has been to approach the social value of the products by means of their association with other materials participating in the Neolithic distribution-networks. The observed geographical and social asymmetries lead to addressing the issue of power structures in Neolithic societies.

In the recent years, increasing interest is being focussed both on environmental and cultural heritage degradation. Nevertheless, these two topics are treated seperately although there are many examples of interaction between social groups and nature. The case of the basin of Vera in the Southeast of the Iberian Peninsula shows how prehistoric and historic societies exploited their environment in different ways, either maintaining ecological equilibrium or causing environmental degradation. Therefore, palaeoecological research has to be centered on establishing the causes of palaeoclimatological and palaeo-environmental changes in order to formulate adequate exploitation strategies for the future. This is specially important for the S.E. of the Iberian Peninsula, the most arid zone of Europe.

Many hormones and nutrient molecules are internalized into their target cells by the common mechanism of receptor-mediated endocytosis. This process involves the clustering of receptors into invaginated regions of the plasma membrane coated on their intracellular surface by the protein clathrin which forms a basket-like casing. This pitted region internalizes to form an independent vesicle which eventually loses its clathrin coat. Movement through the vesicular pathway allows intracellular sorting. The uptake of insulin appears to follow this path. In a variety of tissues, insulin stimulates the internalization of its own receptor upon binding (Hedo and Simpson, 1984; Krupp and Lane, 1982; Knutson et al., 1983). At some point along the endocytotic path, the hormone dissociates from the receptor and is degraded (Krupp and Lane, 1982). The receptor recycles to the plasma membrane where it can bind another insulin molecule to reinitiate the cycle. Besides stimulating receptor internalization, insulin stimulates rapid receptor autophosphorylation (Kohanski et al., 1986; White et al., 1985) activating the tyrosine kinase. The receptor is internalized in this state’(Backer et al., 1989). However, prior to recycling, the receptor is dephosphorylated (Backer et al., 1989) which inactivates the catalytic activity (Klein et al., 1987). How this kinase activity and endocytotic cycle is involved in insulin signalling is not well defined.