Sustained Vigilance Research Articles

Passive and active exercise do not mitigate mental fatigue during a sustained vigilance task.

Executive function (EF) is improved following a single bout of exercise and impaired when an individual experiences mental fatigue (MF). These performance outcomes have been linked to a bi-directional change in cerebral blood flow (CBF). Here, we sought to determine whether MF-induced by a sustained vigilance task (i.e., psychomotor vigilance task: PVT) is mitigated when preceded by a single bout of exercise. Participants completed 20-min single bouts of active exercise (cycle ergometry involving volitional muscle activation), passive exercise (cycle ergometry involving a mechanical flywheel) and a non-exercise control intervention. EF was assessed pre- and post-intervention via the antisaccade task. Following each intervention, a 20-min PVT was completed to induce and assess MF, and transcranial Doppler ultrasound of middle cerebral artery velocity (MCAv) was used to estimate intervention- and PVT-based changes in CBF. Active and passive exercise provided a post-intervention reduction in antisaccade reaction times; that is, exercise benefitted EF. Notably, however, frequentist and Bayesian statistics indicated the EF benefit did not mitigate MF during the PVT. As well, although exercise (active and passive) and the PVT respectively increased and decreased CBF, these changes were not correlated with behavioral measures of EF or MF. Accordingly, a postexercise EF benefit does not mitigate MF during a sustained vigilance task and a bi-directional change in CBF does not serve as a primary mechanism associated with EF and MF changes. Such results provide a framework for future work to explore how different exercise types, intensities and durations may impact MF.

A real-world pharmacovigilance analysis of adverse events associated with irbesartan using the FAERS and JADER databases.

Hypertension is a leading global risk factor for disability and death. Irbesartan, a potent angiotensin II receptor blocker, requires continuous safety monitoring. We conducted a disproportionality analysis of irbesartan-related adverse drug events (ADEs) using the FDA's FAERS and Japan's JADER databases. We extracted irbesartan-related ADE reports from FAERS (Q1 2004 to Q1 2024) and JADER (Q2 2008 to Q4 2023). We used Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and Empirical Bayesian Geometric Mean (EBGM) for signal detection. Sensitivity analyses were conducted to exclude comorbid medications, and subgroup analyses by age and gender were performed to explore ADE occurrence in specific populations. Th time to onset (TTO) of ADEs was assessed using Weibull distribution test and Kaplan-Meier curves. A total of 5,816 (FAERS) and 366 (JADER) reports were analyzed, with irbesartan-related preferred terms (PTs) involving 27 System Organ Classes (SOCs) in FAERS and 22 in JADER. Three SOCs met detection thresholds in both databases: "metabolism and nutrition disorders," "cardiac disorders," and "renal and urinary disorders." We identified 219 positive signals in FAERS and 20 in JADER, including known signals like hyperkalemia, hypotension, and acute kidney injury. Notably, newly identified signals such as acute pancreatitis (n = 50, ROR: 7.76 [5.88-10.25]) and rhabdomyolysis (n = 50, ROR: 7.76 [5.88-10.25]) in FAERS and respiratory failure (n = 7, ROR: 6.76 [3.20-14.26]) in JADER could have significant clinical implications, as they may lead to severe outcomes if not recognized and managed promptly. Subgroup analyses revealed both similarities and differences in signal detection across gender and age groups. Sensitivity analyses, excluding concomitant medications, confirmed the persistence of key positive signals, including hyperkalemia, angioedema, acute pancreatitis, and agranulocytosis. ADEs mainly occurred within 1month (34.14%) and after 1year (32.32%) after dosing, with a median onset of 107days. This study provides valuable real-world evidence on the safety profile of irbesartan. The identification of new safety signals underscores the necessity of updating drug labels, particularly for assessing and managing high-risk patients. Additionally, the TTO analysis emphasizes the importance of sustained vigilance for adverse events over time. In conclusion, our findings contribute to a more comprehensive understanding of irbesartan's safety, aiding healthcare professionals in optimizing its use in clinical practice.

