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To assess the prevalence of abortion among population groups and changes in rates between 2008 and 2014.We used secondary data from the Abortion Patient Survey, the American Community Survey, and the National Survey of Family Growth to estimate abortion rates. We used information from the Abortion Patient Survey to estimate the lifetime incidence of abortion.Between 2008 and 2014, the abortion rate declined 25%, from 19.4 to 14.6 per 1000 women aged 15 to 44 years. The abortion rate for adolescents aged 15 to 19 years declined 46%, the largest of any group. Abortion rates declined for all racial and ethnic groups but were larger for non-White women than for non-Hispanic White women. Although the abortion rate decreased 26% for women with incomes less than 100% of the federal poverty level, this population had the highest abortion rate of all the groups examined: 36.6. If the 2014 age-specific abortion rates prevail, 24% of women aged 15 to 44 years in that year will have an abortion by age 45 years.The decline in abortion was not uniform across all population groups.

Often, catch and release regulations are meant to maximize a fisheries potential to create trophy fish. I evaluated adult Brown Trout populations at five locations within Rapid Creek within Rapid City, SD over a two-year period. In each year, one of these locations was within a catch and release area, while two were outside. In 2012, density and biomass estimates were higher in a site located outside of the catch and release area. Additionally, size structure within the catch and release area was only significantly larger than one of the two sites outside of the regulation area. Mean relative weight values were inversely related to density estimates, with the lowest density sites having the highest mean relative weights. Similarly, a site outside of the catch and release area had the highest abundance and biomass estimates in 2013. The cumulative length distribution was significantly different between the site within the catch and release area and the two located outside. Relative weight was significantly higher in the catch and release area than the two sites outside. As population characteristics within the catch and release area were not consistently better than outside, it is more likely that factors such as habitat and density dependence are impacting the Brown Trout population more than the regulation itself.

Root-knot nematode Meloidogyne incognita is among the biotic factors which has greatly affected both the yield and the quality of the tomato crop. The egg parasitic nematode, Purpureocillium lilacinum (Pl) is considered as one of the most promising agents in controlling and overcoming this plant pathogen. The nematicidal effect of the native isolate Pl AUMC 10149 on second stage juvenile’s survival and egg hatching of M. incognita at different times of exposure was tested in vitro. The obtained data showed that Pl gave a maximum percentage of J2 mortality (97.6%) and egg hatching inhibition (79.8%) after 72 hours of exposure. The potentiality of Pl as well as Bio-Nematon to control M. incognita infecting tomato was conducted using different times of application in vivo. Nine treatments with five replicates were used for such bioagents compared with the nematicide Oxamyl. Each seedling was inoculated with 1000 J2s of nematode/pot and 10 mL of Pl (1x1010 CFU/mL) or Bio-Nematon spore suspension (1x108 CFU/mL) 10mL/pot. The results indicated that the most effective treatments in reducing nematode population, number of galls and egg masses of M. incognita in plant roots was performed with treatment by Pl pre-planting and post-infection with Pl (Rf 1.9) giving a significant enhancement in plant length (64.9%), fresh weight (72.52%) and shoot dry weight (163.41%) without negatively impacting environment. Therefore, the present study confirmed that using P. lilacinum AUMC 10149 can be used as a practical supplement to environmentally friendly disease management of root-knot nematodes in Egypt. Resumo O nematoide-das-galhas Meloidogyne incognita está entre os fatores bióticos que afetaram enormemente a produção e a qualidade da cultura do tomate. O nematoide parasita de ovos, Purpureocillium lilacinum (Pl), é considerado um dos mais promissores agentes no controle e superação desse fitopatógeno. O efeito nematicida do isolado nativo Pl AUMC 10149 na sobrevivência de juvenis de segundo estágio e na eclosão dos ovos de M. incognita em diferentes momentos de exposição foi testado in vitro. Os dados obtidos mostraram que o Pl deu um percentual máximo de mortalidade de J2 (97.6%) e inibição da eclosão dos ovos (79.8%) após 72 horas de exposição. A potencialidade de Pl e de Bio-Nematon para controlar M. incognita infectando tomate foi conduzida em diferentes tempos de aplicação in vivo. Nove tratamentos com cinco repetições foram usados para tais bioagentes em comparação com o nematicida Oxamyl. Cada muda foi inoculada com 1.000 J2s de nematoide / vaso e 10 mL de Pl (1×1010 CFU/mL). Ou suspensão de esporos Bio-Nematon (1×108 CFU/mL) 10mL/pot. Os resultados indicaram que os tratamentos mais eficazes na redução da população de nematoides, número de galhas e desovas de M. incognita nas raízes das plantas foram realizados com Pl pré-plantio e pós-infecção com Pl (Rf 1.9), dando um aumento significativo no comprimento da planta (64.9%), massa fresca (72.52%) e massa seca da parte aérea (163.41%) sem impactar negativamente o meio ambiente. Portanto, o presente estudo confirmou que o uso de P. lilacinum AUMC 10149 pode ser usado como um suplemento prático para o manejo ecologicamente correto de nematoides-das-galhas no Egito.

Thrombocytopenia is, after anemia, the most frequent hematological problem among sick neonates. In this population, thrombocytopenia has traditionally been defined as a platelet count 9 /L, and has been classified as mild (100–150 × 10 9 /L), moderate (50–99 × 10 9 /L), and severe ( 9 /L). However, large population-based studies have shown that platelet counts increase with advancing gestational age, and platelet counts between 100 and 150 × 10 9 /L are more frequent among otherwise healthy extremely preterm infants than among full term neonates or older children. This suggests that different definitions of thrombocytopenia and thrombocytosis should be applied to preterm infants. The diagnostic approach to a thrombocytopenic neonate is facilitated if the thrombocytopenia is categorized as “early onset” (within the first 72 hours of life, usually secondary to congenital or intrauterine abnormalities) or “late onset” (after 72 hours, usually due to acquired conditions). Importantly, infection/sepsis should always be considered near the top of the differential diagnosis, as any delay in diagnosis and treatment can have life-threatening consequences. While in vitro studies have clearly shown that neonatal platelets are hyporesponsive to most agonists, this platelet hyporeactivity is well compensated by factors in neonatal blood that increase clotting (i.e. high hematocrit, high VWF concentrations), resulting in adequate primary hemostasis. The risk of bleeding in thrombocytopenic neonates is poorly predicted by the platelet count; gestational age

In the general population, the construct of race is associated with disparities in cognitive aging. There are notable racial group disparities and inequities among people living with schizophrenia (PLWSz). Despite the salience of the construct of race in schizophrenia, there remains a knowledge gap about racial disparities in cognitive impairment among older adults in this vulnerable population. Our study uses mediation analysis to examine racial disparities in cognitive impairment among older adults with schizophrenia.We assess global cognition in PLWSz over age 55 with the Measurement and Treatment Research to Improve Cognition in Schizophrenia cognitive test battery in our "all-comer" sample (There was a Black/non-Black group racial disparity in global cognitive score (-2.8, 95% CI: -4.4, -1.3) after adjusting for confounding and interaction. This disparity was significantly mediated by years of education.There are notable racial disparities in cognitive impairment among older adults with schizophrenia; however, differences in cognitive scores between racial groups are mediated by level of education.Social determinants of health, particularly educational attainment, are important risk factors for cognitive impairment in PLWSz and should be considered by clinicians. Early screening and assessment of cognitive symptoms is essential to addressing health disparities/inequalities among older adults living with schizophrenia.Controlled Direct EffectsHIV: Human Immunodeficiency VirusMATRICS: Measurement and Treatment Research to Improve Cognition in SchizophreniaMCCB: MATRICS Consensus Cognitive BatteryMTE: Marginal Total EffectsNDE: Natural Direct EffectsPANSS: Positive and Negative Symptom ScalePLWSz: People with schizophrenia.

