Entire US Research Articles

Quadrivalent Conjugate Vaccine and Invasive Meningococcal Disease in US Adolescents and Young Adults

Beginning in 2005, the US implemented routine immunization of adolescents with a quadrivalent conjugate vaccine (MenACWY) for the prevention of invasive meningococcal disease (IMD). To assess whether MenACWY immunization was associated with a reduced IMD burden among the US adolescent population and how the downward trajectory of IMD that began in the mid-1990s might have evolved in the absence of vaccination efforts. In this decision analytical study, a bayesian hierarchical Poisson regression model was developed to investigate the potential trajectory of IMD among US adolescents and young adults without vaccination and evaluate the direct association of vaccination with IMD burden. The model included the entire age-stratified US population and was fitted to national incidence data for serogroups C, W, and Y from January 1, 2001, to December 31, 2021, with stratification by vaccination status for IMD cases. Simulated counterfactual scenario of absent vaccination from 2005 to 2021, while retaining the incidence rate of IMD for unvaccinated individuals estimated during model fitting. The main outcomes were the estimated numbers of IMD cases and deaths averted by MenACWY vaccination among US adolescents and young adults aged 11 to 23 years. Among the entire US population from 2005 to 2021, MenACWY vaccination prevented an estimated 172 (95% credible interval [CrI], 85-345) cases of IMD among US adolescents 11 to 15 years of age and 328 (95% CrI, 164-646) cases of IMD among those aged 16 to 23 years. Absent vaccination, the cumulative incidence of IMD in these age groups would have been at least 59% higher than reported over the same period with vaccination. Using case fatality rates of unvaccinated individuals derived from national data, vaccination averted an estimated 16 (95% CrI, 8-31) deaths among adolescents aged 11 to 15 years and 38 (95% CrI, 19-75) deaths among those aged 16 to 23 years. This decision analytical model suggests that the MenACWY vaccination program in the US was associated with a reduced burden of meningococcal disease. Without vaccination, the incidence rates per 100 000 adolescents and young adults would have been substantially higher than those observed during the vaccine era.

Citizen science observations shed light on how anthropogenic food sources influence wildlife disease.

Research Highlight: Knutie, S., Bahouth, R., Bertone, M., Webb, C., Mehta, M., Nahom, M., Barta, R., Ghai, S., Love, A., Horan, S., Soldo, A., Cochrane, E., Bartholomew, J., Cowan, E., Bjerke, H., Balenger, S., Butler, M., Cornell, A., Kennedy, A., Rolland, V., Schultz, E., Stanback, M., Taff, C., Albery, G. (2024). Understanding spatiotemporal effects of food supplementation on host-parasite interactions using community-based science. Journal of Animal Ecology. https://doi.org/10.1111/1365-2656.14155. Wildlife have become increasingly dependent on anthropogenic food supplementation, resulting in altered nutritional intake and inter- and intraspecific interactions. Subsequently, supplemental feeding can affect both the immunological function of individuals and transmission dynamics among individuals and species. The magnitude of the effect supplemental feeding has on disease is likely to vary across time and space with the nutritional demands of hosts. However, the broad temporal or spatial scale effects of supplementation are poorly understood. Recently, Knutie etal. (2024) introduced their citizen science program, the Nest Parasite Community Project, a broadscale coordinated effort by scientists and the public to monitor box nesting wild birds and their ectoparasites across the eastern United States. The authors amassed an impressive 4-year data set with hundreds of nests spanning the entire US breeding range of Eastern bluebirds (Sialia sialis). In the first study to come from the project, the authors demonstrate that the effects of food supplementation on host-parasite interactions vary across time and space and do not consistently influence host-parasite outcomes, highlighting that host-parasite interactions are often context dependent and influenced by many environmental factors (e.g. weather and habitat quality). The authors also found that supplemental feeding increases host fitness, regardless of parasitism. The study provides strong evidence that citizen science projects can help broaden our understanding of how human food sources influence wildlife disease in various environmental contexts.

