Mapping the distribution of Amblyomma americanum in Georgia, USA

Abstract Background Amblyomma americanum, the lone star tick, is an aggressive questing species that harbors several pathogens dangerous to humans in the United States. The Southeast in particular has large numbers of this tick due to the combined suitable climate and habitats throughout the region. No studies have estimated the underlying distribution of the lone star tick across the state of Georgia, a state where it is the dominant species encountered. Methods Ticks were collected by flagging 198 transects of 750 m2 at 43 state parks and wildlife management areas across the state from March to July of 2022. A suite of climate, landscape, and wildlife variables were assembled, and a logistic regression model was used to assess the association between these environmental factors and the presence of lone star ticks and to predict the distribution of these ticks across the state. Results A total of 59/198 (30%) transects sampled contained adult or nymph A. americanum, with the majority of transects containing these ticks (54/59, 91.5%) in forested habitats. The presence of A. americanum was associated with elevation, normalized difference vegetation index (NDVI) on January 1, isothermality, temperature seasonality, and precipitation in the wettest quarter. Vast regions of central, eastern, and southern coastal Georgia (57% of the state) were categorized as suitable habitat for the lone star tick. Conclusions This study describes the distribution of the lone star tick across the state of Georgia at a finer scale than the current county-level information available. It identifies specific variables associated with tick presence and provides a map that can be used to target areas for tick prevention messaging and awareness. Graphical Abstrac

Heuristic Implementation of Dynamic Programming for Matrix Permutation Problems in Combinatorial Data Analysis

Combinatorial data analysis, matrix permutation, dynamic programming, heuristics,

Efficacy and safety of baricitinib in hospitalized adults with severe or critical COVID-19 (Bari-SolidAct): a randomised, double-blind, placebo-controlled phase 3 trial

International audienceAbstract Background Baricitinib has shown efficacy in hospitalized patients with COVID-19, but no placebo-controlled trials have focused specifically on severe/critical COVID, including vaccinated participants. Methods Bari-SolidAct is a phase-3, multicentre, randomised, double-blind, placebo-controlled trial, enrolling participants from June 3, 2021 to March 7, 2022, stopped prematurely for external evidence. Patients with severe/critical COVID-19 were randomised to Baricitinib 4 mg once daily or placebo, added to standard of care. The primary endpoint was all-cause mortality within 60 days. Participants were remotely followed to day 90 for safety and patient related outcome measures. Results Two hundred ninety-nine patients were screened, 284 randomised, and 275 received study drug or placebo and were included in the modified intent-to-treat analyses (139 receiving baricitinib and 136 placebo). Median age was 60 (IQR 49–69) years, 77% were male and 35% had received at least one dose of SARS-CoV2 vaccine. There were 21 deaths at day 60 in each group, 15.1% in the baricitinib group and 15.4% in the placebo group (adjusted absolute difference and 95% CI − 0.1% [− 8·3 to 8·0]). In sensitivity analysis censoring observations after drug discontinuation or rescue therapy (tocilizumab/increased steroid dose), proportions of death were 5.8% versus 8.8% (− 3.2% [− 9.0 to 2.7]), respectively. There were 148 serious adverse events in 46 participants (33.1%) receiving baricitinib and 155 in 51 participants (37.5%) receiving placebo. In subgroup analyses, there was a potential interaction between vaccination status and treatment allocation on 60-day mortality. In a subsequent post hoc analysis there was a significant interaction between vaccination status and treatment allocation on the occurrence of serious adverse events, with more respiratory complications and severe infections in vaccinated participants treated with baricitinib. Vaccinated participants were on average 11 years older, with more comorbidities. Conclusion This clinical trial was prematurely stopped for external evidence and therefore underpowered to conclude on a potential survival benefit of baricitinib in severe/critical COVID-19. We observed a possible safety signal in vaccinated participants, who were older with more comorbidities. Although based on a post-hoc analysis, these findings warrant further investigation in other trials and real-world studies. Trial registration Bari-SolidAct is registered at NCT04891133 (registered May 18, 2021) and EUClinicalTrials.eu ( 2022-500385-99-00 )