Hyperferritinemia screening to aid identification and differentiation of patients with hyperinflammatory disorders.

High ferritin is an important and sensitive biomarker for hemophagocytic lymphohistiocytosis (HLH), a diverse and deadly group of cytokine storm syndromes. Early action to prevent immunopathology in HLH often includes empiric immunomodulation, which can complicate etiologic work-up and prevent collection of early/pre-treatment research samples. To address this, we instituted an alert system where serum ferritin > 1000ng/mL triggered real-time chart review, assessment of whether the value reflected "inflammatory hyperferritnemia (IHF)", and biobanking of remnant samples from consenting IHF patients. We extracted relevant clinical data; periodically measured serum total IL-18, IL-18 binding protein (IL-18BP), and CXCL9; retrospectively classified patients by etiology into infectious, rheumatic, or immune dysregulation; and subjected a subgroup of samples to a 96-analyte biomarker screen. 180 patients were identified, 30.5% of which had IHF. Maximum ferritin levels were significantly higher in patients with IHF than with either hemoglobinopathy or transplant, and highly elevated total IL-18 levels were distinctive to patients with Stills Disease and/or Macrophage Activation Syndrome (MAS). Multi-analyte analysis showed elevation in proteins associated with cytotoxic lymphocytes in all IHF samples when compared to healthy controls and depression of proteins such as ANGPT1 and VEGFR2 in samples from hyperferritinemic sepsis patients relative to non-sepsis controls. This single-center, real-time IFH screen proved feasible and efficient, validated prior observations about the specificity of IL-18, enabled early sample collection from a complex population, suggested a unique vascular biomarker signature in hyperferritinemic sepsis, and expanded our understanding of IHF heterogeneity.

Conspiratorial Ideation Is Associated with Lower Perceptions of Policy Effectiveness: Views from Local Governments during the COVID-19 Pandemic.

Governments around the world struggled to formulate an effective response to the coronavirus disease 2019 pandemic, which was hampered by the widespread diffusion of various conspiracy theories about the virus. Local governments are often responsible for the implementing mitigation measures such as mask mandates and curfews but have received very limited attention in the scholarly literature. In this article, the authors use data from local policy actors in Colorado to evaluate the relationship between conspiratorial beliefs and perceptions of mitigation policy effectiveness. The authors find that many local policy actors hold conspiratorial beliefs, which combine with partisanship to contribute to lower perceptions of policy effectiveness. The authors conclude by discussing future research directions, noting that the broad adoption of conspiracy theories likely changes enforcement at the local scale.

Large hydropower projects increase stress despite compensation efforts: Evidence from the Brazilian Amazon.

Large hydropower projects continue to be built in developing nations, despite their known negative impacts. Large-scale energy projects strain local infrastructure and reduce access to infrastructure for households that live near them. Here we investigate the link between large-scale hydropower projects and stress. Our results suggest that these projects create stress through two mechanisms: strains on community resources and through the process of displacement. We also ask how compensation and resettlement programs condition these relationships. Using data from the Madeira river basin in the Brazilian Amazon, we find that hydropower projects increase stress by reducing access to energy, water, sanitation and land. Compensation provided was not sufficient to moderate this effect.

Large-scale hydropower impacts and adaptation strategies on rural communities in the Amazonian floodplain of the Madeira River.