Analysis of seasonal H3N2 influenza virus epidemic characteristics and whole genome features in Jining City from 2018 to 2023.

Seasonal H3N2 influenza virus, known for its rapid evolution, poses a serious threat to human health. This study focuses on analyzing the influenza virus trends in Jining City (2018-2023) and understanding the evolving nature of H3N2 strains. Data on influenza-like cases were gathered from Jining City's sentinel hospitals: Jining First People's Hospital and Rencheng Maternal and Child Health Hospital, using the Chinese Influenza Surveillance Information System. Over the period from 2018 to 2023, 7844 throat swab specimens were assessed using real-time fluorescence quantitative PCR for influenza virus nucleic acid detection. For cases positive for seasonal H3N2 influenza virus, virus isolation was followed by whole genome sequencing. Evolutionary trees were built for the eight gene segments, and protein variation analysis was performed. From 2018 to 2023, influenza-like cases in Jining City represented 6.99% (237 299/3 397 247) of outpatient visits, peaking in December and January. Influenza virus was detected in 15.67% (1229/7844) of cases, primarily from December to February. Notably, no cases were found in the 2020-2021 season. Full genome sequencing was conducted on 70 seasonal H3N2 strains, revealing distinct evolutionary branches across seasons. Significant antigenic site variations in the HA protein were noted. No resistance mutations to inhibitors were found, but some strains exhibited mutations in PA, NS1, PA-X, and PB1-F2. Influenza trends in Jining City saw significant shifts in the 2020-2021 and 2022-2023 seasons. Seasonal H3N2 exhibited rapid evolution. Sustained vigilance is imperative for vaccine updates and antiviral selection.

Tackling Carbapenem Resistance and the Imperative for One Health Strategies-Insights from the Portuguese Perspective.

Carbapenemases, a class of enzymes specialized in the hydrolysis of carbapenems, represent a significant threat to global public health. These enzymes are classified into different Ambler's classes based on their active sites, categorized into classes A, D, and B. Among the most prevalent types are IMI/NMC-A, KPC, VIM, IMP, and OXA-48, commonly associated with pathogenic species such as Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa. The emergence and dissemination of carbapenemase-producing bacteria have raised substantial concerns due to their ability to infect humans and animals (both companion and food-producing) and their presence in environmental reservoirs. Adopting a holistic One Health approach, concerted efforts have been directed toward devising comprehensive strategies to mitigate the impact of antimicrobial resistance dissemination. This entails collaborative interventions, highlighting proactive measures by global organizations like the World Health Organization, the Center for Disease Control and Prevention, and the Food and Agriculture Organization. By synthesizing the evolving landscape of carbapenemase epidemiology in Portugal and tracing the trajectory from initial isolated cases to contemporary reports, this review highlights key factors driving antibiotic resistance, such as antimicrobial use and healthcare practices, and underscores the imperative for sustained vigilance, interdisciplinary collaboration, and innovative interventions to curb the escalating threat posed by antibiotic-resistant pathogens. Finally, it discusses potential alternatives and innovations aimed at tackling carbapenemase-mediated antibiotic resistance, including new therapies, enhanced surveillance, and public awareness campaigns.

Crab Harvesting, Sustainability Issues, and International Trade: Insights from Russia

This article aims to analyze Russia’s efforts, both domestically and internationally, to combat illicit crab harvesting and safeguard its marine resources. A comparison of total crab imports and allowable catch in Russian waters from 1990 to 2022 indicates a peak in shadow activities during the mid-2000s, with a cessation of large-scale illegal fishing observed since 2013. A narrative analysis of institutional shifts reveals that the bolstering of internal oversight, heightened accountability for harvesters, and enhanced global cooperation have been pivotal in fostering these positive dynamics. Concerning trends, however, emerged towards the beginning of the current decade, indicating potential instability within the legal framework of the crab industry. Persistent statistical discrepancies in trade with South Korea, diminishing institutional capacities within Russia to combat shadow activities, and heightened media scrutiny of illicit crab harvesting underscore the need for sustained vigilance in addressing both internal and external dimensions of this multifaceted problem.

