Outcomes of SARS-CoV-2-Positive Youths Tested in Emergency Departments: The Global PERN-COVID-19 Study.

[EN] Importance: Severe outcomes among youths with SARS-CoV-2 infections are poorly characterized. Objective: To estimate the proportion of children with severe outcomes within 14 days of testing positive for SARS-CoV-2 in an emergency department (ED). Design, Setting, and Participants: This prospective cohort study with 14-day follow-up enrolled participants between March 2020 and June 2021. Participants were youths aged younger than 18 years who were tested for SARS-CoV-2 infection at one of 41 EDs across 10 countries including Argentina, Australia, Canada, Costa Rica, Italy, New Zealand, Paraguay, Singapore, Spain, and the United States. Statistical analysis was performed from September to October 2021. Exposures: Acute SARS-CoV-2 infection was determined by nucleic acid (eg, polymerase chain reaction) testing. Main Outcomes and Measures: Severe outcomes, a composite measure defined as intensive interventions during hospitalization (eg, inotropic support, positive pressure ventilation), diagnoses indicating severe organ impairment, or death. Results: Among 3222 enrolled youths who tested positive for SARS-CoV-2 infection, 3221 (>99.9%) had index visit outcome data available, 2007 (62.3%) were from the United States, 1694 (52.6%) were male, and 484 (15.0%) had a self-reported chronic illness; the median (IQR) age was 3 (0-10) years. After 14 days of follow-up, 735 children (22.8% [95% CI, 21.4%-24.3%]) were hospitalized, 107 (3.3% [95% CI, 2.7%-4.0%]) had severe outcomes, and 4 children (0.12% [95% CI, 0.03%-0.32%]) died. Characteristics associated with severe outcomes included being aged 5 to 18 years (age 5 to <10 years vs <1 year: odds ratio [OR], 1.60 [95% CI, 1.09-2.34]; age 10 to <18 years vs <1 year: OR, 2.39 [95% CI 1.38-4.14]), having a self-reported chronic illness (OR, 2.34 [95% CI, 1.59-3.44]), prior episode of pneumonia (OR, 3.15 [95% CI, 1.83-5.42]), symptoms starting 4 to 7 days prior to seeking ED care (vs starting 0-3 days before seeking care: OR, 2.22 [95% CI, 1.29-3.82]), and country (eg, Canada vs US: OR, 0.11 [95% CI, 0.05-0.23]; Costa Rica vs US: OR, 1.76 [95% CI, 1.05-2.96]; Spain vs US: OR, 0.51 [95% CI, 0.27-0.98]). Among a subgroup of 2510 participants discharged home from the ED after initial testing and who had complete follow-up, 50 (2.0%; 95% CI, 1.5%-2.6%) were eventually hospitalized and 12 (0.5%; 95% CI, 0.3%-0.8%) had severe outcomes. Compared with hospitalized SARS-CoV-2-negative youths, the risk of severe outcomes was higher among hospitalized SARS-CoV-2-positive youths (risk difference, 3.9%; 95% CI, 1.1%-6.9%). Conclusions and Relevance: In this study, approximately 3% of SARS-CoV-2-positive youths tested in EDs experienced severe outcomes within 2 weeks of their ED visit. Among children discharged home from the ED, the risk was much lower. Risk factors such as age, underlying chronic illness, and symptom duration may be useful to consider when making clinical care decisions.This study was supported by grants from the Canadian Institutes of Health Research (Operating Grant: COVID-19 – Clinical management), Alberta Innovates, the Alberta Health Services – University of Calgary – Clinical Research Fund, the Alberta Children’s Hospital Research Institute, the COVID-19 Research Accelerator Funding Track (CRAFT) Program at the University of California, Davis, and the Cincinnati Children’s Hospital Medical Center Division of Emergency Medicine Small Grants Program. Dr Funk was supported by the University of Calgary Eyes-High Post-Doctoral Research Fund. Dr Freedman was supported by the Alberta Children’s Hospital Foundation Professorship in Child Health and Wellness

Diagnostic and Prognostic Utility of Procalcitonin in Patients Presenting to the Emergency Department with Dyspnea