Introduction: Chronic kidney disease of uncertain etiology (CKDu) has been found at high frequency in several lowland agricultural areas including Meso-America and Sri Lanka. Whether CKDu also occurs in other countries with large agricultural populations remains uncertain, primarily due to lack of systematic data on kidney function. Hemoglobin (Hgb) levels could be an ancillary marker for presence of kidney dysfunction. Our goal is to estimate the causal effect of agricultural work on Hgb level in men. A causal effect may indicate the presence of CKDu. Methods: We use Demographic and Health Surveys (DHS) data from seven African and Asian countries (Ethiopia, Lesotho, Namibia, Senegal, Uganda, Zimbabwe, and India). We use optimal full matching and permutation inference to estimate the causal effect of agricultural work on altitude-adjusted Hgb levels after adjusting for six known confounders. To assess potential bias due to unmeasured socioeconomic differences, we use multiple control groups that differ in non-agricultural occupation. We then conduct sensitivity analyses to assess the robustness of our causal conclusions to unmeasured confounding. Results: Data were available for 41,180 agricultural workers and 55,705 non-agricultural workers in seven countries. On average, Hgb levels were 0.09 g/dL (95% CI [-0.12, -0.07]) lower among agricultural workers compared to matched controls. Significant effects were observed in Ethiopia, India, Lesotho, Senegal, and Uganda, with effects from 0.10 to 0.32 g/dL lower hemoglobin among agricultural workers. The effect was not attenuated in sensitivity analyses involving both better-off and worse-off occupational controls. Discussion: We find evidence that men engaged in agricultural work in five of the seven countries studied have modestly lower Hgb levels compared with other men living in rural areas. Since underlying kidney disease could be a potential explanation for this finding, our data support consideration to integrating kidney function assessments within DHS surveys and other population-based surveys.

PURPOSE To determine the predictive value of International Classification of Diseases, 9th Revision (ICD-9) codes for identifying infantile eye diagnoses. METHODS Population-based retrospective cohort study of all residents of Olmsted County, Minnesota diagnosed at ≤1 year of age with an ocular disorder. The medical records of all infants diagnosed with any ocular disorder from January 1, 2005, through December 31, 2014, were identified. To assess ICD-9 code accuracy, the medical records of all diagnoses with ≥20 cases were individually reviewed and compared to their corresponding ICD-9 codes. Main outcome measures included positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity of ICD-9 codes. RESULTS In a cohort of 5,109 infants with ≥1 eye-related ICD-9 code, 10 ocular diagnoses met study criteria. The most frequent diagnoses were conjunctivitis (N = 1,695) and congenital nasolacrimal duct obstruction (N = 1,250), while the least common was physiologic anisocoria (N = 23). The PPVs ranged from 8.3% to 88.0%, NPVs from 96.3% to 100%, sensitivity from 3.0% to 98.7%, and specificity from 72.6% to 99.9%. ICD-9 codes were most accurate at identifying physiologic anisocoria (PPV: 88.0%) and least accurate at identifying preseptal cellulitis (PPV: 8.3%). In eye specialists versus non-eye specialists, there was a significant difference in PPV of ICD-9 codes for conjunctivitis (26.8% vs. 63.9%, p

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link. In large-scale multiobjective optimization, too many decision variables hinder the convergence search of evolutionary algorithms. Reducing the search range of the decision space will significantly alleviate this puzzle. With this in mind, this paper proposes a fuzzy decision variables framework for largescale multiobjective optimization. The framework divides the entire evolutionary process into two main stages: fuzzy evolution and precise evolution. In fuzzy evolution, we blur the decision variables of the original solution to reduce the search range of the evolutionary algorithm in the decision space so that the evolutionary population can quickly converge. The degree of fuzzification gradually decreases with the evolutionary process. Once the population approximately converges, the framework will turn to precise evolution. In precise evolution, the actual decision variables of the solution are directly optimized to increase the diversity of the population so as to be closer to the true Pareto optimal front. Finally, this paper embeds some representative algorithms into the proposed framework and verifies the framework’s effectiveness through comparative experiments on various large-scale multiobjective problems with 500 to 5000 decision variables. Experimental results show that in large-scale multiobjective optimization, the framework proposed in this paper can significantly improve the performance and computational efficiency of multiobjective optimization algorithms.

This article develops mathematical theory for the population dynamics of microbiomes with their hosts and for holobiont evolution caused by holobiont selection. The objective is to account for the formation of microbiome-host integration.Microbial population-dynamic parameters must mesh with the host’s for coexistence.A horizontally transmitted microbiome is a genetic system with “collective inheritance”. The microbial source pool in the environment corresponds to the gamete pool for nuclear genes. Poisson sampling of the microbial source pool corresponds to binomial sampling of the gamete pool. However, holobiont selection on the microbiome does not lead to a counterpart of the Hardy-Weinberg Law nor to directional selection that always fixes microbial genes conferring the highest holobiont fitness.A microbe might strike an optimal fitness balance between lowering its within-host fitness while increasing holobiont fitness. Such microbes are replaced by otherwise identical microbes that contribute nothing to holobiont fitness. This replacement can be reversed by hosts that initiate immune responses to non-helpful microbes. This discrimination leads to microbial species sorting. Host-orchestrated species sorting (HOSS) followed by microbial competition, rather than co-evolution or multi-level selection, is predicted to be the cause of microbiome-host integration.

PurposeStudies on the association between peripheral neuropathy (PN) and patient-reported outcomes have mostly overlooked sleep quality. Therefore, we aimed to assess the association between PN and sleep quality in a population-based sample of colorectal cancer (CRC) patients up two years after diagnosis. MethodsAll newly diagnosed CRC patients from four Dutch hospitals were eligible for participation. Patients (N=340) completed questionnaires about PN (EORTC QLQ-CIPN20) and sleep (PSQI) before initial treatment (baseline) and one and two years after diagnosis. ResultsPatients who developed sensory PN (n=76) or motor PN (n=79) after treatment more often reported poor sleeping scores (PSQI>5) compared with those who did not develop SPN or MPN at 1-year (SPN: 38% vs. 261%, MPN: 37% vs. 14%) and 2-year follow-up (SPN: 38 vs. 23%, MPN: 37% vs. 18%) (all pConclusionsBoth SPN and MPN were significantly associated with the course of sleep quality among CRC patients up to two years after diagnosis. Clinicians should be encouraged to discuss sleep quality with their patients who either report PN or are at risk of developing PN. Implications for survivors: Improving sleep quality among survivors with PN is important, either by reducing PN symptoms, or directly targeting sleep

A COVID-19 jarvany oriasi hatast gyakorolt az egesz vilagra, azon belul a magyar lakossagra is. A kialakult helyzet rengeteg uj korlatozassal, szigoritassal jart, es ennek kovetkezmenyeivel is meg kellett birkozni, amely az eletmodunkra is hatassal volt. Eppen ezert ugy gondoltuk, hogy erdemes lenne felmerni a lakossag koreben, hogy ki hogyan reagalt erre a kialakult helyzetre, milyen hatasok ertek, tortent-e valtozas az eleteben. Az elet kulonboző teruletein vizsgaltuk meg a megkerdezettek velemenyet, ugy, mint a maganelet, szemelyes kapcsolatok valtozasa, munkahelyi szokasok valtozasanak bemutatasa, valamint az egeszsegi es mentalis allapotra gyakorolt hatasok, de kivancsiak voltunk az ujonnan kialakult jo es rossz szokasokra egyarant. A megkerdezes modszere kerdőives felmeres volt, melyet online juttattunk el a megkerdezettekhez (n=362). A mintabol kapott eredmenyeket kiertekeltuk, leiro statisztikai elemzesnek vetettuk ala, majd az osszefuggesek bemutatasara kereszttablas (crosstabs) vizsgalatot vegeztunk el a hattervaltozok alapjan (nem, az eletkor, az iskolai vegzettseg, a foglalkozas, es a jovedelem). A minta eredmenyei nem reprezentativak, de jol abrazoljak, osszefoglaljak a kialakult helyzetet. Alternate abstract: The COVID-19 epidemic had an enormous impact on the entire world, including the Hungarian population. The situation was accompanied by numerous new restrictions, strict regulations, and their consequences had to be dealt with, which also affected the life of everyone. Therefore, it was considered that it would be worthwhile to assess the different reactions to this situation among the population, what effects the people had to face and whether there was a change in their lives. The opinions of respondents on different areas of life was surveyed, such as private life, changes in personal relationships, introduction of changes in workplace habits, and the effects on health and mental state. Also the survey intended to reveal newly developed good and bad habits. The survey method was a questionnaire-based survey, which was delivered to the respondents online (n=362). The results obtained from the sample were evaluated, subjected to descriptive statistical analysis, and then crosstabs were performed based on background variables (gender, age, educational attainment, occupation, and income) to present correlations. The results of the sample are not representative, but they properly represent and summarize the situation.

