Overcoming the Unprecedented: Southern Voters Battle Against Voter Suppression, Intimidation, and a Virus

This report describes the 2020 elections in five Southern states—Alabama, Florida, Georgia, Louisiana, and Mississippi—with a particular emphasis on election administration problems; voter suppression; the efforts of voting rights organizations to mobilize voters and protect their votes; and the actions of extremists who sought to intimidate voters and spread disinformation.As this report shows, it is abundantly clear that our electoral system needs repair. Numerous states have erected new barriers to voting since the U.S. Supreme Court in 2013 gutted a critical component of the Voting Rights Act of 1965. Many also cling to Jim Crow-era laws, such as felony disenfranchisement, that were specifically designed to suppress the Black vote—or they refuse to enact commonsense changes that would make voting easier and accessible to all citizens. At the same time, some states maintain archaic administrative systems that are woefully inadequate to meet the needs of voters today and ensure fair elections.This report provides a blueprint for reforming the electoral system. The Biden administration and Congress must act quickly to shore up the stability of the electoral process and put our democracy on a firmer footing. Passage of federal laws, including those that strengthen the Voting Rights Act, are necessary steps forward on the path to reform—toward ensuring that all Americans have easy and equal access to the ballot box

Comparison of Airway Intubation Devices When Using a Biohazard Suit: A Feasibility Study

OBJECTIVES: We set out to compare emergency medicine residents\u27 intubating times and success rates for direct laryngoscopy (DL), GlideScope-assisted intubation (GS), and the Supraglottic Airway Laryngopharyngeal Tube (SALT) airway with and without biohazard gear. METHODS: Each resident passed through 2 sets of 3 testing stations (DL, GS, SALT) in succession, intubating Laerdal mannequin heads with the 3 modalities after randomization to start with or without biohazard gear. RESULTS: Thirty-seven residents participated, and 27 were male (73%); 14 (37.8%) had prior experience intubating in biohazard suits. There was a statistically significant difference in those who had prior intubation experience between DL (37, 100%), GS (32, 86.5%), and SALT (12, 32.4%) (P \u3c .001) and in median time to intubation (48 seconds, no suit; 57 seconds, with suits) (P = .03). There was no statistically significant difference between the overall times to intubate for the 3 devices. First-pass success was highest for DL (91.2%, no suit; 83.7%, suit) followed by GS (89%, no suit; 78.3%, suit) and SALT (51%, no suit; 67.6%, suit). CONCLUSION: A minority of participants had prior experience intubating in biohazard suits. Use of biohazard suits extends time to successful intubation. There was no difference in time to intubation for the 3 devices, but first-pass success was highest for DL (with or without biohazard gear)

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

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

Power-Control Theory

The Encyclopedia of Crime and Punishment provides the most comprehensive reference for a vast number of topics relevant to crime and punishment with a unique focus on the multi/interdisciplinary and international aspects of these topics and historical perspectives on crime and punishment around the world. Comprising nearly 300 entries, this invaluable reference resource serves as the most up-to-date and wide-ranging resource on crime and punishment Offers a global perspective from an international team of leading scholars, including coverage of the strong and rapidly growing body of work on criminology in Europe, Asia, and other areas Acknowledges the overlap of criminology and criminal justice with a number of disciplines such as sociology, psychology, epidemiology, history, economics, and public health, and law Entry topics are organized around 12 core substantive areas: international aspects, multi/interdisciplinary aspects, crime types, corrections, policing, law and justice, research methods, criminological theory, correlates of crime, organizations and institutions (U.S.), victimology, and special populations Organized, authored and Edited by leading scholars, all of whom come to the project with exemplary track records and international standing

Implementation and Assessment of a Pharmacy Educational Program Concerning Laboratory Monitoring for Medications

