Vector competence of Aedes aegypti, Culex tarsalis, and Culex quinquefasciatus from California for Zika virus.

Zika virus (ZIKV) has emerged since 2013 as a significant global human health threat following outbreaks in the Pacific Islands and rapid spread throughout South and Central America. Severe congenital and neurological sequelae have been linked to ZIKV infections. Assessing the ability of common mosquito species to transmit ZIKV and characterizing variation in mosquito transmission of different ZIKV strains is important for estimating regional outbreak potential and for prioritizing local mosquito control strategies for Aedes and Culex species. In this study, we evaluated the laboratory vector competence of Aedes aegypti, Culex quinquefasciatus, and Culex tarsalis that originated in areas of California where ZIKV cases in travelers since 2015 were frequent. We compared infection, dissemination, and transmission rates by measuring ZIKV RNA levels in cohorts of mosquitoes that ingested blood meals from type I interferon-deficient mice infected with either a Puerto Rican ZIKV strain from 2015 (PR15), a Brazilian ZIKV strain from 2015 (BR15), or an ancestral Asian-lineage Malaysian ZIKV strain from 1966 (MA66). With PR15, Cx. quinquefasciatus was refractory to infection (0%, N = 42) and Cx. tarsalis was infected at 4% (N = 46). No ZIKV RNA was detected in saliva from either Culex species 14 or 21 days post feeding (dpf). In contrast, Ae. aegypti developed infection rates of 85% (PR15; N = 46), 90% (BR15; N = 20), and 81% (MA66; N = 85) 14 or 15 dpf. Although MA66-infected Ae. aegypti showed higher levels of ZIKV RNA in mosquito bodies and legs, transmission rates were not significantly different across virus strains (P = 0.13, Fisher's exact test). To confirm infectivity and measure the transmitted ZIKV dose, we enumerated infectious ZIKV in Ae. aegypti saliva using Vero cell plaque assays. The expectorated plaque forming units PFU varied by viral strain: MA66-infected expectorated 13±4 PFU (mean±SE, N = 13) compared to 29±6 PFU for PR15-infected (N = 13) and 35±8 PFU for BR15-infected (N = 6; ANOVA, df = 2, F = 3.8, P = 0.035). These laboratory vector competence results support an emerging consensus that Cx. tarsalis and Cx. quinquefasciatus are not vectors of ZIKV. These results also indicate that Ae. aegypti from California are efficient laboratory vectors of ancestral and contemporary Asian lineage ZIKV

Improving Care Coordination between Accountable Care Organizations and Community Partners: Early Findings from the Massachusetts Delivery System Reform Incentive Payment (DSRIP) Program

Research Objective: The Massachusetts’ Medicaid and Children’s Health Insurance Program (MassHealth/MH) initiated the Delivery System Reform Incentive Payment (DSRIP) program in 2017, as part of its section 1115 Demonstration, to coordinate care for Medicaid members, reduce healthcare costs and improve patient outcomes. Central to this program was a requirement that Accountable Care Organizations (ACOs) develop relationships with all behavioral health and at least 2 long-term care service MH contracted Community Partner agencies (CPs) operating in their service areas to be responsible for coordinating care and developing care plans for members. This presentation will describe barriers and facilitators to developing ACO-CP relationships identified in the first 1.5 years of program implementation. Study Design: This paper focuses on ways in which ACOs and CPs are responding to new contracting requirements and programmatic expectations related to the MA 1115 DSRIP. Semi-structured interviews were conducted with individuals in leadership positions at all 17 ACOs and 27 CPs by pairs of trained interviewers, in person, or via video or teleconference. Interview data were analyzed qualitatively, using a framework approach informed by the literature, the program logic model, and the evaluation design. Population Studied: ACOs/CPs nominated 2 to 3 individuals best positioned to speak to implementation topics including governance and organizational structure, workforce development, ACO-CP relationships, provider engagement, care coordination, quality improvement, and environmental factors including the role of MassHealth. Ninety-four interviews were conducted with 99 interviewees across the 44 organizations. The majority of interviewees were female and typically held managerial roles, ranging from program managers to executives. A majority were with their organizations prior to or at the time of DSRIP inception. Principal Findings: Communication and information sharing were identified as key ingredients to coordinating member health care between ACOs and CPs; the absence of effective means to communicate and share information were identified as major barriers. Strategies for enhancing communication included scheduling regular meetings to discuss shared patients (i.e., within and between organizations), designating points of contact (e.g., staff liaisons), and clarifying roles regarding member-facing activities. Information sharing was found to be most effective when organizations agreed on processes, particularly around the use of electronic medical records or other information exchange technologies. ACO and CP interviewees indicated that successful communication and information sharing led to the development of stronger and more positive partner relationships (e.g., between an ACO and the CPs with which they share information and coordinate care well). Participants also described ways in which MassHealth has actively responded to challenges within the original design of the ACO-CP relationship to improve coordination and member experience. Conclusions: Designated points of contact, well-conceived and executed communication strategies, and effective information exchange are essential for developing relationships and coordinating care between ACOs and community-based organizations. Implications for Policy or Practice: States need to consider the complexity of coordinating care with multiple community-based agencies and the importance of standardized processes for effective information sharing when promoting care coordination between health care and human service entities. States should also incorporate means of ongoing technical support and rapid cycle feedback to allow for continuous policy improvement in Medicaid delivery systems

