Is screening for lead poisoning justified?

Evidence is insufficient to recommend for or against universal screening of young children for lead poisoning in high- prevalence communities (strength of recommendation [SOR]: C). In low-prevalence communities, evidence is insufficient to recommend for or against a targeted screening approach, employing locale-specific demographic risk factors and personal risk questionnaires to inform screening decisions (SOR: C). Although evidence does not suggest that treatment of individuals with elevated blood lead levels improves individual outcomes, public health strategies aimed at decreasing lead in the environment appear to have resulted in a significant decline in the number of children with elevated blood lead levels in recent decades. One could thus argue that screening may identify communities with high rates of lead poisoning, where environmental strategies could be targeted. Because the epidemiology of lead poisoning continues to change, local and state health authorities must continuously update information on which to base decisions about screening

A Qualitative Study Exploring Access to Mental Health and Substance Use Support among Individuals Experiencing Homelessness during COVID-19

People experiencing homelessness have higher rates of mental ill-health and substance use and lower access to health services compared to the general population. The COVID-19 pandemic led to changes in service delivery across health and social care services, with many adopting virtual or telephone support for service users. This paper explores the experiences of access to community-based mental health and substance use support for people experiencing homelessness during the COVID-19 pandemic. Qualitative telephone interviews were conducted with 10 women and 16 men (ages 25 to 71) who self-identified as experiencing homelessness in North East England between February and May 2021. With five individuals with lived experience, results were analysed using inductive reflexive thematic analysis. Reactive changes to support provision often led to inadvertent exclusion. Barriers to access included: physical locations, repetition of recovery stories, individual readiness, and limited availability. Participants suggested creating services reflective of need and opportunities for choice and empowerment. Community mental health and substance use support for people experiencing homelessness should ensure the support is personalised, responsive to need, inclusive, and trauma-informed. The findings of this research have important implications for mental health and substance use policy and practice for individuals who experience homelessness during a public health crisis

Hopf algebras and Markov chains: Two examples and a theory

The operation of squaring (coproduct followed by product) in a combinatorial Hopf algebra is shown to induce a Markov chain in natural bases. Chains constructed in this way include widely studied methods of card shuffling, a natural "rock-breaking" process, and Markov chains on simplicial complexes. Many of these chains can be explictly diagonalized using the primitive elements of the algebra and the combinatorics of the free Lie algebra. For card shuffling, this gives an explicit description of the eigenvectors. For rock-breaking, an explicit description of the quasi-stationary distribution and sharp rates to absorption follow.Comment: 51 pages, 17 figures. (Typographical errors corrected. Further fixes will only appear on the version on Amy Pang's website, the arXiv version will not be updated.

A preliminary proteomic characterisation of extracellular vesicles released by the ovine parasitic nematode, Teladorsagia circumcincta

AbstractTeladorsagia circumcincta is a major cause of ovine parasitic gastroenteritis in temperate climatic regions. The development of high levels of anthelmintic resistance in this nematode species challenges its future control. Recent research indicates that many parasite species release extracellular vesicles into their environment, many of which have been classified as endocytic in origin, termed exosomes. These vesicles are considered to play important roles in the intercellular communication between parasites and their hosts, and thus represent potentially useful targets for novel control strategies. Here, we demonstrate that exosome-like extracellular vesicles can be isolated from excretory-secretory (ES) products released by T. circumcincta fourth stage larvae (Tci-L4ES). Furthermore, we perform a comparative proteomic analysis of vesicle-enriched and vesicle-free Tci-L4ES. Approximately 73% of the proteins identified in the vesicle-enriched fraction were unique to this fraction, whilst the remaining 27% were present in both vesicle-enriched and vesicle-free fraction. These unique proteins included structural proteins, nuclear proteins, metabolic proteins, proteolytic enzymes and activation-associated secreted proteins. Finally, we demonstrate that molecules present within the vesicles-enriched material are targets of the IgA and IgG response in T. circumcincta infected sheep, and could potentially represent useful targets for future vaccine intervention studies

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Do introduced honeybees affect seed set and seed quality in a plant adapted for bird pollination?