Asian American Diversity and Representation in the Health Care Workforce, 2007 to 2022

Asian American individuals comprise over 40 ethnoracial groups but are regularly aggregated into 1 category within health workforce analysis, thus obscuring substantial inequities in representation. To describe trends in Asian American diversity across the 4 most populous US health professions (physicians, registered nurses, nursing assistants, and home health aides) and to characterize subgroup representation within professions. Serial cross-sectional study from American Community Survey (ACS) population estimates of people reporting health profession occupations from 2007 to 2022. The ACS samples US residents every day, with approximately 3.5 million surveyed each year. Based on their sampling methods, the ACS then produces estimates of the entire US population for 1-year, 3-year, and 5-year periods. Data were analyzed from April to August 2024. For each year and subgroup, the proportions of the US population, the profession, and Asian American individuals within the profession were calculated. The representation quotient (RQ) of each subgroup was then calculated, defined as the proportion of the subgroup within the profession of interest divided by the proportion of the subgroup within the US population. Trends were examined over the 15-year period. Over the 15-year period, Indian Americans composed the largest percentage of Asian American physicians (mean [SD], 40.6% [1.6%]), followed by Chinese Americans (mean [SD], 18.9% [1.4%]). Pakistani and Indian Americans had the highest relative representation (mean [SD] RQ, 8.9 [0.9] and 7.8 [0.9], respectively). Conversely, Cambodian and Hmong Americans remained largely underrepresented (mean [SD] RQ, 0.2 [0.2] for both). Filipinx Americans accounted for more than half of Asian American registered nurses and nursing assistants, with high relative representation (mean [SD] RQ, 5.6 (0.3) and 2.9 [0.4], respectively). Bangladeshi and Chinese American relative representation were high among home health aides (mean [SD] RQ, 4.1 [1.5] and 2.7 [0.5], respectively). Asian American individuals accounted for an estimated 22% of physicians (approximately 260 693 respondents), 10% of registered nurses (approximately 420 418 respondents), 4.8% of nursing assistants (approximately 93 913 respondents), and 8.3% of home health aides (approximately 60 968 respondents) in 2022. By examining disaggregated data, this study found persistent inequities among Asian American subgroups in the health workforce. Reducing Asian American populations to a single racialized group erases subgroup differences rooted in histories of racism, colonialism, and xenophobia; enables false narratives of Asian American overrepresentation and success; and hampers progress in advancing health justice.

Abstract A015: Small area-estimation for low mammography screening: Geographic and racial disparities in mammography screening, 2015 – 2022

Abstract Background: Mammography screening is associated with at least a 20% reduction in breast cancer mortality. However, there are racial/ethnic differences in breast cancer mortality. For example, non-Hispanic Black (NHB) women are significantly more likely to die of breast cancer than non-Hispanic White (NHW) women. Few studies have reported small-area estimates for mammography screening among the entire US population; differences by race were either not examined or resulted in mixed findings. The American Cancer Society (ACS) and the United States Preventive Services Taskforce (USPSTF) recommend regular mammography screening from age 40 through 74 years. The current study aims to identify areas of up-to-date mammography screening and to elucidate whether mammography screening varied by geographical location, race, or ethnicity. Methods: Mammography screening within the past 12 months was retrieved from the 2015-2022 Behavioral Risk Factor Surveillance System data. The study population consisted of adult women aged 40 and older residing within the United States. 2020 US census tract population estimates were used to generate gender (all women), race/ethnicity (NHB, NHW, non-Hispanic Asian, and Hispanic/Latina), income, and age group weights for each US census tract. Synthetic estimates of mammography screening uptake at the census tract were conducted using our novel PARIS model (Probability of mammography screening within the past year, given age, race/ethnicity, income, and state) using a multilevel logistic regression model. Regional differences in mammography screening by US Census Bureau regions and divisions were examined. Results: Up-to-date mammography among all women in the sample was 55.98% (SD = 2.07; F (3, 72429) = 2886.81, p < .0001). Mammography screening examined by race indicated the greatest screening rates among non-Hispanic Black women (M = 60.78, SD = 3.11) and least among Asian women (M = 48.68, SD = 3.15). Among four US Census Bureau regions, the West region had the lowest rates of mammography screening among women (M = 54.74, SD = 1.85) while the South region had the highest rates (M = 56.55, SD = 2.18; F(3, 72429) = 2886.81, p < .0001). After further parsing geographical units, the West Pacific region, among the 9 US Census Bureau divisions, had the lowest mammography screening (M = 54.53, SD = 1.81) while the East South Central division had the highest rates of mammography screening (M = 56.94, SD = 2.10; F(8, 72429) = 1360.60, p < .0001).Conclusion: Using novel geospatial methods, the current study elucidated significant differences in mammography screening by race and place. These results suggest that Black women and women living in the South have higher up-to-date mammography screening compared to other women. Thus, the existing inequities in breast cancer outcomes may be explained by differences in the cancer care continuum (delays in follow-up care, treatment, and breast cancer survival). Further examination of the interplay between screening uptake, late-stage diagnosis, and death is needed. Citation Format: Sydney P. Howard, Justin X. Moore, Elinita Pollard, Ryan Johnson, Lovoria Williams, Adebola Adegboyega, Jie Chen, Jorge Cortes, Aimee James. Small area-estimation for low mammography screening: Geographic and racial disparities in mammography screening, 2015 – 2022 [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A015.