Barriers and Facilitators to Implementation of Value-Based Care Models in New Medicaid Accountable Care Organizations in Massachusetts: A Study Protocol

Introduction: Massachusetts established 17 new Medicaid accountable care organizations (ACOs) and 24 affiliated Community Partners (CPs) in 2018 as part of a large-scale healthcare reform effort to improve care value. The new ACOs will receive $1.8 billion dollars in state and federal funding over 5 years through the Delivery System Reform Incentive Program (DSRIP). The multi-faceted study described in this protocol aims to address gaps in knowledge about Medicaid ACOs\u27 impact on healthcare value by identifying barriers and facilitators to implementation and sustainment of the DSRIP-funded programs. Methods and analysis: The study\u27s four components are: (1) Document Review to characterize the ACOs and CPs; (2) Semi-structured Key Informant Interviews (KII) with ACO and CP leadership, state-level Medicaid administrators, and patients; (3) Site visits with selected ACOs and CPs; and (4) Surveys of ACO clinical teams and CP staff. The Consolidated Framework for Implementation Research\u27s (CFIR) serves as the study\u27s conceptual framework; its versatile menu of constructs, arranged across five domains (Intervention Characteristics, Inner Setting, Outer Setting, Characteristics of Individuals, and Processes) guides identification of barriers and facilitators across multiple organizational contexts. For example, KII interview guides focus on understanding how Inner and Outer Setting factors may impact implementation. Document Review analysis includes extraction and synthesis of ACO-specific DSRIP-funded programs (i.e., Intervention Characteristics); KIIs and site visit data will be qualitatively analyzed using thematic analytic techniques; surveys will be analyzed using descriptive statistics (e.g., counts, frequencies, means, and standard deviations). Discussion: Understanding barriers and facilitators to implementing and sustaining Medicaid ACOs with varied organizational structures will provide critical context for understanding the overall impact of the Medicaid ACO experiment in Massachusetts. It will also provide important insights for other states considering the ACO model for their Medicaid programs. Ethics and dissemination: IRB determinations were that the overall study did not constitute human subjects research and that each phase of primary data collection should be submitted for IRB review and approval. Study results will be disseminated through traditional channels such as peer reviewed journals, through publicly available reports on the mass.gov website; and directly to key stakeholders in ACO and CP leadership

From moral hazard to risk-response feedback

The Intergovernmental Panel on Climate Change assessments (IPCC) Special Report on 1.5 °C of global warming is clear. Nearly all pathways that hold global warming well below 2 °C involve carbon removal (IPCC, 2015). In addition, solar geoengineering is being considered as a potential tool to offset warming, especially to limit temperature until negative emissions technologies are sufficiently matured (MacMartin et al., 2018). Despite this, there has been a reluctance to embrace carbon removal and solar geoengineering, partly due to the perception that these technologies represent what is widely termed a “moral hazard”: that geoengineering will prevent people from developing the will to change their personal consumption and push for changes in infrastructure (Robock et al., 2010), erode political will for emissions cuts (Keith, 2007), or otherwise stimulate increased carbon emissions at the social-system level of analysis (Bunzl, 2008). These debates over carbon removal and geoengineering echo earlier ones over climate adaptation. We argue that debates over “moral hazard” in many areas of climate policy are unhelpful and misleading. We also propose an alternative framework for dealing with the tradeoffs that motivate the appeal to “moral hazard,” which we call “risk-response feedback.

Isotopic and zooarchaeological approaches towards understanding aquatic resource use in human economies and animal management in the prehistoric Scottish North Atlantic Islands