Understanding social and environmental impacts and household adaptation strategies in the face of expansions in energy infrastructure projects is essential to inform mitigation and interventions programs that promote well-being. Here we conducted surveys in seven communities distributed across varying degrees of proximity to a hydropower dam complex in the Brazilian Amazon along about 250 km of the floodplain of the Madeira River. Based on interviews with 154 fishers from these communities, we examine how fishers perceived changes in fisheries yields, changes in the composition of fish species, and whether and how adaptation strategies had evolved 8-9 years after the dams' construction. Most respondents (91%) indicated declines in yields after the dams for both upstream and downstream zones. Multivariate analyses revealed statistically significant differences in the composition of species yields in pre-and post-dam periods for all communities and in both upstream and downstream zones (p < 0.001). The composition of yields diversified after the dams, with an apparent decline in yields of species of greatest market value (e.g., catfishes Brachyplatystoma spp., Pseudoplatystoma spp., and jatuarana Brycon spp.), and increases in yields of a set of other smaller bodied and faster growing species (e.g., 'branquinhas' Psectrogaster spp., Potamohinna spp., and sardines Triportheus spp.). Both downstream and upstream fishers indicated that fishing profits decreased since the dams' construction (76.8% and 67.9%, respectively). To cope with these changes, the majority of both upstream and downstream fishers (>70%) stated they have had to devote more time to fishing after the dams were built. The time fishers spend traveling to fishing locations also increased for upstream communities (77.1%), but not for downstream communities. Thirty-four percent of the interviewees changed the gear they use to fish after the dams construction, with twice as many mentioning uses of non-selective gear, such as gillnets, and declining use of traditional fishing gears such as castnets and a trap ("covi"). Fish consumption overall decreased: fish was consumed 'everyday' before the dams, but 1-2 times per week or rarely after the dams were built. Although the species that declined were those of high economic value, 53% of fishers stated fish prices have increased overall after the dams. These results shed light on the potential challenges faced by fishers and which adaptation strategies they have evolved to maintain livelihoods since the construction of the dams.

Whose Future, Whose Security?: Unconventional Oil and Gas Extraction and the Economic Vulnerability and Forced Participation of Small-scale Property Owners.

Since the 'shale revolution' of the late 2000s, unconventional oil and gas extraction (UOGE) has been hailed by many as a boon for local and regional economies, workers, and property owners. While energy social science has documented many realities that counter this narrative - natural resource dependent economies, 'boom and bust' cycles of the energy industry, and 'resource curse'- there is less research examining economic impacts of UOGE for small-scale property owners. While some large-scale property owners lease their land, minerals, or water rights to oil and gas companies in exchange for royalties, other property owners are not able or do not wish to do so. Yet, nearby UOGE may negatively impact property values and thus threaten people's sense of economic stability. Several legal mechanisms - forced pooling, split estate, and rule of capture - significantly restrict the rights of many property owners while privileging other property rights. While property ownership represents a privileged status, it is the largest investment many Americans will make and is relied upon for retirement planning, financial stability, and transfer of generational wealth. Yet, despite the importance of property ownership, particularly home ownership, little is known about how proximity to oil and gas development impacts small-scale property owners. This paper analyzes how UOGE impacts property owners' sense of economic precarity. We conducted surveys of hundreds of affected households and interviews with 66 property owners in two Colorado towns that have experienced heavy UOGE. We find that the current regulatory regimes disempower small-scale property owners, create economic vulnerability, and ultimately privilege property rights of mineral owners and operators over others - creating uncompensated losses for small-scale property owners. We explore important implications, including the need for more responsive and community-based governance processes.

Advancing convergence research: Renewable energy solutions for off-grid communities.

Millions of people across the world live off-grid not by choice but because they live in rural areas, have low income, and have no political clout. Delivering sustainable energy solutions to such a substantial amount of the world's population requires more than a technological fix; it requires leveraging the knowledge of underserved populations working together with a transdisciplinary team to find holistically derived solutions. Our original research has resulted in an innovative Convergence Framework integrating the fields of engineering, social sciences, and communication, and is based on working together with communities and other stakeholders to address the challenges posed by delivering clean energy solutions. In this paper, we discuss the evolution of this Framework and illustrate how this Framework is being operationalized in our on-going research project, cocreating hybrid renewable energy systems for off-grid communities in the Brazilian Amazon. The research shows how this Framework can address clean energy transitions, strengthen emerging industries at local level, and foster Global North-South scholarly collaborations. We do so by the integration of social science and engineering and by focusing on community engagement, energy justice, and governance for underserved communities. Further, this solution-driven Framework leads to the emergence of unique approaches that advance scientific knowledge, while at the same time addressing community needs.