Background Among patients in the emergency department, dyspnea is a common complaint and can pose a diagnostic challenge. Biomarkers are used increasingly to improve diagnostic accuracy and aid with prognostication in dyspneic patients. The purpose of this study was to examine the clinical utility of serum procalcitonin (PCT) for the diagnosis of pneumonia in patients presenting to the emergency department with dyspnea. A secondary objective was to evaluate the prognostic value of PCT for death to 1 year. Methods This study pooled the patient populations of 2 prospective cohorts that previously enrolled patients presenting to 2 urban emergency departments with dyspnea. A total of 453 patients had serum samples available for biomarker analysis. Clinician certainty for the diagnosis of acutely decompensated heart failure was reviewed. Discrimination, calibration, and net reclassification improvement for the diagnosis of pneumonia as well as fatal outcomes were considered. The main outcome was accuracy of PCT for diagnostic categorization of pneumonia. The prognostic value of PCT for survival to 1 year was a secondary outcome. Results Pneumonia alone was diagnosed in 30 patients (6.6%), heart failure without pneumonia in 212 patients (47%), and both diagnoses in 30 patients (6.6%). Procalcitonin concentrations were higher in subjects with pneumonia (0.38 vs 0.06 ng/mL; P < .001). Area under the receiver operating characteristic curve for the diagnosis of pneumonia based on PCT was 0.84 (95% confidence interval [CI], 0.77-0.91; P < .001). Across all levels of clinician-based estimates of heart failure, PCT was sensitive and specific; notably, in patients judged with diagnostic uncertainty (n = 70), a PCT value of 0.10 ng/mL had the optimal balance of sensitivity and specificity (80% and 77%, respectively) for pneumonia. Adding PCT results to variables predictive of pneumonia resulted in a net reclassification improvement of 0.54 (95% CI, 0.24-0.83; P < .001) for both up- and down-reclassifying events. In adjusted analyses, elevated PCT was a predictor of 1-year mortality (hazard ratio 1.8; 95% CI, 1.4-2.3; P < .001) and was additive when elevated in conjunction with natriuretic peptides for this application. Conclusion In emergency department patients with acute dyspnea, PCT is an accurate diagnostic marker for pneumonia and adds independent prognostic information for 1-year mortality

The quality of different types of child care at 10 and 18 months. A comparison between types and factors related to quality.

The quality of care offered in four different types of non-parental child care to 307 infants at 10 months old and 331 infants at 18 months old was compared and factors associated with higher quality were identified. Observed quality was lowest in nurseries at each age point, except that at 18 months they offered more learning activities. There were few differences in the observed quality of care by child-minders, grandparents and nannies, although grandparents had somewhat lower safety and health scores and offered children fewer activities. Cost was largely unrelated to quality of care except in child-minding, where higher cost was associated with higher quality. Observed ratios of children to adults had a significant impact on quality of nursery care; the more infants or toddlers each adult had to care for, the lower the quality of the care she gave them. Mothers' overall satisfaction with their child's care was positively associated with its quality for home-based care but not for nursery settings

Virological outcomes of second-line protease inhibitor-based treatment for human immunodeficiency virus type 1 in a high-prevalence rural South African setting: a competing-risks prospective cohort analysis

Background. Second-line antiretroviral therapy (ART) based on ritonavir-boosted protease inhibitors (bPIs) represents the only available option after first-line failure for the majority of individuals living with human immunodeficiency virus (HIV) worldwide. Maximizing their effectiveness is imperative. Methods. This cohort study was nested within the French National Agency for AIDS and Viral Hepatitis Research (ANRS) 12249 Treatment as Prevention (TasP) cluster-randomized trial in rural KwaZulu-Natal, South Africa. We prospectively investigated risk factors for virological failure (VF) of bPI-based ART in the combined study arms. VF was defined by a plasma viral load >1000 copies/mL ≥6 months after initiating bPI-based ART. Cumulative incidence of VF was estimated and competing risk regression was used to derive the subdistribution hazard ratio (SHR) of the associations between VF and patient clinical and demographic factors, taking into account death and loss to follow-up. Results. One hundred one participants contributed 178.7 person-years of follow-up. Sixty-five percent were female; the median age was 37.4 years. Second-line ART regimens were based on ritonavir-boosted lopinavir, combined with zidovudine or tenofovir plus lamivudine or emtricitabine. The incidence of VF on second-line ART was 12.9 per 100 person-years (n = 23), and prevalence of VF at censoring was 17.8%. Thirteen of these 23 (56.5%) virologic failures resuppressed after a median of 8.0 months (interquartile range, 2.8-16.8 months) in this setting where viral load monitoring was available. Tuberculosis treatment was associated with VF (SHR, 11.50 [95% confidence interval, 3.92-33.74]; P < .001). Conclusions. Second-line VF was frequent in this setting. Resuppression occurred in more than half of failures, highlighting the value of viral load monitoring of second-line ART. Tuberculosis was associated with VF; therefore, novel approaches to optimize the effectiveness of PI-based ART in high-tuberculosis-burden settings are needed

Local temperature and ecological similarity drive distributional dynamics of tropical mammals worldwide