What a genius, building a home for more than 10 centuries in the Sahara desert with all the necessary amenities to withstand a hyper-arid climate like that of Timimoun and Tiout. During our work missions during the period: 2000-2019 in the south-west of the Sahara, we were interested in the feeding of Timimoun ksours by the foggaras. This study shows that feeding ksar water remains an unresolved problem for the ksouriens of the Sahara. Two success stories in this area of water have been cited in this paper. These are the ksours of Timimoun which are fed by the foggaras. The ksar of Tiout was supplied with water by an ancestral dam. These are the two cases of the Sahara that have benefited from water with zero energy. These two examples demonstrate the ingenuity of the ksours population. If after ten centuries, the oasis have managed to master the architecture of the ksours, against the supply of ksar in water has shortcomings.

Background: We aimed to develop census-linked longitudinal mortality data for Japan and assess their validity as a new resource for estimating socioeconomic inequalities in health. Methods: Using deterministic linkage, we identified, from national censuses for 2000 and 2010 and national death records, persons and deceased persons who had unique personal identifiers (generated using sex, birth year/month, address, and marital status). For the period 2010–2015, 1,537,337 Japanese men and women aged 30–79 years (1.9% in national census) were extracted to represent the sample population. This population was weighted to adjust for confounding factors. We estimated age-standardized mortality rates (ASMRs) by education level and occupational class. The slope index of inequality (SII) and relative index inequality (RII) by educational level were calculated as inequality measures. Results: The reweighted sample population’s mortality rates were somewhat higher than those of the complete registry, especially in younger age-groups and for external causes. All-cause ASMRs (per 100,000 person-years) for individuals aged 40–79 years with high, middle, and low education levels were 1,078 (95% confidence interval [CI], 1,051–1,105), 1,299 (95% CI, 1,279–1,320), and 1,670 (95% CI, 1,634–1,707) for men, and 561 (95% CI, 536–587), 601 (95% CI, 589–613), and 777 (95% CI, 745–808) for women, respectively, during 2010–2015. SII and RII by educational level increased among both sexes between 2000–2005 and 2010–2015, which indicates that mortality inequalities increased. Conclusion: The developed census-linked longitudinal mortality data provide new estimates of socioeconomic inequalities in Japan that can be triangulated with estimates obtained with other methods.

Millimeter wave (mmWave) spectrum promises unprecedented data rates in 5G New Radio (NR). However, mmWave links are susceptible to severe path and propagation losses. Implementation of directional antennas that can manifest multiple beams becomes necessary at 5G base stations (gNBs) and User Equipments (UEs). Random access procedure (RAP), which is the first stage to establish connections to gNB, in its current state would be inadequate for such systems. To support RAP, 5G NR introduced mapping of different subsets of preambles in Physical Random Access Channel (PRACH) to different beams. We explore changes in RAP due to preamble-beam mapping and present a novel online algorithm to dynamically distribute preambles amongst beams to achieve fair access opportunities. The proposed algorithm can also eliminate overload problem of the beams with large UE population especially for high arrival rates. We extend the proposed algorithm to be applicable for RAP with access class barring mechanism which enables UEs to transmit a preamble with an optimal probability and, therefore, reduce access congestion. Through extensive simulations, we validate the efficiency of our proposed algorithms in providing fair channel access opportunities, improving throughput (or stability region), and reducing access delay when the system has high rate of UE arrivals and has unbalanced UE arrivals over different beams.

The United States population is aging and increasing in comorbidity, and patient care is accordingly growing increasingly complex. Complexity impacts patterns of resource consumption, adverse event and medical error rates, health-related quality of life, physician burnout, and more. Tools capturing complexity can be of benefit in the modern value-based reimbursement landscape and have been well-studied in specialties other than dermatology. In this paper, we describe the validation of a tool specific to outpatient dermatologic care that captures the complexity of clinical visit medical decision-making. We performed a cross-sectional retrospective study to determine the inter-rater reliability and face validity of the tool. By objectively grading a clinical encounter based on clinical complexity, there is increased awareness of opportunities to improve clinical care and the allocation of healthcare costs and resources within the dermatologic community can be better assessed.

BACKGROUND Lacrosse is one of the fastest-growing sports in the United States. Its rules regarding permitted contact differ by sex and age. There are no known studies using a nationally representative data set to analyze lacrosse injury patterns over several years by sex and age in the youth population. METHODS A retrospective analysis was performed using data from the National Electronic Injury Surveillance System for youth aged 11-18 years who were treated for lacrosse-related injuries in U.S. emergency departments from 2000 to 2016. Based on our review of the case narratives, we created and coded a new injury-mechanism variable. We generated national estimates from 6406 cases. RESULTS An estimated 206,274 lacrosse-related injuries to youths aged 11-18 years were treated in U.S. emergency departments from 2000 to 2016. The rate of injuries per 10,000 significantly increased from 1.9 in 2000 to a peak of 5.3 in 2012 (p < 0.0001), followed by a significant decrease to 3.4 in 2016 (p = 0.020). Injury mechanism, body part injured, and diagnosis differed by sex. Boys were 1.62 times (95%CI: 1.25-2.09) more likely than girls to be injured by player-to-player contact. Girls were 2.21 times (95%CI: 1.96-2.49) more likely than boys to have non-contact injuries. Overall, as age increased, the percentage of injuries from lacrosse sticks decreased and player-to-player contact increased. CONCLUSION Despite additional protective regulations in the sport, lacrosse is an important source of injury where we continue to see differences by sex and age. This study supports the continuation, modification, and addition of rules aimed at reducing lacrosse injury risk.

Absract Background Obstetrics as a speciality has a very long association with the transfusion services and poses its own set of immunohematological (IHL) challenges. A study was carried out to evaluate the spectrum of IHL issues in obstetrics in our setup and to suggest a way forward. Methods This study was carried out in a transfusion services setup catering to antenatal care (ANC) clientele in two tertiary-level health care setups. Samples were collected from all ANC patients requiring transfusion and patients reporting for Indirect Coombs Test (ICT). Data included ICT positive cases with implicated alloantibodies, those requiring specialised procedures and the foetal outcome. The results were described using descriptive statistics by frequencies and percentages. Results A total of 4683 eligible samples were included in the study, out of 21,893 antenatal patients visiting our setup during study period. One hundred thirty-six ANC patient samples were found to be ICT positive. The most common single alloantibody was anti-D (n = 77, 57.5%). Double antibody positivity was found in 28 patients. Multiple alloantibodies were found in 1 patient. Up to 48% of these allo-anti D cases necessitated specialised procedures. Conclusion The IHL issues of obstetrics faced in our setup are no less than that in Indian population. We have much higher frequency of double alloantibody in our ANC population. The authors propose that all multiparous ANC patients, especially with a history of transfusion, irrespective of Rh D status should be screened for irregular alloantibodies to circumvent these issues and the last-minute rush for provision of compatible units.

Summary This study aims to detect voice disorders related to vocal fold nodule, Reinke’s edema and neurological pathologies through multiband cepstral features of the sustained vowel /a/. Detection is performed between pairs of study groups and multiband analysis is accomplished using the wavelet transform. For each pair of groups, a parameters selection is carried out. Time series of the selected parameters are used as input for four classifiers with leave-one-out cross validation. Classification accuracies of 100% are achieved for all pairs including the control group, surpassing the state-of-art methods based on cepstral features, while accuracies higher than 88.50% are obtained for the pathological pairs. The results indicated that the method may be adequate to assist in the diagnosis of the voice disorders addressed. The results must be updated in the future with a larger population to ensure generalization.

Prevalence of testosterone deficiency is increasing in the adolescent and young adult male population. As the average paternal age rises, there is a significant population of men with hypogonadism seeking testosterone therapy wishing to achieve or maintain fertility potential. Identification of potential lifestyle modifications that may improve the testosterone deficiency is one of the initial interventions of the holistic strategy in treatment. This is followed by drug therapy; however, traditional testosterone therapy acts as a contraceptive by suppressing the hypothalamus-pituitary-gonadal (HPG) axis and therefore cannot be used as a treatment strategy. A solution has been the off-label use of selective estrogen receptor modulators, human chorionic gonadotropin (hCG), and anastrozole inhibitors to treat hypogonadal symptoms while increasing intratesticular testosterone, a necessity for spermatogenesis. Recently, a novel therapy, Natesto intranasal testosterone gel, has been shown to increase serum testosterone levels while maintaining semen parameters. This is hypothesized to be because of its short-acting properties having lesser effect on the HPG axis, in contrast to the long-acting properties of traditional testosterone therapy. It is important to differentiate hypogonadal men between those seeking to achieve or maintain fertility status because the drug therapy of choice differs. This can be accomplished by determining the levels of 17-hydroxyprogesterone (17-OHP), because it is a biomarker for intratesticular testosterone. Those with low 17-OHP may wish to initiate treatment with alternative therapies, whereas those with high 17-OHP may trial short-acting testosterone therapies. As the urologist's armamentarium continues to increase, better strategies to increase testosterone levels in men seeking fertility can be achieved.