Long-Term Clinical and Radiographic Outcomes in Patients With Clinically Isolated Aortitis.

OBJECTIVE: The optimal management of patients with incidentally found clinically isolated aortitis (CIA) after aneurysm repair is unclear. This study compared long-term surgical and clinical outcomes after surgical repair of thoracic aortic aneurysm between patients with CIA and patients with noninflammatory etiologies. METHODS: This is a matched cohort study. Patients with CIA were identified by histopathology following open thoracic aortic aneurysm repair. Two comparators without inflammation on pathology were matched to each patient by year of surgical repair. Outcomes included surgical complications, new vascular abnormalities on imaging, and death. RESULTS: One hundred sixty-two patients were included: 53 with CIA and 109 matched comparators. Median follow-up time was similar between groups (CIA 3.7 vs. comparator 3.3 years, P = 0.64). There was no difference in postoperative complications, surgical revision, or death between groups. Only 32% of patients with CIA saw a rheumatologist in the outpatient setting and 33% received immunosuppressive treatment. On surveillance imaging, no difference was seen in new or worsening aortic aneurysms, but there were significantly more vascular abnormalities in branch arteries of the thoracic aorta in patients with CIA (39% vs. 11%, P < 0.01). CONCLUSION: Among patients who underwent surgical repair of a thoracic aortic aneurysm, patients with CIA were more likely than noninflammatory comparators to develop radiographic abnormalities in aortic branch arteries. Notably, there was no difference in risk of new aortic aneurysms or surgical complications despite most patients with CIA never receiving immunosuppression. This suggests that more selective initiation of immunosuppression in CIA may be considered after aortic aneurysm repair.

Collective Neoliberalism and Market Fundamentalism: Why Concerned People Acquiesce to the Oil and Gas Industry.

In the US, unconventional oil and gas (UOG) production has elicited strong public response. As production occurs amid residential and commercial spaces, environmental, social, economic, regulatory, and mental health impacts have been documented across locations. Some community groups have mobilized against this activity, while others have not. We examine how and why UOG production becomes normalized despite its disruptions and risks. Through years of fieldwork, we have observed limited organized mobilization. Even activists express hesitation to demand transformative changes or complete stoppage of UOG production. Yet the drivers of these dynamics need to be better understood. We argue that these passive 'sites of acceptance' emerge through a two-part influence of neoliberalism. First, a mosaic of ideas and policy measures privileging de-regulation and free markets manifests itself in a unique discourse we call collective neoliberalism. Second, neoliberalism as a system of governance creates a fractured, devolved regulatory environment ripe for regulatory capture and lacking sufficient resources. This, in turn, can discourage local efforts to limit or regulate UOG production as regulators seem unresponsive, poorly resourced, or tacitly more supportive of industry than the public. We use ethnographic data collected amid dense, widespread UOG production in Colorado to illustrate these patterns.

Rates of timely paracentesis for patients admitted to hospital with cirrhosis and ascites remain low but are unaffected by the COVID-19 pandemic.

For the first 6 months of the novel coronavirus-19 (COVID-19) pandemic, the hospital medicine procedure service at our center was temporarily unavailable. We assessed paracentesis rates and clinical outcomes for patients admitted with cirrhosis and ascites before and during the COVID-19 pandemic. Two hundred and twenty-four and 131 patients with cirrhosis and ascited were admitted to hospital before and during COVID-19 respectively. Approximately 50.9% and 49.6% of patients underwent a paracentesis within 24 h pre- and mid-pandemic, p = .83. No differences were observed for length-of-stay or 30-day readmissions. GI consultation was associated with higher rates of paracentesis in both eras (p < .001 pre-COVID-19, and p = .01 COVID-19). Changes due to the COVID-19 pandemic did not result in changes to rates of timely paracentesis in patients admitted with cirrhosis and ascites. While involvement of gastroenterology may increase rates of paracentesis, further efforts are needed to optimize rates of timely paracentesis to positively impact clinical outcomes.