Association of diastolic and systolic blood pressure with depression: a cross-sectional study from NHANES 2005-2018.

Many studies worldwide have reported the association between mental health and blood pressure, but the results are mixed, and even contradictory. We aim to investigate the relationship between systolic and diastolic blood pressure and depression in the entire US population. This study analyzed cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. All adults completed 3-4 blood pressure measurements after sitting quietly for 5 minutes. Depression was diagnosed based on the Patient Health Questionnaire (PHQ-9), with a score ≥10 defined as depression. Weighted logistic regression and restricted cubic splines (RCS) were used to assess the relationship between blood pressure and depression. Two-piecewise linear regression was used to determine the inflection point. Additionally, subgroup analyses and interaction tests were conducted to identify potential subgroups. Finally, two sensitivity analyses were conducted. A total of 26,581 American adults were included, with a mean age of 47.2 years, of whom 13,354 (49.54%) were male; 2,261 individuals were defined as depressed, with a weighted prevalence of 7.41%. All participants' mean systolic blood pressure (SBP) was 121.7 mmHg, and the mean diastolic blood pressure (DBP) was 70.9 mmHg. RCS showed a nonlinear association between SBP and depression, while DBP showed a positive linear association with depression. Two-piecewise linear regression showed that the inflection point of the association between SBP and depression was 129.7 mmHg. Weighted logistic regression showed that after fully adjusting for depression-related risk factors, there was a significant positive correlation between per 10 mmHg increase in DBP and depression (OR: 1.06, 95% CI: 1.00-1.12, P=0.04); however, only on the left side of the inflection point, SBP tended to decrease the odds of depression (P =0.09). Furthermore, interaction analysis showed that the association between DBP and depression was significantly stronger in cancer patients (P for interaction=0.02); on the left side of the inflection point (<129.7 mmHg), current smokers also significantly interacted with SBP (P for interaction=0.018). Finally, two sensitivity analyses also supported our findings. In the adult population of the United States, there is a positive linear association between DBP and depression, while the association between SBP and depression exhibits a significant threshold effect, maintaining SBP at 129.7 mmHg is associated with the lowest prevalence of depression.

Potential US Health Care Savings Based on Clinician Views of Feasible Site-of-Care Shifts

Shifting care to alternative sites when clinically appropriate may be associated with reduced US health care spending, improved access, and, in some cases, improved care outcomes. To fill 2 main gaps in the current literature on site-of-care shifts: (1) understanding the clinician perspective on appropriateness of alternative care sites, given the central role they play in referrals and patient trust and (2) considering all potential sites where care could shift and calculating net savings potential. In this survey study, physicians (MDs and DOs), nurse practitioners, physician assistants, nurse anesthetists, radiology and imaging technicians, and psychologists were surveyed from September 17 to November 22, 2021, about potential shifts of care from the hospital setting to alternative sites. Participants were selected by the survey firm Intellisurvey to provide broad representation across all specialties of interest. A minimum of 34 clinicians responded to each question. Data were analyzed from April 2022 through October 2023. More than 5000 individual diagnostic and procedural codes were reviewed and sorted into 312 distinct care activities by an expert panel of physicians. Survey respondents were then provided with the 2019 claims-based distribution across sites of care for each care activity and were asked, "based on your clinical judgment, what portion of [care activity] could safely occur in each of the following sites of care, without compromising clinical outcomes?" Based on clinician-reported distributions, the total potential shift of volume from hospital-based settings to alternative sites and the associated net savings were estimated. Survey respondents included 1069 practicing clinicians (386 female [36.1%]; mean [SD] years since residency of physicians, 21.0 [9.7] years; mean [SD] age of nonphysicians, 45.3 [9.4] years) across specialties, all of whom practiced more than 20 clinical hours per week. There were 794 physicians (74.3%), and the remaining 275 respondents were midlevel professionals, such as physician assistants. Among 312 care activities surveyed, respondents indicated that 10.3 percentage points (95% CI, 10.0-10.5 percentage points) of commercial and 10.9 percentage points (95% CI, 10.7-11.1 percentage points) of Medicare volume currently taking place in hospital-based settings could shift to alternative sites with today's technology without compromising clinical outcomes. Across the entire US health care system, these shifts could be associated with a reduction in overall health care consumption spending ($3 562 339 000 000 000) by approximately $113.8 billion ($113 767 446 087 174 [3.2%]) to $147.7 billion ($147 661 672 284 263 [4.1%]) annually. In this study, a substantial net savings opportunity was estimated. However, realizing this potential will require ongoing alignment among organizations, clinicians, and policymakers to overcome barriers to these shifts.