Background: In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD), the treatment strategy for non-infarct-related artery (non-IRA) remains controversial. Quantitative flow ratio (QFR) is a new angiography-based physiological assessment index. However, there is little evidence on the practical clinical application of QFR. Methods: Two hundred and twenty-nine patients with STEMI and MVD were recruited for this study. Patients were randomly assigned to either receive QFR-guided complete revascularization (QFR-G-CR) of non-IRA or receive no further invasive treatment. The primary (1o) endpoint analyzed included death due to all causes, non-fatal myocardial infarction (MI), and ischemia-induced revascularization at 12 months post-surgery. Secondary (2o) endpoints included cardiovascular death, unstable angina, stent thrombosis, New York Heart Association (NYHA) class IV heart failure (HF), and stroke at 1 year post surgery. Massive bleeding and contrast-associated acute kidney injury (CAKI) were used as safety endpoints. Results: Around the 12 month follow up, the 1o outcome was recorded in 11/115 patients (9.6%) in the QFR-G-CR population, relative to 23/114 patients (20.1%) in the IRA-only PCI population (hazard ratio [HR]: 0.45; 95% confidence interval [CI]: 0.22–0.92; p = 0.025). Unstable angina in 6 (5.2%) and 16 (14.0%) patients (HR: 0.36; 95% CI: 0.14–0.92; p = 0.026), respectively. No marked alterations were found in the massive bleeding and CAKI categories. Conclusions: In conclusion, STEMI and MVD patients can benefit from QFR-G-CR of non-IRA lesions in the initial stages of acute MI. This can help reduce incidences of major adverse cardiovascular events and unstable angina, relative to IRA treatment only. Chinese Clinical Trial Registration number: ChiCTR2100044120.

In the post World War II period, most U.S. cities experienced large movements of population from the city centers to the suburbs. In this paper we provide causal evidence that this process of suburbanization can be explained by the rise of violent crime in city centers. We do so by proposing a new instrument to exogenously predict violent crime. This instrument uses as time variation the U.S. national levels of lead poisoning. Cross-sectional variation comes from a proxy for soil quality, which explains the fate of lead in soil and its subsequent bio-availability. Using data for more than 300 U.S. cities, results show that the increase in violent crime from the level in 1960 to its maximum in 1991 decreased the proportion of people living in city centers by 15 percentage points. This increase in crime moved almost 25 million people to the suburbs. As a result of suburbanization, we find that people remaining in the city center are more likely to be black people, consistent with the "white flight" phenomenon. We then demonstrate that this suburbanization process had aggregate effects on the city. Exploiting a spatial equilibrium model, we determine that violent crime had externalities on productivity and amenities.

Learning-to-learn, a progressive speedup of learning while solving a series of similar problems, represents a core process of knowledge acquisition that draws attention in both neuroscience and artificial intelligence. To investigate its underlying brain mechanism, we trained a recurrent neural network model on arbitrary sensorimotor mappings known to depend on the prefrontal cortex. The network displayed an exponential time course of accelerated learning. The neural substrate of a schema emerges within a low-dimensional subspace of population activity; its reuse in new problems facilitates learning by limiting connection weight changes. Our work highlights the weight-driven modifications of the vector field, which determines the population trajectory of a recurrent network and behavior. Such plasticity is especially important for preserving and reusing the learnt schema in spite of undesirable changes of the vector field due to the transition to learning a new problem; the accumulated changes across problems account for the learning-to-learn dynamics.

BACKGROUND White rice is a staple food for Japanese, a population at high risk for colorectal cancer (CRC). We investigated the association between white rice intake and CRC among Japanese Americans in the Multiethnic Cohort (MEC) study. METHODS The Multiethnic Cohort Study is a prospective study established in Hawaii and California in 1993-1996. Usual dietary intake was assessed by a validated quantitative food frequency questionnaire at baseline. Cox proportional hazards models were used to compute hazard ratios (HR) and 95% confidence intervals (CI) for quartiles of intake and to perform trend tests across sex-specific quartiles with adjustment for relevant confounders. RESULTS We identified 1,553 invasive CRC cases among 49,136 Japanese Americans (23,595 men and 25,541 women) during a mean follow-up of 19 years. White rice consumption was not associated with overall CRC incidence in men (p-trend = 0.11) or women (p-trend = 0.56). After excluding participants with a history of diabetes, the inverse associations were significant for CRC (p-trend = 0.03, HR for quartile 4 (Q4) vs. 1 = 0.81; 95% CI: 0.64-1.03) and tumors of the distal colon (p-trend = 0.006, HR for Q4 vs. Q1: 0.66; 0.44-0.99) among men but not women. CONCLUSIONS White rice consumption was not associated with an increased risk of overall CRC among Japanese Americans. An inverse association was observed with risk of CRC and distal colon cancer in men without a history of diabetes.

BACKGROUND Environmental and genetic factors are suggested to exhibit factor-based association with HDL-cholesterol (HDL-C) levels. However, the population-based effects of environmental and genetic factors have not been compared clearly. We conducted a cross-sectional study using data from the Japan Multi-Institutional Collaborative Cohort (J-MICC) Study to evaluate the population-based impact of smoking, drinking, and genetic factors on low HDL-C. METHODS Data from 11,498 men and women aged 35-69 years were collected for a genome-wide association study (GWAS). Sixty-five HDL-C-related SNPs with genome-wide significance (P < 5 × 10-8) were selected from the GWAS catalog, and seven representative SNPs were defined, and the population-based impact was estimated using population attributable fraction (PAF). RESULTS We found that smoking, drinking, daily activity, habitual exercise, egg intake, BMI, age, sex and the SNPs CETP rs3764261, APOA5 rs662799, LIPC rs1800588, LPL rs328, ABCA1 rs2575876, LIPG rs3786247, and APOE rs429358 were associated with HDL-C levels. The gene-environmental interactions on smoking and drinking were not statistically significant. The PAF for low HDL-C was the highest in men (63.2%) and in rs3764261 (31.5%) of the genetic factors, and the PAFs of smoking and drinking were 23.1% and 41.8%, respectively. CONCLUSIONS The present study showed that the population-based impact of genomic factor CETP rs3764261 for low HDL-C was higher than that of smoking and lower than that of drinking.

Introduction The safety of electroconvulsive therapy has improved greatly over the last decades, making the potentially adverse effects on memory and other neurocognitive functions the main clinical aspect of concern in the present. In Colombia, the general population and healthcare professionals (even some psychiatrists) seem to have mostly negative opinions towards electroconvulsive therapy treatment, but maybe this could be reconsidered if more information is provided; therefore, the aim of the present study was to evaluate the changes in memory and the severity of the symptoms in a group of patients with severe depression before and after electroconvulsive therapy. Methods Twenty-three patients ranging in age from 23 to 70 years from the electroconvulsive therapy service at the San Juan de Dios Clinic (Manizales, Colombia) were recruited in order to assess the effect of electroconvulsive therapy on memory in patients with severe depression. Depressive symptoms and memory were assessed with the Hamilton Depression Scale (HAMD) and Rey Auditory Verbal Learning Test (RAVLT), respectively. The assessment was administered to participants before the initial treatment of electroconvulsive therapy series (0-1 day) and 2 days after their last treatment. Results Electroconvulsive therapy resulted in significant improvement in the rating of depression. There were no significant differences in the five learning trials, delayed recall, learning and forgetting scores from pre-treatment to post-treatment. Significant pre-treatment/post-treatment differences were found in the delayed recognition trial. Conclusions Pre- and post- electroconvulsive therapy cognitive assessment is a feasible and useful procedure. In general, memory performance does not worsen after electroconvulsive therapy in patients with depression. Only delayed recognition is affected a few days following electroconvulsive therapy, particularly in patients with low educational level and bitemporal (BT) electrode placement.