Despite being surrounded by aquatic resources, the Prehistoric populations of the North Atlantic Islands have a complex history of aquatic resource that until now has been little understood. Specifically the changing importance and uses of aquatic resources through time, and the role of aquatic resources in the management of animals in prehistory requires further attention. This paper presents results of faunal isotopic analysis in combination with existing human isotopic evidence and zooarchaeological datasets from Neolithic, Bronze Age and Iron Age sites in the Western Isles (also known as the Outer Hebrides) and Orkney to explore the importance of aquatic resources in the lives of these prehistory populations. In Orkney coastal grazing was an important aspect in the management of sheep throughout prehistory, whereas in the Western Isles this was only evident in the Bronze Age. Aquatic protein was also used in the management of pigs in the Western Isles during the Middle Iron Age. There is little evidence of humans consuming aquatic resources in the Neolithic, and only minor evidence of consumption in the Bronze Age. During the Iron Age aquatic resources become more important in the diet of humans. The Prehistoric Atlantic Islanders of Scotland had a complex and dynamic relationship with aquatic resources, especially in the role of animal management that changed throughout the course of prehistory.The authorswould like to express thanks to NERC for funding this research (Grant number NE/F021054/1, PI Richard Evershed), and the NERC Life Sciences Mass Spectrometry Facility in East Kilbride (EK158- 03/10) for their financial assistance with the analytical researc

Acute kidney disease and renal recovery : consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup

Consensus definitions have been reached for both acute kidney injury (AKI) and chronic kidney disease (CKD) and these definitions are now routinely used in research and clinical practice. The KDIGO guideline defines AKI as an abrupt decrease in kidney function occurring over 7 days or less, whereas CKD is defined by the persistence of kidney disease for a period of > 90 days. AKI and CKD are increasingly recognized as related entities and in some instances probably represent a continuum of the disease process. For patients in whom pathophysiologic processes are ongoing, the term acute kidney disease (AKD) has been proposed to define the course of disease after AKI; however, definitions of AKD and strategies for the management of patients with AKD are not currently available. In this consensus statement, the Acute Disease Quality Initiative (ADQI) proposes definitions, staging criteria for AKD, and strategies for the management of affected patients. We also make recommendations for areas of future research, which aim to improve understanding of the underlying processes and improve outcomes for patients with AKD

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Optimal residential water conservation strategies considering related energy in California

Although most freshwater resources are used in agriculture, residential water use is a much more energy intensive user. Based on this, we analyze the increased willingness to adopt water conservation strategies if energy cost is included in the customers' utility function. Using a Water-Energy-CO2 emissions model for household water end uses and probability distribution functions for parameters affecting water and water-related energy use in 10 different locations in California, this research introduces a probabilistic two-stage optimization model considering technical and behavioral decision variables to obtain the most economical strategies to minimize household water and water-related energy bills and costs given both water and energy price shocks. Results can provide an upper bound of household savings for customers with well-behaved preferences, and show greater adoption rates to reduce energy intensive appliances when energy is accounted, resulting in an overall 24% reduction in indoor water use that represents a 30% reduction in water-related energy use and a 53% reduction in household water-related CO2 emissions. Previous use patterns and water and energy rate structures can affect greatly the potential benefits for customers and so their behavior. Given that water and energy are somewhat complementary goods for customers, we use results of the optimization to obtain own-price and cross-price elasticities of residential water use by simulating increases in water and energy prices. While the results are highly influenced by assumptions due to lack of empirical data, the method presented has no precedent in the literature and hopefully will stimulate the collection of additional relevant data.This paper has been developed as a result of a mobility stay funded by the Erasmus Mundus Programme of the European Commission under the Transatlantic Partnership for Excellence in Engineering-TEE Project. Water end-use data were kindly provided by Aquacraft Inc. who are able to release the data under private agreements and to whom we are very grateful.Escrivà Bou, À.; Lund, J.; Pulido-Velazquez, M. (2015). Optimal residential water conservation strategies considering related energy in California. Water Resources Research. 51(6):4482-4498. doi:10.1002/2014WR016821S4482449851

Report of the Snowmass 2021 Topical Group on Lattice Gauge Theory

Lattice gauge theory continues to be a powerful theoretical and computational approach to simulating strongly interacting quantum field theories, whose applications permeate almost all disciplines of modern-day research in High-Energy Physics. Whether it is to enable precision quark- and lepton-flavor physics, to uncover signals of new physics in nucleons and nuclei, to elucidate hadron structure and spectrum, to serve as a numerical laboratory to reach beyond the Standard Model, or to invent and improve state-of-the-art computational paradigms, the lattice-gauge-theory program is in a prime position to impact the course of developments and enhance discovery potential of a vibrant experimental program in High-Energy Physics over the coming decade. This projection is based on abundant successful results that have emerged using lattice gauge theory over the years: on continued improvement in theoretical frameworks and algorithmic suits; on the forthcoming transition into the exascale era of high-performance computing; and on a skillful, dedicated, and organized community of lattice gauge theorists in the U.S. and worldwide. The prospects of this effort in pushing the frontiers of research in High-Energy Physics have recently been studied within the U.S. decadal Particle Physics Planning Exercise (Snowmass 2021), and the conclusions are summarized in this Topical Report.Comment: 57 pages, 1 figure. Submitted to the Proceedings of the US Community Study on the Future of Particle Physics (Snowmass 2021). Topical Group Report for TF05 - Lattice Gauge Theor