An invasive prey and changing climate interact to shape the breeding phenology of an endangered predator.

Changes in phenology are occurring from global climate change, yet the impacts of other types of global change on the phenology of animals remain less appreciated. Understanding the potential for synergistic effects of different types of global change on phenology is needed, because changing climate regimes can have cascading effects, particularly on invasive species that vary in their thermal tolerances. Using 25 years of data from 5963 nests and 4675 marked individuals across the entire US breeding range of an endangered predator, the snail kite (Rostrhamus sociabilis plumbeus), we isolated the effects of an invasion of novel prey and warming temperatures on breeding phenology and its demographic consequences. Over this time period, breeding season length doubled, increasing by approximately 14 weeks. Both temperature and the establishment of invasive prey interacted to explain the timing of nest initiation. Temperature and invasive prey played distinct roles: earlier nest initiation occurred with increasing temperatures, whereas late nesting increased with invasion. Ultimately, both nest survival and juvenile survival declined later in the year, such that effects from invasive prey, but not warming temperatures, have the apparent potential for mistiming in breeding phenology by some individuals. Nonetheless, relatively few nesting events occurred during late fall when nest survival was very low, and seasonal declines in nest survival were weaker and renesting was more frequent in invaded wetlands, such that total reproductive output increased with invasion. Variation in demographic effects illustrate that considering only particular components of demography (e.g., nest survival rates) may be inadequate to infer the overall consequences of changes in phenology, particularly the potential for mistiming of phenological events. These results emphasize that species invasions may profoundly alter phenology of native species, such effects are distinct from climate effects, and both interact to drive population change.

Irrigation expansion shows potential for increased maize yield and reduced nitrogen leaching in the Midwest US

CONTEXTYield gaps in Midwest US rainfed maize (Zea mays L.) are likely to continue to increase as the frequency of extreme weather events associated with future climate change increase (i.e., high temperatures, precipitation variability). One solution to closing this gap is the expansion of irrigation in regions that currently do not utilize this practice. While irrigation expansion has the potential to increase maize yields and crop productivity, there is also the potential to see improvement in nitrogen loss. However, it remains unclear at what point irrigation should be triggered (i.e., plant available water content (AWC) thresholds) to obtain a balance between crop productivity and environmental improvements. OBJECTIVEThe objective of this study is to assess the effects of irrigation management on maize yield, nitrogen leaching, and water use efficiency under the expansion of irrigation across the entire Midwest US and to determine the optimal plant AWC threshold to trigger irrigation for achieving a substantial increase in maize yield and reduction in nitrogen leaching while using the minimal amount of required irrigation. METHODSWe use an agroecosystem model, Agro-IBIS, to simulate both rainfed and irrigated maize production and nitrogen leaching under likely future climate conditions (i.e., wet-warm, dry-warm). To determine the optimal plant AWC threshold for irrigation, irrigation scenarios were conducted for a range of plant AWC thresholds (0.2 to 0.8) across the entire Midwest US. RESULTS AND CONCLUSIONSOur results show that Midwest US regions that do not currently utilize irrigation could experience an 11–37% increase in maize yield and a 12–32% decrease in nitrogen leaching when irrigation (39.0 to 96.8 mm yr−1) is triggered at the lower end of the plant AWC threshold (e.g., 0.3). Maize grown under dry-warm and wet-warm climate conditions will likely experience increased yields and reduced nitrogen loss with minimal irrigation. While these findings suggest that the expansion of irrigation could help close yield gaps while improving other ecosystem services, future work should focus on simulating these conditions under a wider range of precipitation extremes and fertilizer management to better understand the potential interactions under a changing climate. SIGNIFICANCEThis study outlines the optimal plant AWC threshold for irrigation to maximize maize yields in the Midwest while minimizing nitrogen loss and can provide valuable insights for making informed decisions about landscape management under future conditions.

High resolution assessment of commercial fisheries activity along the US West Coast using Vessel Monitoring System data with a case study using California groundfish fisheries