Beyond the acute phase: a comprehensive literature review of long-term sequelae resulting from infectious diseases.

Infectious diseases have consistently served as pivotal influences on numerous civilizations, inducing morbidity, mortality, and consequently redirecting the course of history. Their impact extends far beyond the acute phase, characterized by the majority of symptom presentations, to a multitude of adverse events and sequelae that follow viral, parasitic, fungal, or bacterial infections. In this context, myriad sequelae related to various infectious diseases have been identified, spanning short to long-term durations. Although these sequelae are known to affect thousands of individuals individually, a comprehensive evaluation of all potential long-term effects of infectious diseases has yet to be undertaken. We present a comprehensive literature review delineating the primary sequelae attributable to major infectious diseases, categorized by systems, symptoms, and duration. This compilation serves as a crucial resource, illuminating the long-term ramifications of infectious diseases for healthcare professionals worldwide. Moreover, this review highlights the substantial burden that these sequelae impose on global health and economies, a facet often overshadowed by the predominant focus on the acute phase. Patients are frequently discharged following the resolution of the acute phase, with minimal long-term follow-up to comprehend and address potential sequelae. This emphasizes the pressing need for sustained vigilance, thorough patient monitoring, strategic health management, and rigorous research to understand and mitigate the lasting economic and health impacts of infectious diseases more fully.

Pathogenicity and Antibiotic Resistance of Pseudomonas aeruginosa: A Comprehensive Review

Pseudomonas aeruginosa (P. aeruginosa) presents a complex challenge in terms of pathogenicity and antibiotic resistance. This versatile pathogen adeptly colonises various host tissues and evades the immune system through its intricate virulence factors. The review delves into the antimicrobial resistance mechanisms at play, which encompass inherent resistance characteristics and those acquired through genetic mutations and horizontal gene transfer. Notably, efflux pump systems and limited membrane permeability underpin its inherent resistance, rendering many conventional antibiotics ineffective. Multidrug Resistant (MDR) strains are on the rise, posing a substantial threat to patient care and infection control. In response, innovative strategies are being explored, including combination therapies to enhance the effectiveness of existing antibiotics and drug repurposing, redirecting existing medications to target P. aeruginosa. Phage therapy, which leverages bacteriophages to combat P. aeruginosa infections, is gaining attention as a promising solution. Infection prevention and control are pivotal, particularly in healthcare settings, to curtail the spread of P. aeruginosa. Surveillance programs are crucial for monitoring the prevalence and dissemination of antibiotic-resistant strains and guiding response strategies during outbreaks. Comprehending P. aeruginosa’s complex virulence and resistance mechanisms is paramount for developing efficient treatments and effective infection control measures. Ongoing research and collaborative efforts are instrumental in mitigating the substantial impact of P. aeruginosa infections on public health, underscoring the need for sustained vigilance and innovation in infectious disease management.

Looking beyond vaccines: Cultural tightness-looseness moderates the relationship between immunization coverage and disease prevention vigilance.

Advancements in vaccination technologies mitigate disease transmission risks but may inadvertently suppress the behavioral immune system, an evolved disease avoidance mechanism. Applying behavioral immune system theory and utilizing robust big data analytics, we examined associations between rising vaccination coverage and government policies, public mobility, and online information seeking regarding disease precautions. We tested whether cultural tightness-looseness moderates the relationship between mass immunization and disease prevention vigilance. Comprehensive time series analyses were conducted using American data (Study 1) and international data (Study 2), employing transfer function modeling, cross-correlation function analysis, and meta-regression analysis. Across both the US and global analyses, as vaccination rates rose over time, government COVID-19 restrictions significantly relaxed, community mobility increased, and online searches for prevention information declined. The relationship between higher vaccination rates and lower disease prevention vigilance was stronger in culturally looser contexts. Results provide initial evidence that mass immunization may be associated with attenuated sensitivity and enhanced flexibility of disease avoidance psychology and actions. However, cultural tightness-looseness significantly moderates this relationship, with tighter cultures displaying sustained vigilance amidst immunization upticks. These findings offer valuable perspectives to inform nuanced policymaking and public health strategies that balance prudent precautions against undue alarm when expanding vaccine coverage worldwide.