Palliative Care: A Survey of Program Benchmarking for Productivity and Compensation.

Background: Palliative Care (PC) encompasses an integrated health care philosophy of care for individuals with serious illnesses and their families. Referrals to palliative care often come from other healthcare clinicians who lack the time and skill required to address the needs of the patient and their caregivers. At its heart, palliative care is individualized to the values, beliefs, and goals of the patient. The process of eliciting values, beliefs, and goals takes time and expertise, and correspondingly, palliative care is labor intensive. To date, there has been no concentrated focus on how to accurately capture the productivity or work of palliative care clinicians. As a result, there is not a universally accepted method of measuring the effort which includes impact, activity, composition, and productivity of a palliative care program. Objective: This paper reviews results obtained during a telephone survey of similar hospital-based palliative care programs on how they measure productivity. Currently, based on the survey, there are two focused methods for benchmarking: work relative value units (wRVU) and consult volume. This paper highlights the variability of wRVUs and the challenge of using them to compare different PC programs. Design: The design was an open-ended question telephone survey. Using the characteristics of our hospital program, the team created a composite of descriptions to consider for comparison. Then, various hospital-based palliative care teams were selected based on publicly reported data through Vizient, a national benchmarking organization. Based on a literature review, an open-ended question survey was created. These questions explored program composition, clinician productivity and performance benchmarks. Data was collected manually and stored in a confidential file. Result: Ninety-four programs were queried that met the following composite: (1) participated in Vizient program and (2) self-reported a hospital-based, inpatient palliative program. Forty-one programs responded to the request to participate. Of these, 32 programs consisted of facilities who had hospitalists who provided palliative care, but there was not a dedicated palliative care team. Nine programs had a dedicated palliative care team with clinicians who only practiced palliative medicine. Inquiry to these programs revealed that within these nine programs-two methods of capturing clinician productivity were used-five sites used a wRVU metric and four sites used a consult volume metric. Conclusion: Preliminary findings support the complexity of benchmarking PC programs against peer institutions with a standard productivity model based on the variability in program composition.

Feasibility of hybrid in-stream generator-photovoltaic systems for Amazonian off-grid communities.

While there have been efforts to supply off-grid energy in the Amazon, these attempts have focused on low upfront costs and deployment rates. These "get-energy-quick" methods have almost solely adopted diesel generators, ignoring the environmental and social risks associated with the known noise and pollution of combustion engines. Alternatively, it is recommended, herein, to supply off-grid needs with renewable, distributed microgrids comprised of photovoltaics (PV) and in-stream generators (ISG). Utilization of a hybrid combination of renewable generators can provide an energetically, environmentally, and financially feasible alternative to typical electrification methods, depending on available solar irradiation and riverine characteristics, that with community engagement allows for a participatory codesign process that takes into consideration people's needs. A convergent solution development framework that includes designers-a team of social scientists, engineers, and communication specialists-and communities as well as the local industry is examined here, by which the future negative impacts at the human-machine-environment nexus can be minimized by iterative, continuous interaction between these key actors.

Effect of "finite pool of worry" and COVID-19 on UK climate change perceptions.

Research reveals that a "finite pool of worry" constrains concern about and action on climate change. Nevertheless, a longitudinal panel survey of 1,858 UK residents, surveyed in April 2019 and June 2020, reveals little evidence for diminishing climate change concern during the COVID-19 pandemic. Further, the sample identifies climate change as a bigger threat than COVID-19. The findings suggest climate change has become an intransigent concern within UK public consciousness.

Comparison of Aortitis Versus Noninflammatory Aortic Aneurysms Among Patients Who Undergo Open Aortic Aneurysm Repair.