Commercial fisheries along the US West Coast are important components of local and regional economies. They use various fishing gear, target a high diversity of species, and are highly spatially heterogeneous, making it challenging to generate a synoptic picture of fisheries activity in the region. Still, understanding the spatial and temporal dynamics of US West Coast fisheries is critical to meet the US legal mandate to manage fisheries sustainably and to better coordinate activities among a growing number of users of ocean space, including offshore renewable energy, aquaculture, shipping, and interactions with habitats and key non-fishery species such as seabirds and marine mammals. We analyzed vessel tracking data from Vessel Monitoring System (VMS) from 2010 to 2017 to generate high-resolution spatio-temporal estimates of contemporary fishing effort across a wide range of commercial fisheries along the entire US West Coast. We identified over 247,000 fishing trips across the entire VMS data, covering over 25 different fisheries. We validated the spatial accuracy of our analyses using independent estimates of spatial groundfish fisheries effort generated through the NOAA’s National Marine Fisheries Service Observer Program. Additionally, for commercial groundfish fisheries operating in federal waters in California, we combined the VMS data with landings and ex-vessel value data from California commercial fisheries landings receipts to generate highly resolved estimates of landings and ex-vessel value, matching over 38,000 fish tickets with VMS data that included 87% of the landings and 76% of the ex-vessel value for groundfish. We highlight fisheries-specific and spatially-resolved patterns of effort, landings, and ex-vessel value, a bimodal distribution of fishing effort with respect to depth, and variable and generally declining effort over eight years. The information generated by our study can help inform future sustainable spatial fisheries management and other activities in the marine environment including offshore renewable energy planning.

NeTrainSim: a network-level simulator for modeling freight train longitudinal motion and energy consumption

AbstractAlthough train modeling research is vast, most available simulation tools are confined to city- or trip-scale analysis, primarily offering micro-level simulations of network segments. This paper addresses this void by developing the NeTrainSim simulator for heavy long-haul freight trains on a network of multiple intersecting tracks. The main objective of this simulator is to enable a comprehensive analysis of energy consumption and the associated carbon footprint for the entire train system. Four case studies were conducted to demonstrate the simulator’s performance. The first case study validates the model by comparing NeTrainSim output to empirical trajectory data. The results demonstrate that the simulated trajectory is precise enough to estimate the train energy consumption and carbon dioxide emissions. The second application demonstrates the train-following model considering six trains following each other. The results showcase the model ability to maintain safe-following distances between successive trains. The next study highlights the simulator’s ability to resolve train conflicts for different scenarios. Finally, the suitability of the NeTrainSim for modeling realistic railroad networks is verified through the modeling of the entire US network and comparing alternative powertrains on the fleet energy consumption.

Sugar-sweetened beverage intake and long-term mortality in individuals with metabolic dysfunction-associated steatotic liver disease: a longitudinal analysis of the National Health and Nutrition Examination Survey database.

Consuming sugar-sweetened beverages (SSBs) has been linked to the development of various adverse health conditions, including metabolic dysfunction-associated steatotic liver disease (MASLD). This study evaluated associations between SSB intake and long-term mortality among individuals with MASLD using a nationally representative database. This population-based, longitudinal study extracted data of adults aged 20-79 years with MASLD from the USA (US) National Health and Nutrition Examination Survey database 2003-2014. Associations between the amount of SSB intake and all-cause, cancer and cardiovascular disease mortality until the end of 2019 were determined using Cox proportional hazards regression analyses. A total of 12 965 individuals aged 20-79 years who had MASLD were identified in the database. After exclusion, 5630 participants remained for the analyses. This cohort can be extrapolated to 43 420 321 individuals in the entire US after proper weighting. The mean age of the study cohort was 44.1 years. After adjusting for confounders, no significant association was observed between SSB intake (tertile 3 vs. tertile 1) and all-cause [adjusted hazard ratio (aHR): 1.03, 95% confidence interval (CI), 0.60-1.76) or cancer mortality (aHR, 0.41; 95% CI, 0.15-1.16). However, higher SSB intake (tertile 3 vs. tertile 1) was significantly associated with elevated cardiovascular disease mortality risk (aHR = 2.83; 95% CI, 1.01-7.91). In US adults with MASLD, high SSB intake is associated with nearly three-fold increased cardiovascular disease mortality risk. The findings underscore the critical need for concerted action on the part of healthcare providers and policymakers.

Increasing Racial and Ethnic Disparities in Ambient Air Pollution-Attributable Morbidity and Mortality in the United States.

Ambient nitrogen dioxide () and fine particulate matter with aerodynamic diameter () threaten public health in the US, and systemic racism has led to modern-day disparities in the distribution and associated health impacts of these pollutants. Many studies on environmental injustices related to ambient air pollution focus only on disparities in pollutant concentrations or provide only an assessment of pollution or health disparities at a snapshot in time. In this study, we compare injustices in and health burdens, considering health impacts across the entire US; document changing disparities in these health burdens over time (2010-2019); and evaluate how more stringent air quality standards would reduce disparities in health impacts associated with these pollutants. Through a health impact assessment, we quantified census tract-level variations in health outcomes attributable to and using health impact functions that combine demographic data from the US Census Bureau; two spatially resolved pollutant datasets, which fuse satellite data with physical and statistical models; and epidemiologically derived relative risk estimates and incidence rates from the Global Burden of Disease study. Despite overall decreases in the public health damages associated with and , racial and ethnic relative disparities in pediatric asthma and premature mortality have widened in the US during the last decade. Racial relative disparities in premature mortality and pediatric asthma have increased by 16% and 19%, respectively, between 2010 and 2019. Similarly, ethnic relative disparities in premature mortality have increased by 40% and pediatric asthma by 10%. Enacting and attaining more stringent air quality standards for both pollutants could preferentially benefit the most marginalized and minoritized communities by greatly reducing racial and ethnic relative disparities in pollution-attributable health burdens in the US. Our methods provide a semi-observational approach to track changes in disparities in air pollution and associated health burdens across the US. https://doi.org/10.1289/EHP11900.