National Influenza Annual Report, Canada, 2022-2023: Canada's first fall epidemic since the 2019-2020 season.

Coinciding with the beginning of the coronavirus disease 2019 (COVID-19) pandemic in March 2020, Canadian seasonal influenza circulation was suppressed, which was a trend reported globally. Canada saw a brief and delayed return of community influenza circulation during the spring of the 2021-2022 influenza season. Surveillance for Canada's 2022-2023 seasonal influenza epidemic began in epidemiological week 35 (week starting August 28, 2022) and ended in epidemiological week 34 (week ending August 26, 2023). The 2022-2023 season marked the return to pre-pandemic-like influenza circulation. The epidemic began in epidemiological week 43 (week ending October 29, 2022) and lasted 10 weeks. Driven by influenza A(H3N2), the epidemic was relatively early, extraordinary in intensity, and short in length. This season, a total of 74,344 laboratory-confirmed influenza detections were reported out of 1,188,962 total laboratory tests. A total of 93% of detections were influenza A (n=68,923). Influenza A(H3N2) accounted for 89% of the subtyped specimens (n=17,638/19,876). Late-season, Canada saw community circulation of influenza B for the first time since the 2019-2020 season. The 2022-2023 influenza season in Canada had an extraordinary impact on children and youth; nearly half (n=6,194/13,729, 45%) of reported influenza A(H3N2) detections were in the paediatric (younger than 19 years) population. Weekly paediatric influenza-associated hospital admissions were persistently above historical peak levels for several weeks. The total number of influenza-associated paediatric hospitalizations (n=1,792) far exceeded historical averages (n=1,091). With the return of seasonal influenza circulation and endemic co-circulation of multiple high burden respiratory viruses, sustained vigilance is warranted. Annual seasonal influenza vaccination is a key public health intervention available to protect Canadians.

Poliomyelitis alert on Tunisian borders: response and challenges

Abstract Introduction Poliomyelitis, which disappeared in Tunisia 30 years ago, should be the second disease to be eradicated after smallpox. However, a few endemic foci persist and its recent detection in some regions is causing great concern. On January 11, 2023, Tunisia received an alert with the notification of 2 polio cases in Algeria, the second of which was detected in November 2022 at about 400 KM from Tunisia. The objective of this study is to describe the results of the investigations following this alert as well as the prevention and response measures triggered. Methods We conducted an active search for acute flaccid paralysis (AFP) cases in all governorates and a retrospective search for possible unreported AFP cases hospitalized from November 1, 2022. Vaccination coverage was verified for catch-up if incomplete vaccination. Surveillance of poliovirus shedding in patients with primary immunodeficiencies (PIDs) was also conducted as well as other public health measures. Results As of April 20, 2023, 38 AFP cases have been reported through active search. Retrospective hospital-based surveillance has revealed 31 cases. In addition, 3142 children with deficient vaccination were identified, distributed differently by region. All of them were caught up with Inactivated polio vaccine (IPV). A total of 90 PIDs were followed up. The replacement of the Oral polio vaccine (OPV) dose at 6 months by IPV in the national immunization schedule as well as a request for verification of the possibility of using the new OPV2 in Tunisia and of the required requirements were made. Conclusions The risk of poliomyelitis resurgence in our country is not negligible. Sustained vigilance is necessary, particularly through ensuring high vaccination coverage and effective surveillance to rapidly detect any imported case. This is essential in view of the global context and the existence of outbreaks especially in certain African countries with which several exchanges and migratory flows remain. Key messages • The Poliomyelitis alert on Tunisian borders in January 2023 is a real threat, that should also be taken into consideration by neighboring countries. • Sustained vigilance is necessary, particularly through effective surveillance and appropriate vaccination strategy.