Surrogate-assisted evolutionary algorithms (SAEAs) have been widely used for solving complex and computationally expensive optimization problems. However, most of the existing algorithms converge slowly in the later stage. This article proposes a novel two-stage data-driven evolutionary optimization (TS-DDEO) that meets the requirements of early exploration and later exploitation. In the first stage, a surrogate-assisted hierarchical particle swarm optimization method is used to find a promising area from the entire search space. In the second stage, we propose a best-data-driven optimization (BDDO) method with a strong exploitation ability to accelerate the optimization process. BDDO has a real-time update mechanism for the surrogate model and population and uses a predefined number of ranking-top solutions to update population and surrogates. BDDO combines three surrogate-assisted evolutionary sampling strategies: 1) surrogate-assisted differential evolution sampling; 2) surrogate-assisted local search; and 3) a surrogate-assisted full-crossover (FC) strategy which is proposed to integrate existing best genotypes in the population. Experiments and analysis have validated the effectiveness of the two-stage framework, the BDDO method, and the FC strategy. Moreover, the proposed algorithm is compared with five state-of-the-art SAEAs on high-dimensional benchmark functions. The result shows that TS-DDEO performs better both in effectiveness and robustness.

When surveys rely on repeat participants, this raises the possibility that survey participation may affect future responses, perhaps by prompting information acquisition between survey waves. We show that these “learning-through-survey” effects are large for household inflation expectations. Repeat survey participants generally have lower inflation expectations and uncertainty, particularly if their initial uncertainty was high. Consequently, repeat participants may be more informed about or attentive to inflation. This has important implications: for example, inflation expectations of new participants are more influenced by oil prices, and estimates of the elasticity of intertemporal substitution are lower for new participants. (JEL C83, D84, E31, E37, E58)

Background Since July 2019, Pakistan and Afghanistan have been facing an outbreak of serotype-2 circulating vaccine derived poliovirus (cVDPV2) in addition to continued transmission of serotype-1 wild poliovirus (WPV1) and SARS-CoV-2 in 2020. Understanding the risks of cVDPV2 transmission due to pause of global vaccination efforts and the impact of potential vaccination response strategies in the current context of COVID-19 mitigation measures is critical. Methods We developed a stochastic, geographically structured mathematical model of cVDPV2 transmission which captures both mucosal and humoral immunity separately and allows for reversion of serotype-2 oral polio vaccine (OPV2) virus to cVDPV2 following vaccine administration. The model includes geographic heterogeneities in vaccination coverage, population immunity and population movement. The model was fitted to historic cVDPV2 cases in Pakistan and Afghanistan between January 2010-April 2016 and July 2019-March 2020 using iterated particle filtering. The model was used to simulate spread of cVDPV2 infection from July 2019 to explore impact of various proposed vaccination responses on stopping transmission and risk of spread of reverted Sabin-2 under varying assumptions of impacts from COVID-19 lockdown measures on movement patterns as well as declines in vaccination coverage. Results Simulated monthly incidence of cVDPV2 from the best-fit model demonstrated general spatio-temporal alignment with observed cVDPV2 cases. The model predicted substantial spread of cVDPV2 infection, with widespread transmission through 2020 in the absence of any vaccination activities. Vaccination responses were predicted to substantially reduce transmission and case burden, with a greater impact from earlier responses and those with larger geographic scope. While the greatest risk of seeding reverted Sabin-2 was predicted in areas targeted with OPV2, subsequent spread was greatest in areas with no or delayed response. The proposed vaccination strategy demonstrated ability to stop the cVDPV2 outbreak (with low risk of reverted Sabin-2 spread) by February 2021. Conclusion Outbreak response vaccination campaigns against cVDPV2 will be challenging throughout the COVID-19 pandemic but must be implemented urgently when feasible to stop transmission of cVDPV2.

We test whether the length of an indefinite horizon, or that the horizon is indefinite as opposed to finite, affects cooperation in repeated 3x3 Red Queen Games. With our participant population, and our experimental program and procedures, the length of the indefinite horizon significantly affects cooperation in the Prisoner's Dilemma. However, it does not significantly affect cooperation in the Red Queen Game. Nor does the indefiniteness of the horizon significantly affect cooperation in this latter game. Our results highlight the importance of learning in indefinite games with even slightly larger strategy spaces than the Prisoner's Dilemma.

Objective Homeless and marginally housed populations experience a higher prevalence of visual impairment relative to the general population. The aim of this pilot study is to present a novel model for conducting ocular screening clinics for homeless individuals during a pandemic and to describe the status of ocular health in this population during this time. Methods In this cross-sectional study, 3 outdoor tent-based ocular screening clinics were held in a park in Toronto. Most participants were recruited from local shelters, but additional spots were allocated for homeless individuals on a drop-in basis. Prior to enrolment, each participant underwent COVID-19 screening via a questionnaire and temperature measurement. Those who screened negative received a comprehensive eye examination, including vision testing, dilated fundus examination, and autorefraction. Results Eleven individuals completed all assessments. The mean age of participants was 54.5 years, and 11 of the participants were male. Visual impairment was found in 5 individuals. Refractive error via pinhole testing was found in 1 patient. Ocular pathology in this sample was found in 4 participants. Two patients required a referral to an ophthalmologist. From a psychosocial perspective, 4 participants reported significant difficulties. Conclusions This novel tent-based ocular screening program provides a viable option for screening in a pandemic.

An expensive multimodal optimization problem (EMMOP) is that the computation of the objective function is time consuming and it has multiple global optima. This article proposes a decomposition differential evolution (DE) based on the radial basis function (RBF) for EMMOPs, called D/REM. It mainly consists of two phases: the promising subregions detection (PSD) and the local search phase (LSP). In PSD, a population update strategy is designed and the mean-shift clustering is employed to predict the promising subregions of EMMOP. In LSP, a local RBF surrogate model is constructed for each promising subregion and each local RBF surrogate model tracks a global optimum of EMMOP. In this way, an EMMOP is decomposed into many expensive global optimization subproblems. To handle these subproblems, a popular DE variant, JADE, acts as the search engine to deal with these subproblems. A large number of numerical experiments unambiguously validate that D/REM can solve EMMOPs effectively and efficiently.

Introduction Every 40seconds, one person in the world commits suicide. As such, suicide is considered a public health problem, and prior suicide attempt is one of the risk factors associated with completed suicide. Despite the strategies implemented and the studies carried out, in Colombia suicide figures are on the rise, more markedly in the economically active population. Objective To identify the sociodemographic, family, personal, economic and religious factors associated with suicide attempt in patients of productive age (18-62 years old) in a mental health institution in Bogota, Colombia. Methods An analytical prevalence study was conducted at the Nuestra Senora de la Paz mental health clinic in Bogota. To explore the relationship between the factors described and suicide attempt, a review of 350 medical records of the selected population was carried out. Results In total, 37.7% of the sample presented a suicide attempt. Associations were found between the suicide attempt and higher education than primary school (PR=0.47 [0.23-0.97]), no economic income (PR=1.72 [1.13-2.61]), no partner (PR=2.10 [1.33-3.32]), alcohol consumption (p=0.045), hallucinogen use (PR=2.39 [0.97-3.43]) and the presence of personality disorder (PR=1.93 [1.11-3.34]). Conclusions The results of the study are similar to those previously described in other studies around the world. There is a need to recognise and address various factors associated with suicide attempt in depressed patients in order to implement promotion and prevention actions, early identification and specific interventions that have an impact on the numbers of completed suicide in the country.

Objectives To assess people's level of recognition of rheumatic disease symptoms and their awareness that the rheumatologist is the main effector when it comes to these disorders. Materials and methods Survey performed in 8 towns in the Buenos Aires Province. Every town had at least one rheumatologist. Three clinical cases were presented: (1) inflammatory low back pain, (2) systemic disease, and (3) chronic polyarthritis. The population was asked whether (a) a physician should be immediately consulted, or (b) they could wait. They were asked whether they would advocate any initial treatment. They were also asked which physician should be consulted. Results Out of 150 surveys, 68% were female, the average age was 51.7 years old. Most people asserted that treatment with anti-inflammatory drugs should come first: 83% in inflammatory low back pain, 70% in systemic disease, and 70% in chronic polyarthritis (p = 0.02). The number of men that suggested waiting was higher (47% vs. 28% of women; p = 0.04). A rheumatologist was recommended by 51% for chronic polyarthritis, 15% for systemic disease, and 8% for inflammatory low back pain (p Conclusions Chronic polyarthritis was the disease people identified best as within the rheumatologist's field of expertise. Men tended to delay consultation more than women. Consultation is less likely when the level of education is lower.