Impact of the COVID-19 Pandemic on People Living With Rare Diseases and Their Families: Results of a National Survey.

With more than 103 million cases and 1.1 million deaths, the COVID-19 pandemic has had devastating consequences for the health system and the well-being of the entire US population. The Rare Diseases Clinical Research Network funded by the National Institutes of Health was strategically positioned to study the impact of the pandemic on the large, vulnerable population of people living with rare diseases (RDs). This study was designed to describe the characteristics of COVID-19 in the RD population, determine whether patient subgroups experienced increased occurrence or severity of infection and whether the pandemic changed RD symptoms and treatment, and understand the broader impact on respondents and their families. US residents who had an RD and were <90 years old completed a web-based survey investigating self-reported COVID-19 infection, pandemic-related changes in RD symptoms and medications, access to care, and psychological impact on self and family. We estimated the incidence of self-reported COVID-19 and compared it with that in the US population; evaluated the frequency of COVID-19 symptoms according to self-reported infection; assessed infection duration, complications and need for hospitalization; assessed the influence of the COVID-19 pandemic on RD symptoms and treatment, and whether the pandemic influenced access to care, special food and nutrition, or demand for professional psychological assistance. Between May 2, 2020, and December 15, 2020, in total, 3413 individuals completed the survey. Most were female (2212/3413, 64.81%), White (3038/3413, 89.01%), and aged ≥25 years (2646/3413, 77.53%). Overall, 80.6% (2751/3413) did not acquire COVID-19, 2.08% (71/3413) acquired it, and 16.58% (566/3413) did not know. Self-reported cases represented an annual incidence rate of 2.2% (95% CI 1.7%-2.8%). COVID-19 cases were more than twice the expected (71 vs 30.3; P<.001). COVID-19 was associated with specific symptoms (loss of taste: odds ratio [OR] 38.9, 95% CI 22.4-67.6, loss of smell: OR 30.6, 95% CI 17.7-53.1) and multiple symptoms (>9 symptoms vs none: OR 82.5, 95% CI 29-234 and 5-9: OR 44.8, 95% CI 18.7-107). Median symptom duration was 16 (IQR 9-30) days. Hospitalization (7/71, 10%) and ventilator support (4/71, 6%) were uncommon. Respondents who acquired COVID-19 reported increased occurrence and severity of RD symptoms and use or dosage of select medications; those who did not acquire COVID-19 reported decreased occurrence and severity of RD symptoms and use of medications; those who did not know had an intermediate pattern. The pandemic made it difficult to access care, receive treatment, get hospitalized, and caused mood changes for respondents and their families. Self-reported COVID-19 was more frequent than expected and was associated with increased prevalence and severity of RD symptoms and greater use of medications. The pandemic negatively affected access to care and caused mood changes in the respondents and family members. Continued surveillance is necessary.

Bigfoot: If it's there, could it be a bear?

AbstractIt has been suggested that the American black bear (Ursus americanus) may be responsible for a significant number of purported sightings of an alleged unknown species of hominid in North America. Previous analyses have identified a correlation between ‘sasquatch’ or ‘bigfoot’ sightings and black bear populations in the Pacific Northwest using ecological niche models and simple models of expected animal sightings. The present study expands the analysis to the entire US and Canada by modelling sasquatch sightings and bear populations in each state/province while adjusting for human population and forest area in a generalized linear model. Sasquatch sightings were statistically significantly associated with bear populations such that, on the average, every bear increase in the bear population is associated with a ( CI: –) increase in sasquatch sightings. Thus, as black bear populations increase, sasquatch sightings are expected to increase. On average, across all states and provinces in 2006, after controlling for human population and forest area, there were approximately bears per sasquatch sighting. Based on statistical considerations, it is likely that many supposed sasquatch are really misidentified known forms. If bigfoot is there, it could be a bear.