Unraveling the Dynamics of Omicron (BA.1, BA.2, and BA.5) Waves and Emergence of the Deltacton Variant: Genomic Epidemiology of the SARS-CoV-2 Epidemic in Cyprus (Oct 2021-Oct 2022).

Commencing in December 2019 with the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), three years of the coronavirus disease 2019 (COVID-19) pandemic have transpired. The virus has consistently demonstrated a tendency for evolutionary adaptation, resulting in mutations that impact both immune evasion and transmissibility. This ongoing process has led to successive waves of infections. This study offers a comprehensive assessment spanning genetic, phylogenetic, phylodynamic, and phylogeographic dimensions, focused on the trajectory of the SARS-CoV-2 epidemic in Cyprus. Based on a dataset comprising 4700 viral genomic sequences obtained from affected individuals between October 2021 and October 2022, our analysis is presented. Over this timeframe, a total of 167 distinct lineages and sublineages emerged, including variants such as Delta and Omicron (1, 2, and 5). Notably, during the fifth wave of infections, Omicron subvariants 1 and 2 gained prominence, followed by the ascendancy of Omicron 5 in the subsequent sixth wave. Additionally, during the fifth wave (December 2021-January 2022), a unique set of Delta sequences with genetic mutations associated with Omicron variant 1, dubbed "Deltacron", was identified. The emergence of this phenomenon initially evoked skepticism, characterized by concerns primarily centered around contamination or coinfection as plausible etiological contributors. These hypotheses were predominantly disseminated through unsubstantiated assertions within the realms of social and mass media, lacking concurrent scientific evidence to validate their claims. Nevertheless, the exhaustive molecular analyses presented in this study have demonstrated that such occurrences would likely lead to a frameshift mutation-a genetic aberration conspicuously absent in our provided sequences. This substantiates the accuracy of our initial assertion while refuting contamination or coinfection as potential etiologies. Comparable observations on a global scale dispelled doubt, eventually leading to the recognition of Delta-Omicron variants by the scientific community and their subsequent monitoring by the World Health Organization (WHO). As our investigation delved deeper into the intricate dynamics of the SARS-CoV-2 epidemic in Cyprus, a discernible pattern emerged, highlighting the major role of international connections in shaping the virus's local trajectory. Notably, the United States and the United Kingdom were the central conduits governing the entry and exit of the virus to and from Cyprus. Moreover, notable migratory routes included nations such as Greece, South Korea, France, Germany, Brazil, Spain, Australia, Denmark, Sweden, and Italy. These empirical findings underscore that the spread of SARS-CoV-2 within Cyprus was markedly influenced by the influx of new, highly transmissible variants, triggering successive waves of infection. This investigation elucidates the emergence of new waves of infection subsequent to the advent of highly contagious and transmissible viral variants, notably characterized by an abundance of mutations localized within the spike protein. Notably, this discovery decisively contradicts the hitherto hypothesis of seasonal fluctuations in the virus's epidemiological dynamics. This study emphasizes the importance of meticulously examining molecular genetics alongside virus migration patterns within a specific region. Past experiences also emphasize the substantial evolutionary potential of viruses such as SARS-CoV-2, underscoring the need for sustained vigilance. However, as the pandemic's dynamics continue to evolve, a balanced approach between caution and resilience becomes paramount. This ethos encourages an approach founded on informed prudence and self-preservation, guided by public health authorities, rather than enduring apprehension. Such an approach empowers societies to adapt and progress, fostering a poised confidence rooted in well-founded adaptation.