ABSTRACTBackground: The pharmacist’s role in monitoring medication therapy, including the ability to order laboratory tests as a delegated medical function, has increased dramatically over the past 20 years.Objectives: To implement and assess the impact of an intervention designed to educate pharmacists about appropriate medication-related laboratory monitoring and clinical interpretation of results.Methods: This pilot project had a pretest–posttest study design. The intervention was an educational program comprising 8 self-directed learning modules, each with a corresponding seminar. Evaluation of the program included scoring of the appropriateness and significance of clinical interventions related to laboratory monitoring, pre- and postprogram test scores, and participants’ subjective assessments of their abilities to order and assess the results of medication-related laboratory investigations. Descriptive statistics, the Wilcoxon signed rank test, the Student t-test, and the paired Student t-test were used where appropriate. Associations were assessed with the Pearson or Spearman rho correlation coefficient. All statistical tests were 2-tailed, and the p value for significance was established a priori at 0.05.Results: There was no statistically significant difference with regard to the appropriateness (p = 0.70) or significance (p = 0.94) of clinical interventions undertaken before and after the educational program. Among the 21 pharmacists who completed the program, the average test score (± standard deviation) was 27.2 ± 8.1 before the program, increasing to 39.2 ± 8.7 after the program (p < 0.001). There was a statistically significant improvement in the perceived level of knowledge for each individual module (p < 0.05 for all).Conclusions: The establishment of an educational program led to improvements in both subjective and objective measures of knowledge and perceived abilities to order and assess the results of medication-related laboratory tests.RÉSUMÉContexte : Le rôle du pharmacien dans la surveillance de la pharmacothérapie, notamment la capacité de prescrire des examens de laboratoire en tant qu’acte médical délégué, a grandement gagné en importance au cours des vingt dernières années.Objectifs : Mettre en place une intervention conçue pour enseigner aux pharmaciens comment surveiller adéquatement la pharmacothérapie au moyen d’examens de laboratoire pertinents et comment réaliser l’interprétation clinique des résultats, puis évaluer les effets de cet enseignement.Méthodes : Le présent projet pilote emploie un plan d’étude prétest post-test. L’intervention prenait la forme d’un programme d’enseignement comptant huit modules d’apprentissage autodirigé, chacun assorti d’un séminaire correspondant. L’évaluation du programme comprenait : l’attribution d’un score pour la pertinence et la portée des interventions cliniques liées à la surveillance par des examens de laboratoire, la comparaison des notes obtenues au test administré avant et après le programme d’enseignement et des évaluations subjectives par les participants de leurs capacités à prescrire des examens de laboratoire adaptés à la pharmacothérapie et à en évaluer les résultats. Le cas échéant, des éléments de statistique descriptive, le test de Wilcoxon, le test de Student et le test t pour échantillons appariés ont été employés. Les associations ont été évaluées à l’aide du coefficient de corrélation de Spearman ou de Pearson. Tous les tests statistiques étaient bilatéraux et le seuil de signification a été établi a priori à 0,05.Résultats : On n’a observé aucune différence statistiquement significative en ce qui touche à la pertinence (p = 0,70) ou à la portée (p = 0,94) des interventions cliniques effectuées avant et après le programme d’enseignement. Parmi les 21 pharmaciens ayant complété le programme, la note moyenne (± l’écart-type) obtenue au test était de 27,2 ± 8,1 avant le programme d’enseignement pour ensuite atteindre 39,2 ± 8,7 après le programme (p < 0,001). On a relevé une amélioration statistiquement significative quant au niveau subjectif de connaissance pour chaque module (p < 0,05 pour chacun).Conclusions : La mise en place d’un programme d’enseignement a mené à des améliorations, tant sur le plan des mesures subjectives et objectives des connaissances que des capacités subjectives à prescrire des examens de laboratoire adaptés à la pharmacothérapie et à en évaluer les résultats

Conformational Dynamics of Specific Aβ Oligomers Govern Their Ability to Replicate and Induce Neuronal Apoptosis

Oligomers of amyloid-β (Aβ) have emerged as the primary toxic agents responsible for early synaptic dysfunction and neuronal death in Alzheimer\u27s disease (AD). Characterization of oligomers is an important step in the progress toward delineating the complex molecular mechanisms involved in AD pathogenesis. In our previous reports, we established that a distinct 12-24mer neurotoxic oligomer of Aβ42, called Large Fatty Acid derived Oligomers (LFAOs), exhibits a unique property of replication in which LFAOs directly duplicate to quantitatively larger amounts upon interacting with monomers. This self-propagative process of replication is somewhat reminiscent of prion propagation. In this report, we sought to investigate the concentration-dependent conformational dynamics LFAOs undergo and how such transitions manifest in their ability to replicate and induce neuronal apoptosis. The results indicate that LFAOs undergo a concentration-dependent transition between 12mers and disperse 12-24mers with a dissociation constant (Kd) of 0.1 μM. The two species differ in their respective tertiary/quaternary structures but not their secondary structures. This conformational dynamics of LFAOs correlates with their ability to replicate and to induce apoptosis in SH-SY5Y human neuroblastoma cells, with 12mers being more neurotoxic and prone to replication than 12-24mers. The latter result implicates the replication process dominates at low physiological concentrations. The observations made in this report may have profound significance in deciphering the elusive roles of Aβ oligomer phenotypes and in determining their prion-type behavior in AD pathology