Aims: Worldwide, evidence suggests that exotic pollinators can disrupt plant mating patterns. However, few studies have determined if pollination by the honeybee Apis mellifera (the world\u27s most widely introduced pollinator) reduces offspring quality when compared with pollination by native birds. The Australian Proteaceae provide an excellent opportunity to test the impact of honeybees in pollination systems that are adapted to birds and non-flying mammals. Methods: We compared the frequency of flower visitation and foraging behaviour of birds and insects within seven populations of Banksia ericifolia. Banksia ericifolia is hermaphroditic and has large nectar-rich, orange inflorescences typical of bird and mammal pollinated species. For a subset of the study populations, we compared the quality of seed produced via an exclusion treatment (that only allowed invertebrates to access flowers) with an open-pollination treatment (potentially visited by mammals, birds and invertebrates), by measuring seed weight, germination rates (T50), percent germination, seedling height after 14 days since the emergence of the cotyledon and time to emergence of the cotyledon. Important Findings: Apis mellifera was the only apparent insect pollinator and the most frequent flower visitor, while the open treatment inflorescences were also frequently visited by avian pollinators, primarily honeyeater species. The foraging behaviour of honeybees and honeyeaters showed striking differences that potentially affect patterns of pollen transfer. Honeybees made significantly greater proportions of within cf. among plant movements and only 30% (n=48) of honeybees foraged for pollen (nectar foragers carried no pollen) whilst all birds were observed to contact both stigmas and anthers when foraging for nectar. Despite these fundamental differences in behaviour, there was little effect of treatment on seed set or quality. Our data show that while honeybees appear to alter patterns of pollen transfer within B. ericifolia populations, they do not impact reproductive rates or performance of early life-stages

Do introduced honeybees affect seed set and seed quality in a plant adapted for bird pollination?

Aims: Worldwide, evidence suggests that exotic pollinators can disrupt plant mating patterns. However, few studies have determined if pollination by the honeybee Apis mellifera (the world’s most widely introduced pollinator) reduces offspring quality when compared with pollination by native birds. The Australian Proteaceae provides an excellent opportunity to test the impact of honeybees in pollination systems that are adapted to birds and non-flying mammals. Methods: We compared the frequency of flower visitation and foraging behaviour of birds and insects within seven populations of Banksia ericifolia. Banksia ericifolia is hermaphroditic and has large nectar-rich, orange inflorescences typical of bird and mammal pollinated species. For a subset of the study populations, we compared the quality of seed produced via an exclusion treatment (that only allowed invertebrates to access flowers) with an open-pollination treatment (potentially visited by mammals, birds and invertebrates), by measuring seed weight, germination rates (T50), percent germination, seedling height after 14 days since the emergence of the cotyledon and time to emergence of the cotyledon. Important Findings: Apis mellifera was the only apparent insect pollinator and the most frequent flower visitor, while the open treatment inflorescences were also frequently visited by avian pollinators, primarily honeyeater species. The foraging behaviour of honeybees and honeyeaters showed striking differences that potentially affect patterns of pollen transfer. Honeybees made significantly greater proportions of within cf. among plant movements and only 30% (n = 48) of honeybees foraged for pollen (nectar foragers carried no pollen) whilst all birds were observed to contact both stigmas and anthers when foraging for nectar. Despite these fundamental differences in behaviour, there was little effect of treatment on seed set or quality. Our data show that while honeybees appear to alter patterns of pollen transfer within B. ericifolia populations, they do not impact reproductive rates or performance of early life-stages

Community Care of North Carolina: Improving Care Through Community Health Networks

The United States leads the world in health care costs but ranks far below many developed countries in health outcomes. Finding ways to narrow this gap remains elusive. This article describes the response of one state to establish community health networks to achieve quality, utilization, and cost objectives for the care of its Medicaid recipients. The program, known as Community Care of North Carolina, is an innovative effort organized and operated by practicing community physicians. In partnership with hospitals, health departments, and departments of social services, these community networks have improved quality and reduced cost since their inception a decade ago. The program is now saving the State of North Carolina at least $160 million annually. A description of this experience and the lessons learned from it can inform others seeking to implement effective systems of care for patients with chronic illness

Maternal elaborative reminiscing mediates the effect of child maltreatment on behavioral and physiological functioning

Theoretical and empirical evidence suggest that the way in which parents discuss everyday emotional experiences with their young children (i.e., elaborative reminiscing) has significant implications for child cognitive and socio-emotional functioning, and that maltreating parents have a particularly difficult time in engaging in this type of dialogue. This dyadic interactional exchange, therefore, has the potential to be an important process variable linking child maltreatment to developmental outcomes at multiple levels of analysis. The current investigation evaluated the role of maternal elaborative reminiscing in associations between maltreatment and child cognitive, emotional, and physiological functioning. Participants included 43 maltreated and 49 nonmaltreated children (aged 3–6) and their mothers. Dyads participated in a joint reminiscing task about four past emotional events, and children participated in assessments of receptive language and emotion knowledge. Child salivary cortisol was also collected from children three times a day (waking, midday, and bedtime) on two consecutive days to assess daily levels and diurnal decline. Results indicated that maltreating mothers engaged in significantly less elaborative reminiscing than nonmaltreating mothers. Maternal elaborative reminiscing mediated associations between child maltreatment and child receptive language and child emotion knowledge. Additionally, there was support for an indirect pathway between child maltreatment and child cortisol diurnal decline through maternal elaborative reminiscing. Directions for future research are discussed and potential clinical implications are addressed