Indonesia’s COVID-19 Trend After the End of a Public Health Emergency of International Concern: Preparation for an Endemic

Three years into the pandemic, the World Health Organization revoked the COVID-19 public health emergency of international concern on May 5, 2023. This decision sparked debate, notably around the possibility of a surge in cases due to the SARS-CoV-2 mutations. To manage this transition, the Indonesian government enacted stringent controls on case numbers. This case series study provided an overview of COVID-19 case trends in Indonesia following the revocation of public health emergency of international concern status by the World Health Organization. Data were collected for 5 weeks after the statement (May 6–June 10, 2023) from the COVID-19 Task Force’s official online platform of the Indonesian Ministry of Health. The trends were monitored in daily confirmed, active, recovered, and death cases, and analyzed the data using Microsoft Excel and Stata 16. The findings indicated a positive trend for Indonesia, with decreased daily confirmed cases (89.42%) and active cases (44.16%). Recovered cases accounted for 97.47%, higher than the global average (96%). Unfortunately, the death rate (2.38%) exceeded the global statistic (1%). These results highlighted the need for sustained vigilance, enhancement of the 3T strategy (testing, tracing, and treatment), and wider vaccination coverage. It remains critical to uphold the 3M protocols—mask-wearing, physical distancing, and hand hygiene—to prevent a potential rebound in cases, even without the public health emergency of international concern status,as the situation transitions toward endemic COVID-19.

Indonesia’s COVID-19 Trend After the End of a Public Health Emergency of International Concern: Preparation for an Endemic

Three years into the pandemic, the World Health Organization revoked the COVID-19 public health emergency of international concern on May 5, 2023. This decision sparked debate, notably around the possibility of a surge in cases due to the SARS-CoV-2 mutations. To manage this transition, the Indonesian government enacted stringent controls on case numbers. This case series study provided an overview of COVID-19 case trends in Indonesia following the revocation of public health emergency of international concern status by the World Health Organization. Data were collected for 5 weeks after the statement (May 6–June 10, 2023) from the COVID-19 Task Force’s official online platform of the Indonesian Ministry of Health. The trends were monitored in daily confirmed, active, recovered, and death cases, and analyzed the data using Microsoft Excel and Stata 16. The findings indicated a positive trend for Indonesia, with decreased daily confirmed cases (89.42%) and active cases (44.16%). Recovered cases accounted for 97.47%, higher than the global average (96%). Unfortunately, the death rate (2.38%) exceeded the global statistic (1%). These results highlighted the need for sustained vigilance, enhancement of the 3T strategy (testing, tracing, and treatment), and wider vaccination coverage. It remains critical to uphold the 3M protocols—mask-wearing, physical distancing, and hand hygiene—to prevent a potential rebound in cases, even without the previously designated public health emergency of international concern status,as the situation transitions toward endemic COVID-19.

National influenza mid-season report, 2022-2023: A rapid and early epidemic onset.

Canada's 2022-2023 national influenza epidemic was declared in epidemiological week 43 (week ending October 29, 2022), relatively early in comparison to historical seasons. This year marks the return to pre-pandemic-like influenza circulation, following the brief and delayed influenza epidemic declared in the spring of the 2021-2022 season. To date this season, 59,459 detections of influenza have been reported out of 456,536 tests; both values exceeding historical averages. This epidemic is being fundamentally driven by influenza A, with influenza A(H3N2) accounting for 94% of subtyped detections. This season to date has had a significant impact on adolescents and young children, with a high proportion of detections occurring in those aged 0-19 years (42%). Provinces and territories have reported higher than usual influenza-associated hospitalizations, intensive care unit admissions, and deaths in comparison with previous seasons; in particular, paediatric hospitalization incidence was persistently far above historical peak levels for several weeks. The return of seasonal influenza circulation highlights the importance of sustained vigilance with regard to influenza and employment of available mitigation measures, especially of annual seasonal influenza vaccination.

Demographic, behavioural and occupational risk factors associated with SARS-CoV-2 infection in UK healthcare workers: a retrospective observational study

ObjectiveHealthcare workers (HCWs) are at higher risk of SARS-CoV-2 infection than the general population. This group is pivotal to healthcare system resilience during the COVID-19, and future, pandemics. We investigated...