Introduction Streptococcus bovis/equinus complex (SBEC) is a major cause of infective endocarditis (IE), although its incidence varies greatly depending on the geographical area. The characteristics of IE caused by Streptococcus gallolyticus susp. gallolyticus are well known; there are hardly any descriptions of IE caused by other species or biotypes. Methods Retrospective cohort study, from 1990 to 2019, of all SBEC IE in adults in three Spanish hospitals, Lugo (LH), Barcelona (BH) and Ferrol (FH) where the population is mainly rural, urban and mixed, respectively. The incidence of IE was analyzed in 3 areas. Clinical characteristics of IE (277 cases, 258 biotyped) were compared according to SBEC species and biotypes. Results There are significant differences between the incidence of SBEC IE in HL (27.9/106) vs. HF and HB (8.8 and 7,1, respectively, p Conclusions IE due to SBEC has geographical variations in incidence and different clinical characteristics among biotypes. The association with CRC was high.

In this article the elements of institutional environment development and strategies for solving the problem of stable functioning of social and economic sphere of life of society are considered, discussed and analyzed. The relevance of the study is an attempt to highlight the main indicators of modernization of the institutional environment of Ukraine. These indicators are: global index of the effectiveness of public administration, the index of incapacity of states, the index of global competitiveness, the index of economic freedom, the index of easiness of doing business, the index of acceptance of corruption. All these indicators are included in the process of formation of the institutional environment of Ukraine. The research is based on the methods of the empirical research:, observation, comparison, and, in addition, on the methods of content analysis. Results. The institutional environment provides the basis for the activity for the subjects of the socioeconomic system and also defines the vector of its development. The Global Competitiveness Index not only assesses the degree of competitiveness of a country, but also helps to see the real situation in the country. It shows its competitive advantages and problems that slow down economic development. The Index of Economic Freedom identifies the main problems of an optimal level of economic freedom. It shows that the higher the index of economic freedom leads to the higher level of welfare of the population. The Easiness of Doing Business Index assesses the «rules of the game». In other words, laws, regulations, and other government acts that have impact on reducing unprofitable and bankrupt businesses. This index, in addition, assesses the condition for facilitating for doing business in Ukraine. The Failed States Index helps to analyze Ukraine's ability to control the integrity of its territory, political, demographic, economic and social situation in the country The Corruption Perceptions Index is usually used in political and econometric studies to explain the effectiveness of government administration, economic development and the level of democracy in Ukraine. Moreover, it is used to reduce the corruption in government-business relations. The institutional environment in Ukraine continuously forming. This is why the analysis of some elements of the development of the institutional environment in Ukraine is necessary to identify the optimal strategy for solving the problem of stable functioning of social and economic sphere of life of society

PURPOSE Overexpression of the HER2 protein occurs in 25% to 30% of human breast cancers and leads to a particularly aggressive form of the disease. Efficacy and safety of recombinant humanized anti-HER2 monoclonal antibody as a single agent was evaluated in women with HER2-overexpressing metastatic breast cancer that had progressed after chemotherapy for metastatic disease. PATIENTS AND METHODS Two hundred twenty-two women, with HER2-overexpressing metastatic breast cancer that had progressed after one or two chemotherapy regimens, were enrolled. Patients received a loading dose of 4 mg/kg intravenously, followed by a 2-mg/kg maintenance dose at weekly intervals. RESULTS Study patients had advanced metastatic disease and had received extensive prior therapy. A blinded, independent response evaluation committee identified eight complete and 26 partial responses, for an objective response rate of 15% in the intent-to-treat population (95% confidence interval, 11% to 21%). The median duration of response was 9.1 months; the median duration of survival was 13 months. The most common adverse events, which occurred in approximately 40% of patients, were infusion-associated fever and/or chills that usually occurred only during the first infusion, and were of mild to moderate severity. These symptoms were treated successfully with acetaminophen and/or diphenhydramine. The most clinically significant adverse event was cardiac dysfunction, which occurred in 4.7% of patients. Only 1% of patients discontinued the study because of treatment-related adverse events. CONCLUSION Recombinant humanized anti-HER2 monoclonal antibody, administered as a single agent, produces durable objective responses and is well tolerated by women with HER2-overexpressing metastatic breast cancer that has progressed after chemotherapy for metastatic disease. Side effects that are commonly observed with chemotherapy, such as alopecia, mucositis, and neutropenia, are rarely seen.

The job-shop scheduling problem (JSSP) is a challenging scheduling and optimization problem in the industry and engineering, which relates to the work efficiency and operational costs of factories. The completion time of all jobs is the most commonly considered optimization objective in the existing work. However, factories focus on both time and cost objectives, including completion time, total tardiness, advance time, production cost, and machine loss. Therefore, this article first time proposes a many-objective JSSP that considers all these five objectives to make the model more practical to reflect the various demands of factories. To optimize these five objectives simultaneously, a novel multiple populations for multiple objectives (MPMO) framework-based genetic algorithm (GA) approach, called MPMOGA, is proposed. First, MPMOGA employs five populations to optimize the five objectives, respectively. Second, to avoid each population only focusing on its corresponding single objective, an archive sharing technique (AST) is proposed to store the elite solutions collected from the five populations so that the populations can obtain optimization information about the other objectives from the archive. This way, MPMOGA can approximate different parts of the entire Pareto front (PF). Third, an archive update strategy (AUS) is proposed to further improve the quality of the solutions in the archive. The test instances in the widely used test sets are adopted to evaluate the performance of MPMOGA. The experimental results show that MPMOGA outperforms the compared state-of-the-art algorithms on most of the test instances.

International audience; Objectives: COVID-19 pandemic and its consequences have put into great difficulty health professionals, and the general population, fostering the emergence of various psychological and psychiatric disorders. Medical and psychological emergency units' mission is the medical and psychological emergency care of people impacted during a traumatic event. Given their expertise in crisis management, they set up an important medical and psychological support system adapted to the health crisis' characteristics. The unusual modalities of intervention, the specific clinic that these professionals faced in this context of great tension may have unsettled workers and generate a psychological impact. This study aims to assess the existence of such repercussions among medical and psychological emergency unit professionals involved in this new system.Method: In all, 313 medical and psychological emergency unit professionals agreed to participate at the online survey. They filled surveys and visual analog scales assessing the difficulties encountered in the system, as well as their level of satisfaction, post-traumatic stress, burnout, level of anxiety and depression and coping strategies put in place.Results: Results show few significant emotional difficulties. However higher scores are found among women, among professionals who felt a negative impact on their personal lives, as well as for those who thought they had been infected with COVID-19. The establishment of coping strategies such as active coping, planning, expressing feelings, positive reinterpretation and acceptance helped to decrease the level of emotional complexities and brought more compassionate satisfaction. We note that participants with more medical and psychological emergency unit experience tend to show less emotional hardship and more compassionate satisfaction. It appears that older as well as younger professionals have lower burnout scores, as do workers who conducted more interviews for the same person. Likewise, participants who were satisfied of the system organization and of the support - a majority in this study - report less emotional challenges and more compassionate satisfaction.Conclusion: Psychological impact in this new system among medical and psychological emergency unit professionals is overall low. It appears that some coping strategies, perceived usefulness, satisfaction with the organization and the received support are associated with a lower level of emotional difficulties. A supportive framework and an operative organization of the medical and psychological emergency unit system in times of crisis has a protective effect on the participants.

Background Children and adolescents with fragile X syndrome (FXS) manifest significant symptoms of anxiety, particularly in response to face-to-face social interaction. In this study we used functional near-infrared spectroscopy (fNIRS) to reveal a specific pattern of brain activation and habituation in response to face stimuli in young girls with FXS, an important but understudied clinical population. Methods Participants were 32 girls with FXS (age: 11.8 ± 2.9 years) and a control group of 28 girls without FXS (age: 10.5 ± 2.3 years) matched for age, general cognitive function and autism symptoms. Functional NIRS was used to assess brain activation during a face habituation task including repeated upright/inverted faces and greeble (nonface) objects. Results Compared to the control group, girls with FXS showed significant hyper-activation in the frontopolar and dorsal lateral prefrontal cortices in response to all face stimuli (upright + inverted). Lack of neural habituation (and significant sensitization) was also observed in the FXS group in the frontopolar cortex in response to upright face stimuli. Finally, aberrant frontopolar sensitization in response to upright faces in girls with FXS was significantly correlated with notable cognitive-behavioral and social-emotional outcomes relevant to this condition including executive function, autism symptoms, depression and anxiety. Conclusions These findings strongly support a hypothesis of neural hyper-activation and accentuated sensitization during face processing in FXS, a phenomenon that could be developed as a biomarker endpoint for improving treatment trial evaluation in girls with this condition.