AimIdentifying the underlying drivers of speciesâ distributional dynamics is critical for predicting change and managing biological diversity. While anthropogenic factors such as climate change can affect species distributions through time, other naturally occurring ecological processes can also have an influence. Theory predicts that interactions between species can influence distributional dynamics, yet empirical evidence remains sparse. A powerful approach is to monitor and model local colonization and extinctionâ the processes that generate change in distributions over timeâ and to identify their abiotic and biotic associations. Intensive cameraâ trap monitoring provides an opportunity to assess the role of temperature and species interactions in the colonization and extinction dynamics of tropical mammals, many of which are species of conservation concern. Using data from a panâ tropical monitoring network, we examined how shortâ term local temperature change and ecological similarity between species (a proxy for the strength of species interactions) influenced the processes that drive distributional shifts.LocationTropical forests worldwide.Time period2007â 2016.Major taxa studiedTerrestrial mammals.MethodsWe used dynamic occupancy models to assess the influence of the abiotic and biotic environment on the distributional dynamics of 42 mammal populations from 36 species on 7 tropical elevation gradients around the world.ResultsOverall, temperature, ecological similarity, or both, were linked to colonization or extinction dynamics in 29 populations. For six species, the effect of temperature depended upon the local mammal community similarity. This result suggests that the way in which temperature influences local colonization and extinction dynamics depends on local mammal community composition.Main conclusionsThese results indicate that varying temperatures influence tropical mammal distributions in surprising ways and suggest that interactions between species mediate distributional dynamics.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149732/1/geb12908.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149732/2/geb12908_am.pd

Limited carbon and biodiversity co-benefits for tropical forest mammals and birds

The conservation of tropical forest carbon stocks offers the opportunity to curb climate change by reducing greenhouse gas emissions from deforestation and simultaneously conserve biodiversity. However, there has been considerable debate about the extent to which carbon stock conservation will provide benefits to biodiversity in part because whether forests that contain high carbon density in their aboveground biomass also contain high animal diversity is unknown. Here, we empirically examined medium to large bodied ground-dwelling mammal and bird (hereafter "wildlife") diversity and carbon stock levels within the tropics using camera trap and vegetation data from a pantropical network of sites. Specifically, we tested whether tropical forests that stored more carbon contained higher wildlife species richness, taxonomic diversity, and trait diversity. We found that carbon stocks were not a significant predictor for any of these three measures of diversity, which suggests that benefits for wildlife diversity will not be maximized unless wildlife diversity is explicitly taken into account; prioritizing carbon stocks alone will not necessarily meet biodiversity conservation goals. We recommend conservation planning that considers both objectives because there is the potential for more wildlife diversity and carbon stock conservation to be achieved for the same total budget if both objectives are pursued in tandem rather than independently. Tropical forests with low elevation variability and low tree density supported significantly higher wildlife diversity. These tropical forest characteristics may provide more affordable proxies of wildlife diversity for future multi-objective conservation planning when fine scale data on wildlife are lacking

Invasion of freshwater ecosystems is promoted by network connectivity to hotspots of human activity

Aim: Hotspots of human activity are focal points for ecosystem disturbance and non‐native introduction, from which invading populations disperse and spread. As such, connectivity to locations used by humans may influence the likelihood of invasion. Moreover, connectivity in freshwater ecosystems may follow the hydrological network. Here we tested whether multiple forms of connectivity to human recreational activities promotes biological invasion of freshwater ecosystems. Location: England, UK. Time period: 1990–2018. Major taxa studied: One hundred and twenty‐six non‐native freshwater birds, crustaceans, fish, molluscs and plants. Methods: Machine learning was used to predict spatial gradients in human recreation and two high risk activities for invasion (fishing and water sports). Connectivity indices were developed for each activity, in which human influence decayed from activity hotspots according to Euclidean distance (spatial connectivity) or hydrological network distance (downstream, upstream and along‐channel connectivity). Generalized linear mixed models identified the connectivity type most associated to invasive species richness of each group, while controlling for other anthropogenic and environmental drivers. Results: Connectivity to humans generally had stronger positive effects on invasion than all other drivers except recording effort. Recreation had stronger influence than urban land cover, and for most groups high risk activities had stronger effects than general recreation. Downstream human connectivity was most important for invasion by most of the groups, potentially reflecting predominantly hydrological dispersal. An exception was birds, for which spatial connectivity was most important, possibly because of overland dispersal capacity. Main conclusions: These findings support the hypothesis that freshwater invasion is partly determined by an interaction between human activity and species dispersal in the hydrological network. By comparing alternative connectivity types for different human activities, our approach could enable robust inference of specific pathways and spread mechanisms associated with particular taxa. This would provide evidence to support better prioritization of surveillance and management for invasive non‐native species

Frequency of five cardiovascular/hemostatic entities as primary manifestations of SARS-CoV-2 infection: Results of the UMC-19-S2

Infection by SARS-Cov-2 is mainly characterized by fever and respiratory symptoms, with dyspnea and lung infiltrates in more severe cases [1,2]. Many patients also present a pro-coagulant state, which is biochemically detected by increased D-dimer levels and is related to complications and a worse prognosis [1,3]. In this context, isolated case reports and short case series have suggested an increased risk of patients with COVID-19 to develop clinically relevant cardiovascular and hemostatic disturbances [3–7]. Nonetheless, many of these reports refer to hospitalized patients, and as hospitalization itself usually increases complications in bedridden patients with multidrug treatmentor in very poor condition, it is unknown if such cardiovascular/hemostatic processes are related to the pathogenesis of SARS-Cov-2. Focus on patients with COVID-19 at emergency department (ED) arrival could help to answer this question