Magma pressurization sustains ongoing eruptive episode at dome-building Soufrière Hills volcano, Montserrat

Abstract Dome-building volcanoes, where long-term eruptive episodes can be interspersed with periods of intra-eruptive repose, are particularly challenging for volcanic hazard assessment. Defining the end of eruptive episodes is vitally important for the socioeconomic recovery of affected communities but highly problematic due to the potential for rapid transition from prolonged, seemingly low-risk repose to dangerous effusive or explosive activity. It is currently unclear what constitutes the end of repose and an eruptive episode. We show that analysis of surface deformation can characterize repose and help define an eruptive episode. At Soufrière Hills volcano, Montserrat, the long-term post–2010 deformation at 12 continuous GPS stations requires the pressure in the magma system to have increased with time; time-dependent stress relaxation or crustal creep cannot explain the deformation trends alone. Continued pressurization within the magmatic system during repose could initiate a renewed eruption, qualifying as sustained unrest and therefore continuation of the eruptive episode. For Soufrière Hills volcano, persistent magma pressurization highlights the need for sustained vigilance in the monitoring and management of the volcano and its surroundings, despite the last eruptive activity ending in 2010. Our results show promise for application to other dome-building volcanoes.

Effects of caffeine, methylliberine, and theacrine on vigilance, marksmanship, and hemodynamic responses in tactical personnel: a double-blind, randomized, placebo-controlled trial

ABSTRACTBackgroundTactical athletes require fast reaction times (RT) along with high levels of vigilance and marksmanship performance. Caffeine has been shown to improve these measures but also results in increased blood pressure and jitteriness. Research on other purine alkaloids, such as methylliberine and theacrine, has suggested they do not increase blood pressure or jitteriness to the same extent, but their impact on tactical performance is unknown.MethodsA between-subjects, randomized, placebo-controlled design was used to test the effects of placebo (PLA), 300 mg caffeine (CAF), and a combination of 150 mg caffeine, 100 mg methylliberine, and 50 mg theacrine (CMT) on RT and marksmanship along with hemodynamic and arousal measures following a sustained vigilance task in tactical personnel (n = 48). Following consumption of the supplement, participants underwent a 150-min protocol consisting of two rounds. Each round began with leisurely reading followed by a 30-min vigilance task before beginning two trials of movement and marksmanship tasks. Hemodynamics and felt arousal were assessed throughout the protocol. Composite Z-scores were calculated for overall performance measures at each timepoint, and mixed-effects models were used to assess differences in RT, accuracy, and composite Z-scores along with hemodynamics and felt arousal. An α-level of 0.05 was used to determine statistical significance, and Cohen’s d was used to quantify effect sizes.ResultsA Group-by-Time interaction for vigilance RT (P = 0.038) indicated improvements for both CAF and CMT from round 1 to round 2 (P < 0.01) while PLA did not change (P = 0.27). No Group main effects or Group-by-Time interactions were found for movement or marksmanship performance (P > 0.20). Group main effects for systolic (SBP; P = 0.001) and diastolic blood pressure (DBP; P = 0.028) indicated higher SBP in CAF (P = 0.003, d= 0.84) and CMT (P = 0.007, d= 0.79) compared to PLA but only higher DBP in CAF (P = 0.025, d= 0.74). No Group-by-Time interaction or Group main effect was found for felt arousal (P > 0.16).ConclusionsThese findings suggest similar benefits on RT during a vigilance task between CAF, containing 300 mg caffeine, and CMT above PLA, though CAF resulted in slightly less favorable hemodynamic changes. This study is the first to provide data showing similar efficacy of combined caffeine, methylliberine, and theacrine compared to double the caffeine dose consumed alone on vigilance RT but without a significant rise in DBP above PLA in tactical personnel.

The Evolution of Vigilance and Its Atrophy Preceding the COVID-19 Global Pandemic.