What causes host-use specificity in herbivorous insects? Population genetic models predict specialization when habitat preference can evolve and there is antagonistic pleiotropy at a performance-affecting locus. But empirically for herbivorous insects, host-use performance is governed by many genetic loci, and antagonistic pleiotropy seems to be rare. Here, we use individual-based quantitative genetic simulation models to investigate the role of pleiotropy in the evolution of sympatric host-use specialization when performance and preference are quantitative traits. We look first at pleiotropies affecting only host-use performance. We find that when the host environment changes slowly the evolution of host-use specialization requires levels of antagonistic pleiotropy much higher than what has been observed in nature. On the other hand, with rapid environmental change or pronounced asymmetries in productivity across host species, the evolution of host-use specialization readily occurs without pleiotropy. When pleiotropies affect preference as well as performance, even with slow environmental change and host species of equal productivity, we observe fluctuations in host-use breadth, with mean specificity increasing with the pervasiveness of antagonistic pleiotropy. So, our simulations show that pleiotropy is not necessary for specialization, although it can be sufficient, provided it is extensive or multifarious.

In aquaculture, selective breeding for survival till harvest have become an alternative strategy for improving disease resistance and production. However, knowledge of genetic parameters of harvest survival, e.g., heritability and genetic correlations between survival and growth rate traits, is still scarce. The aims of this study were to estimate genetic parameters for harvest survival and growth rate traits under commercial farming conditions in olive flounder (Paralichthys olivaceus). Harvest survival was defined as a binary trait; growth traits were measured as average daily gain (ADG), specific growth rate (SGR), daily growth coefficient (DGC) and body weight (BW). Data from a population of 241 full-sib families (involving 39,904 individuals, four generations) were used. Heritabilities of survival were low but significant, which were 0.15 ± 0.04 and 0.22 ± 0.01 on observed and underlying scale, respectively. Heritability estimates for ADG, SGR and DGC were medium to high, which were 0.33 ± 0.06, 0.83 ± 0.07, 0.58 ± 0.07, respectively. While the heritability of BW is of low magnitude (0.17 ± 0.08). The genetic correlations between harvest survival and three growth rate traits (i.e., ADG, SGR and DGC) were very strong (ranging from 0.66 to 0.79), which is an exciting result. However, the genetic correlation between harvest survival and BW was much lower (0.17 ± 0.08). These results suggest that selection for harvest survival would consequentially result in concomitant increase of growth rate, and vice versa. Our findings revealed novel insights into the genetic improvement of growth rate and harvest survival through genetic selection in olive flounder.

The COVID-19 pandemic has affected the care of patients with other diseases. Difficulty in access to healthcare during these months has been especially relevant for persons with HIV infection (PWH). This study therefore sought to ascertain the clinical outcomes and effectiveness of the measures implemented among PWH in a region with one of the highest incidence rates in Europe.Retrospective, observational, pre-post intervention study to compare the outcomes of PWH attended at a high-complexity healthcare hospital from March to October 2020 and during the same months across the period 2016-2019. The intervention consisted of home drug deliveries and preferential use of non face-to-face consultations. The effectiveness of the measures implemented was determined by reference to the number of emergency visits, hospitalisations, mortality rate, and percentage of PWH with viral load50 copies, before and after the two pandemic waves.A total of 2,760 PWH were attended from January 2016 to October 2020. During the pandemic, there was a monthly mean of 106.87 telephone consultations and 2,075 home deliveries of medical drugs dispensed to ambulatory patients. No statistically significant differences were found between the rate of admission of patients with COVID-HIV co-infection and that of the remaining patients (1,172.76 admissions/100,000 population vs. 1,424.29,Our results show that the strategies implemented during the first 8 months of the pandemic prevented any deterioration in the control and follow-up parameters routinely used on PWH. Furthermore, they contribute to the debate about how telemedicine and telepharmacy can fit into future healthcare models.Introducción: La pandemia causada por el SARS-CoV-2 ha afectado a la atención de pacientes con otras enfermedades. La dificultad en el acceso a la asistencia sanitaria durante estos meses es especialmente relevante en las personas con infección por VIH (PWH). El objetivo del estudio fue conocer los resultados clínicos y la efectividad de las medidas implementadas en PWH en una de las regiones con mayor incidencia de Europa.Métodos: Estudio observacional retrospectivo, pre-post intervención, comparando los resultados de PWH atendidos en un hospital de alta complejidad entre marzo-octubre de 2020 y el mismo periodo de 2016 a 2019. La intervención consistió en el envío a domicilio de medicamentos y la realización preferente de consultas no presenciales. La efectividad de las medidas implementadas se determinó por el número de visitas a Urgencias, hospitalizaciones, mortalidad y porcentaje de PWH con carga viral50 copias antes y después de dos olas pandémicas.Resultados: Se atendieron 2.760 PWH entre enero de 2016 y octubre de 2020. Durante la pandemia se realizaron una media mensual de 106,87 consultas telefónicas y 2.075 envíos a domicilio de medicamentos de dispensación ambulatoria. No se encontraron diferencias estadísticamente significativas en la frecuentación de pacientes con co-infección COVID-VIH respecto al resto (1.172,76 ingresos/100.000 habitantes vs. 1.424,29, p = 0,401), ni en su mortalidad (11,54% vs. 12,96%, p = 0,939). El porcentaje de PWH con carga viral50 copias fue similar antes y después de la pandemia (1,20% pre-pandemia vs. 0,51% en 2020, p = 0,078).Conclusión: Nuestros resultados revelan que las estrategias implementadas durante los 8 primeros meses de pandemia han evitado el deterioro en parámetros de control y seguimiento empleados habitualmente en PWH. Además, contribuyen a la reflexión sobre el encaje de la telemedicina y telefarmacia en modelos asistenciales futuros.

Recent advances in high-resolution microscopy have allowed scientists to better understand the underlying brain connectivity. However, due to the limitation that biological specimens can only be imaged at a single timepoint, studying changes to neural projections is limited to general observations using population analysis. In this paper, we introduce NeuRegenerate, a novel end-to-end framework for the prediction and visualization of changes in neural fiber morphology within a subject, for specified age-timepoints.To predict projections, we present neuReGANerator, a deep-learning network based on cycle-consistent generative adversarial network (cycleGAN) that translates features of neuronal structures in a region, across age-timepoints, for large brain microscopy volumes. We improve the reconstruction quality of neuronal structures by implementing a density multiplier and a new loss function, called the hallucination loss.Moreover, to alleviate artifacts that occur due to tiling of large input volumes, we introduce a spatial-consistency module in the training pipeline of neuReGANerator. We show that neuReGANerator has a reconstruction accuracy of 94% in predicting neuronal structures. Finally, to visualize the predicted change in projections, NeuRegenerate offers two modes: (1) neuroCompare to simultaneously visualize the difference in the structures of the neuronal projections, across the age timepoints, and (2) neuroMorph, a vesselness-based morphing technique to interactively visualize the transformation of the structures from one age-timepoint to the other. Our framework is designed specifically for volumes acquired using wide-field microscopy. We demonstrate our framework by visualizing the structural changes in neuronal fibers within the cholinergic system of the mouse brain between a young and old specimen., Comment: Accepted for publication in IEEE Transactions on Visualization and Computer Graphics