The historical lepto-variance of the US stock returns

&lt;abstract&gt; &lt;p&gt;Regression trees (RT) involve sorting samples based on a particular feature and identifying the splitting point that yields the highest drop in variance from a parent node to its children. The optimal factor for reducing mean squared error (MSE) is the target variable itself. Consequently, employing the target variable as the basis for splitting sets an upper limit on the reduction of MSE and, equivalently, a lower limit on the residual MSE. Building upon this observation, we define lepto-regression as the process of constructing an RT of a target feature on itself. Lepto-variance pertains to the portion of variance that cannot be mitigated by any regression tree, providing a measure of inherent variance at a specific tree depth. This concept is valuable as it offers insights into the intrinsic structure of the dataset by establishing an upper boundary on the "resolving power" of RTs for a sample. The maximal variance that can be accounted for by RTs with depths up to &lt;italic&gt;k&lt;/italic&gt; is termed the sample k-bit macro-variance. At each depth, the overall variance within a dataset is thus broken into lepto- and macro-variance. We perform 1- and 2-bit lepto-variance analysis for the entire US stock universe for a large historical period since 1926. We find that the optimal 1-bit split is a 30–70 balance. The two children subsets are centered roughly at −1% and 0.5%. The 1-bit macro-variance is almost 42% of the total US stock variability. The other 58% is structure beyond the resolving power of a 1-bit RT. The 2-bit lepto-variance equals 26.3% of the total, with 42% and 47% of the 1-bit lepto-variance of the left and right subtree, respectively.&lt;/p&gt; &lt;/abstract&gt;

Quantification and visualization of US racial geography using the National Racial Geography Dataset 2020.

Racial geography studies the spatial distributions of multiracial populations. Technical challenges arise from the fact that US Census data, upon which all US-based studies rely, is only available in the form of spatial aggregates at a few levels of granularity. This negatively affects spatial analysis and, consequently, the quantification of racial segregation, especially on a smaller length scale. A recent methodology called the Racial Landscape (RL) stochastically disaggregates racial data at the level of census block aggregates into a grid of monoracial cells. RL-transformed racial data makes possible pattern-based, zoneless analysis, and visualization of racial geography. Here, we introduce the National Racial Geography Dataset 2020 (NRGD2020)-a collection of RL-based grids calculated from the 2020 census data and covering the entire conterminous US. It includes a virtual image layer for a bird's-eye-like view visualization of the spatial distribution of racial sub-populations, numerical grids for calculating racial diversity and segregation within user-defined regions, and precalculated maps of racial diversity and segregation on various length scales. NRGD2020 aims to facilitate and extend spatial analyses of racial geography and to make it more interpretable by tightly integrating quantitative analysis with visualization (mapping).

Charcot neuroarthropathy in persons with diabetes: It's time for a paradigm shift in our thinking.

The aim of this paper is to review the recent literature regarding the epidemiology and surgical management of Charcot neuro-osteoarthropathy (CNO). We propose that a fundamental change in the approach and assumptions regarding the historical treatment of active CNO should be considered. Although the true incidence and prevalence of CNO in the US population with diabetes are not known, we estimated the incidence to be 27,602 per year and the prevalence to be 208,880 persons. In persons with diabetes, the incidence of CNO is higher than that of prostate, lung, kidney, and thyroid cancer, and in the entire US population, the incidence of CNO is higher than that of multiple myeloma, soft tissue sarcoma, and primary bone sarcoma. In persons with diabetes, the incidence of CNO is higher than fractures of the femoral shaft, distal femur, tibia, talus, calcaneus and Lisfranc ligament injuries. Surgical techniques have evolved over the past half century, and surgery is the standard for treating displaced fractures and intra-articular injuries. Since CNO is a fracture, dislocation, or fracture dislocation in patients with neuropathy, why do we treat CNO differently? Elsewhere in the skeleton displaced osseous and ligament injuries are treated surgically. Based on the information presented in this manuscript, we suggest that it is time for a paradigm shift in the treatment of persons with CNO. While uncommon, CNO in persons with diabetes is not rare. Given the advances in surgical techniques, surgical intervention should be considered earlier in persons with CNO who are at risk for developing deformity related foot ulceration.