IntroductionRecent infectious outbreaks preceding the COVID-19 crisis resulted in the evolution of vigilance for preparedness against the next pandemic. This vigilance was maintained to varying degrees in different jurisdictions.ObjectiveTo evaluate the evolution of vigilance following previous epidemics and pandemics and the subsequent atrophy of vigilance prior to the COVID-19 global pandemic.MethodsWe evaluated documentation discussing US, Canada, and South Korea from March 2002 to October 2021. Our policy search strategy was rooted in academic literature, government documents and media reports.ResultsIn the US, there were examples of atrophy of vigilance; however, there was clear understanding of pandemic readiness actions that were simply not executed amongst political chaos. In Canada, political mishaps were less evident at the time the pandemic unfolded. Nevertheless, atrophy was evident with erosion in preparedness programs following SARS. South Korea appeared least subjected to atrophy of vigilance. The more recent MERS outbreak prompted evolution of sustained vigilance and compliance with basic public health measures such as mask wearing.RecommendationsPolicy options need to be explored and instituted that increase protection of preparedness programs through institutional safeguards and accountability measure.

Circadian Effects on Attention and Working Memory in College Students With Attention Deficit and Hyperactivity Symptoms.

ObjectiveIndividuals with an evening chronotype prefer to sleep later at night, wake up later in the day and perform best later in the day as compared to individuals with morning chronotype. Thus, college students without ADHD symptoms with evening chronotypes show reduced cognitive performance in the morning relative to nighttime (i.e., desynchrony effect). In combination with symptoms presented in attention deficit hyperactivity disorder (ADHD), we predicted that having evening chronotype renders impairment in attention during the morning, when students require optimal performance, amplifying desynchrony.MethodFour hundred college students were surveyed for evening chronotype and symptoms of ADHD. Of those surveyed, 43 students with evening chronotype (19 with ADHD symptoms) performed laboratory attention tasks and were queried about fatigue during morning and evening sessions.ResultsStudents with ADHD symptoms demonstrated a greater decrement in sustained attentional vigilance when abstaining from stimulants and asked to perform cognitive tests at times misaligned with natural circadian rhythms in arousal compared to their non-ADHD counterparts with the same chronotype. While individuals with ADHD symptoms had slower reaction-times during sustained attention tasks in the morning session compared to those without symptoms, there was no significant group difference in working memory performance, even though both groups made more errors in the morning session compared to the evening session.ConclusionThese findings suggest that evening chronotype students with ADHD symptoms are at a greater disadvantage when having to perform sustained attention tasks at times that are not aligned to their circadian rhythm compared to their neuro-typical peers. The implications of this finding may be useful for the provision of disability accommodations to college age students with ADHD when they are expected to perform tasks requiring sustained attention at times misaligned with their circadian rhythms.

Emergence of SARS-CoV-2 Spike Mutations during Prolonged Infection in Immunocompromised Hosts.

ABSTRACTImmunocompromised hosts with prolonged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections have been implicated in the emergence of highly mutated SARS-CoV-2 variants. Spike mutations are of particular concern because the spike protein is a key target for vaccines and therapeutics for SARS-CoV-2. Here, we report the emergence of spike mutations in two immunocompromised patients with persistent SARS-CoV-2 reverse transcription (RT)-PCR positivity (>90 days). Whole-genome sequence analysis of samples obtained before and after coronavirus disease 2019 (COVID-19) treatment demonstrated the development of partial therapeutic escape mutations and increased intrahost SARS-CoV-2 genome diversity over time. This case series thus adds to the accumulating evidence that immunocompromised hosts with persistent infections are important sources of SARS-CoV-2 genome diversity and, in particular, clinically important spike protein diversity.IMPORTANCE The emergence of clinically important mutations described in this report highlights the need for sustained vigilance and containment measures when managing immunocompromised patients with persistent COVID-19. Even as jurisdictions across the globe start lifting pandemic control measures, immunocompromised patients with persistent COVID-19 constitute a unique group that requires close genomic monitoring and enhanced infection control measures, to ensure early detection and containment of mutations and variants of therapeutic and public health importance.