Research Objective There has been a documented rise of racism and hostility towards Asian Pacific Islanders (API) groups across the nation. With the anticipated population‐level increase in mental health issues as a result of COVID‐19, API college students are an especially high risk group to consider as API young and emerging adults tend to report similar levels of depression and anxiety symptoms compared with their peers, but underutilize service relative to their level of need. The objective of this presentation is to understand the impact of the pandemic on API mental health using large‐scale data, by evaluating pre‐pandemic (Fall 2019), initial months of the pandemic (March‐May 2020) and recent pandemic (Fall 2020) trends in API mental health and treatment utilization, as well as discussing the public health implications in higher education settings for API student populations. Study Design Data comes from 3 administrations of the Healthy Minds Study: Sept‐Dec 2019 (n=33,372 students across 32 campuses), March‐May 2020 (n=12,039 students across 7 campuses) and Sept‐Dec 2020 (n=15,949 students across 28 campuses). This data represents the largest and most comprehensive nationally recognized assessment of API student mental health symptoms, help‐seeking behavior and experiences of discrimination directly related to COVID‐19. We used bi‐variate analyses to compare mental health symptoms and treatment utilization across API students who identified as international students and those who reported US citizenship or permanent residency in the US. We used cross‐sectional logistic regression models to assess the association between discrimination and mental health symptoms and help‐seeking behavior. Population Studied Young and emerging adults who identify as Asian or Pacific Islander and are enrolled at a college or university in the United States. Principal Findings Comparing Fall 2019 to Fall 2020, we found that API non‐international students reported a 23% increase in severe anxiety, a 10% increase in moderate or severe anxiety, and a 9% increase in severe depression; API international students reported a 16% increase in severe depression and a 12% increase in severe anxiety. In Spring 2020, 22% of API students experienced COVID‐related discrimination or hostility (25% in Fall 2020). COVID‐related discrimination or hostility was associated with greater odds of meeting the criteria for one or more clinically significant mental health conditions [aOR: 1.83; 95% CI: 1.35‐2.49; p=0.000]. Treatment utilization among Asian students with at least one clinically significant mental health condition decreased by 26% between Fall 2019 and Spring 2020. Conclusions Throughout the COVID‐19 pandemic, both API international and non‐international students reported increases in mental health symptoms and decreases in treatment utilization. Our analyses also suggest that COVID‐related discrimination is correlated with greater odds of clinically significant mental health symptoms as well decreased help‐seeking. Implications for Policy or Practice The racialization of COVID‐19 has the potential to produce long‐lasting effects on attitudes towards API populations. Culturally tailored psychoeducation, collaborative care models and active recruitment of diverse and culturally‐competent mental health providers are potential avenues to facilitate help‐seeking. Given the mental health challenges that API populations are facing, it will be crucial to make an active effort towards resolving mental health treatment disparities already looming in API communities.

Spatial management of fishing effort can be used to avoid catching undesirable size classes for target species, and improve yield-per-recruit for the exploited stock. Adaptive closure management has been proposed as a means to more effectively utilise spatial management, however these management provisions often lack quantitative evaluation which constrains the information available to inform decisions. We demonstrate the use of a spatially and size structured population dynamics model to evaluate the potential impact of spatial management on a multijurisdictional fishery for a highly migratory species (eastern king prawn, Penaeus [Melicertus] plebejus). Under current conditions in the fishery, the overall effect of closures on harvest was estimated to be comparatively minor, regardless of assumptions about how effort or fisher behavior are affected by spatial management. Alternative assumptions about the movement patterns of eastern king prawn had little influence on the impact of closures on overall harvest. However, when effort was increased to historic levels similar to those observed when the closures were implemented, a much greater impact on overall harvest was observed. The approach taken and simulation outcomes are discussed in the context of spatial management for both eastern king prawn, and penaeid fisheries more broadly.

OBJECTIVE Arthritis is a common chronic condition in the ageing population. Its impact on physical function varies according to sociodemographic and race/ethnic factors. The study objective was to examine the impact of arthritis on physical function and disability among non-disabled older Mexican Americans over time. DESIGN A 23-year prospective cohort study of 2230 Mexican Americans aged 65 years and older from the Hispanic Established Population for the Epidemiologic Study of the Elderly (1993/94-2016). The independent variable was self-reported physician-diagnosed arthritis, and the outcomes included Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), mobility, Short Physical Performance Battery (SPPB), and handgrip strength. Covariates were sociodemographic, medical conditions, body mass index, depressive symptoms, and cognitive function. General linear mixed models were performed to estimate the change in SPPB and muscle strength. General Equation Estimation models estimated the odds ratios (OR) of becoming ADL- or IADL- or mobility - disabled as a function of arthritis. All variables were used as time-varying except for sex, education, and nativity. RESULTS Overall, participants with arthritis had higher odds ratio (OR) of any ADL [OR = 1.35, 95% Confidence Interval (CI) = 1.09-1.68] and mobility (OR = 1.34, 95% CI = 1.18-1.52) disability over time than those without arthritis, after controlling for all covariates. Women, but not men, reporting arthritis had increased risk for ADL and mobility disability. The total SPPB score declined 0.18 points per year among those with arthritis than those without arthritis, after controlling for all covariates (p-value

Objectives. To describe health-related behaviors or indicators associated with overall health and well-being using the Global Assessment Tool (GAT), a health behavior and psychosocial questionnaire completed annually by US Army personnel. Methods. We analyzed GAT responses from 2014 to 2018, consisting of 367 000 to 449 000 respondents per year. We used generalized estimating equations to predict the presence of each health behavior or indicator, aggregated by year and stratified on various demographics. Results. Key findings included decreases from 2014 to 2018 in risky health behaviors such as hazardous drinking (7.5% decrease) and tobacco use (7.9% decrease), dietary supplement use (5.0% to 10.6% decrease, depending on type), self-reported musculoskeletal injury (5.1% decrease), and pain interference (3.6% decrease). Physical activity, sleep, and nutritional habits largely remained consistent over time. Conclusions. In the Army, tobacco, alcohol, and risky dietary supplement usage appears to be declining, whereas lifestyle health behaviors have been stable. Whether these trends reflect responses to health education is unknown. The GAT provides useful insights into the health of the Army, which can be leveraged when developing health-related educational programs and policies. Public Health Implications. Health behaviors that have changed less over time (e.g., nutrition, sleep) may require novel approaches compared with those that changed more (e.g., dietary supplement use, drinking). (Am J Public Health. 2021;111(11):2064–2074. https://doi.org/10.2105/AJPH.2021.306456 )

As an ethnic religion, the Amish are of interest to population health researchers due to a distinctive health profile arising from ethnic attributes, including a closed genetic pool and shared culture that shapes lifestyle practices. Amish-focused health research both furthers our knowledge of health conditions by comparing Amish with non-Amish and assists health practitioners in serving this rapidly growing population. Amish health research, now representing approximately a quarter of all Amish-focused publications, is in need of review, to the end of strengthening this knowledge body's coherence, clarifying research directions, and identifying knowledge gaps, lapses, and stagnations. Herein, we synthesize and discuss Amish physical health conditions research, both the population's distinctive health profile and mechanisms shaping this profile. Specifically, we summarize research addressing BMI, physical activity, and body image; diet and supplements; cancer; cardiovascular conditions; communicable diseases; immunity; sleep; genetic disorders; tobacco and alcohol use; periodontal conditions; traumatic injuries; natural treatments for burns; fertility; and sexually transmitted diseases. In reflection, we raise questions about the nature of intervening mechanisms shaping the Amish health profile, the strange omission of several common independent variables commonly used when studying other ethnic groups' health, several recurring methodological complications, and public health policy considerations.

Objectives. To assess the impact of the COVID-19 pandemic on immunization services across the life course. Methods. In this retrospective study, we used Michigan immunization registry data from 2018 through September 2020 to assess the number of vaccine doses administered, number of sites providing immunization services to the Vaccines for Children population, provider location types that administer adult vaccines, and vaccination coverage for children. Results. Of 12 004 384 individual vaccine doses assessed, 48.6%, 15.6%, and 35.8% were administered to children (aged 0–8 years), adolescents (aged 9–18 years), and adults (aged 19‒105 years), respectively. Doses administered overall decreased beginning in February 2020, with peak declines observed in April 2020 (63.3%). Overall decreases in adult doses were observed in all settings except obstetrics and gynecology provider offices and pharmacies. Local health departments reported a 66.4% decrease in doses reported. For children, the total number of sites administering pediatric vaccines decreased while childhood vaccination coverage decreased 4.4% overall and 5.8% in Medicaid-enrolled children. Conclusions. The critical challenge is to return to prepandemic levels of vaccine doses administered as well as to catch up individuals for vaccinations missed. (Am J Public Health. 2021;111(11):2027–2035. https://doi.org/10.2105/AJPH.2021.306474 )

Cognitive processing therapy (CPT) is a first-line, evidence-based treatment for posttraumatic stress disorder (PTSD). Little is known, however, about the use of CPT for older adults. As the United States population continues to grow and age, an understanding of the utility of CPT for older adults is vital. We present a case study describing the assessment and cognitive treatment of a 74-year-old woman veteran with PTSD secondary to military sexual trauma. CPT was associated with decreased PTSD symptoms as measured before and after treatment. Factors contributing to the veteran’s response, as well as contextual and environmental factors, are discussed. The case demonstrates that CPT may be effective for older adults without major modification.