Common Ground: The Unique Synergy Between the Oil Field and Aerospace

Though disparate locations, outer space and the oil field have much more in common than one might think. Both can be taxing on operations and often redefine the idea of an isolated and, at times, hostile work environment. Harsh atmospheric conditions and wide-ranging pressure regimes call for unique technological applications and operations to achieve the best performance and results, whether it’s the gravitational and meteorological challenges of another planet or the crushing pressures and changing meta-ocean conditions of the deep offshore. Despite the obvious differences, operating in both the terran oil field and the blackness of space offer hurdles that can be cleared by similar means. Shared technologies between the two industries have been around for decades and center around disciplines like automation, robotics, and remote sensing. The National Aeronautics and Space Administration (NASA) itself has dabbled in oilfield studies, especially when it comes to greenhouse gas emissions and their impact on the atmosphere. In 2021, the agency’s Jet Propulsion Laboratory, along with the University of Arizona and Arizona State University, completed a study to identify methane super-emitters in the Permian Basin. The month-long, airborne study concluded that fixing the worst leaks identified in the area’s infrastructure could cut methane emissions by 55 tons an hour, equivalent to 5.5% of the US Environmental Protection Agency’s estimates of all methane emissions from hydrocarbon production across the entire US. The study pointed to malfunctioning equipment as the likely culprit for the 123 sources found. Conversely, NASA has also tapped into oilfield technology for some of its planned drilling operations on the moon. It will be the first such operation on any planetary body outside of the Earth. One of the earliest directives of NASA’s Artemis program is to try and find water near the lunar South Pole. Polar Resources Ice Mining Experiment-1 (PRIME-1) will be the first in-situ resource utilization demonstration on the moon. For the first time, NASA will robotically sample and analyze for ice from below the surface. PRIME-1 will use TRIDENT (The Regolith and Ice Drill for Exploring New Terrain) to drill in a single location at a site with a high likelihood of having water, whether in liquid or ice form. TRIDENT was developed and supplied by Honeybee Robotics, which also supplies geotechnical tools and sensors, among other tech, to the oil patch. The system, to be integrated into VIPER, NASA’s first robotic moon rover, will drill about a meter below the surface, each time bringing up samples that NASA will analyze with a mass spectrometer. The launch of the NOVA-C, which carries the PRIME-1, was previously delayed. At press time, the payload was due to blast off on board Space X’s Falcon 9 rocket in early 2024. NASA said in October the VIPER will reach its destination at Mons Mouton near the lunar South Pole in November 2024.

Ship recycling—estimating future stocks and readiness for green steel transformation

This article addresses ship recycling. Often criticized for dire health and safety conditions at breaking destinations in the Global South, our article considers ship recycling as a potential future source for secondary steel in green transformations. It represents an analysis of forthcoming changes in the regulatory framework, an initial assessment of steel stocks based on publicly available data, and a local case study. Here, the article assesses the capability of Bremen, a city in Northern Germany, to gain a relevant future market share. Our results indicate (a) the regulatory framework is dynamic due to the entry into force of the Hong Kong Convention in 2025 und the current revision of the EU Ship Recycling Regulation; (b) the future market is significant, roughly equivalent to the entire current US car fleet in terms of steel stocks; (c) the ability to act locally depends on a variety of critical factors, including political will, entrepreneurial capital, and space requirements. The article concludes with an outlook on the importance of such a development for the transition towards ‘net zero steel’ and provides a perspective on future research needs.

Abstract 18865: Cardiac Arrest on Weekends Are More Fatal Than Weekdays - A Study From National Database

Introduction: The overall survival of cardiac arrest patients is very poor. There is a higher incidence of cardiac arrest on weekends especially on Saturdays as per national statistics. Also, hospitals experience reduced staffing on the weekends. We examined the outcomes of cardiac arrests on weekends compared to weekdays. Hypothesis: There is no difference in mortality in cardiac arrests which happen over the weekday compared to over the weekend. Methods: This retrospective cohort study used a national inpatient sample database to identify patients from 2016 to 2019 presenting with cardiac arrest on weekdays vs on weekends. SAS 9.3 was used for data analysis. The data were weighted to generate national estimates of the entire US hospitalized population. Results: Out of 57,300 patients who presented with cardiac arrest during the study period, 41,410 were on weekdays (72.2%; mean age 65.9; 56.2% males) and 15,890 were on weekends (27.8%, mean age 65.2; 56.7% males). Inhospital mortality was less on weekdays than on weekends (72.4% vs 76.2%). The younger age group (18-40 years) had a higher share of of cardiac arrest on weekends when compared to weekdays (8.2% vs 7.1%). Weekday admissions had a higher rate of prior MI (8.9% vs 7.6%) and a higher rate of comorbities including DM (39.4% vs 36%), CHF (32.2% vs 28.9%), Renal Failure (29.5% vs 26.6%), CAD (34.8% vs 31.7%). Weekend admissions had a higher rate of smoking history (16.9% vs 15.1%). All p values &lt;0.001. Conclusions: Cardiac arrest on weekends has a higher mortality rate compared to weekdays. We found a higher burden of comorbidities on patients with weekday cardiac arrest.