OBJECTIVE: Distinguishing aortitis-induced aneurysms from noninflammatory aortic aneurysms is difficult and often incidentally diagnosed on histologic examination after surgical repair. This study was undertaken to examine surgically diagnosed aortitis and identify patient characteristics and imaging findings associated with the disease. METHODS: In this case-control study, cases had newly diagnosed, biopsy-proven noninfectious aortitis after open thoracic aortic aneurysm surgical repair. Five controls were matched with cases for year of surgery and lacked significant inflammation on surgical pathology analysis. Data on comorbidities, demographic characteristics, and laboratory and imaging abnormalities prior to surgery were collected. Associations between exposures and outcomes were evaluated using conditional logistic regression. Backward stepwise logistic regression was used to determine factors independently associated with aortitis. Odds ratios (ORs) with 95%confidence intervals (95%CIs) were calculated. RESULTS: The study included 262 patients (43 patients with aortitis and 219 controls). Patients with aortitis were older at the time of surgery, predominantly female, and less likely to have a history of coronary artery disease (CAD). Multivariable analysis revealed that aortitis was independently associated with an older age at the time of surgery (OR 1.08 [95%CI 1.03-1.13], P < 0.01), female sex (OR 2.36 [95%CI 1.01-5.51], P = 0.04), absence of CAD (OR 6.92 [95%CI 2.14-22.34], P = 0.04), a larger aneurysm diameter (OR 1.74 [95%CI 1.02-2.98], P = 0.04), and arterial wall thickening on imaging (OR 56.93 [95%CI 4.31-752.33], P < 0.01). CONCLUSION: Among patients who undergo open surgical repair of an aortic aneurysm, elderly women with no history of CAD who have evidence of other aortic or arterial wall thickening on imaging are more likely to have histologic evidence of aortitis. Patients with these characteristics may benefit from further rheumatologic evaluation.

Free Market Ideology and Deregulation in Colorado's Oilfields: Evidence for triple movement activism?

Unconventional oil and gas extraction (UOGE) has spurred an unprecedented boom in on-shore production in the U.S. Despite a surge in related research, a void exists regarding inquiries into policy outcomes and perceptions. To address this, support for federal regulatory exemptions for UOGE is examined using survey data collected in 2015 from two northern Colorado communities. Current regulatory exemptions for UOGE can be understood as components of broader societal processes of neoliberalization. Free market ideology increases public support for federal regulatory exemptions for UOGE. Perceived negative impacts do not necessarily drive people to support increased federal regulation. Utilizing neo-Polanyian theory, interaction between free market ideology and perceived negative impacts is explored. Free market ideology appears to moderate people's views of regulation: increasing the effect of perceived negative impacts while simultaneously increasing support for deregulation. To conclude, the ways in which free market ideology might normalize the impacts of UOGE activity are discussed.

Closed arterial lab sampling devices: a study of compliance and best practice.

As the quality of patient care continues to improve, nursing professionals are continuously tasked with researching, implementing, and evaluating best practices. The practice of obtaining blood samples from paediatric patients, using a conventional three-way stopcock method, has been associated with peripheral arterial catheter intraluminal contamination and catheter-related bloodstream infections. A paediatric cardiac intensive care unit (PCICU), in a large medical centre in the USA, set an objective to mitigate the risk of possible contamination by implementing the use of closed arterial lab sampling devices. The project extensively reviewed comparative literature of studies between conventional three-way stopcock methods and closed arterial lab sampling devices. Furthermore, it successfully implemented the recommended best practice with sustained compliance. This article discusses appraising current literature, translating into practice, and evaluating compliance throughout the PCICU over a 2-year period.

A Multidisciplinary Research Framework on Green Schools: Infrastructure, Social Environment, Occupant Health, and Performance.

BACKGROUND: Sustainable school buildings hold much promise to reducing operating costs, improve occupant well-being and, ultimately, teacher and student performance. However, there is a scarcity of evidence on the effects of sustainable school buildings on health and performance indicators. We sought to create a framework for a multidisciplinary research agenda that links school facilities, health, and educational outcomes. METHODS: We conducted a nonsystematic review of peer review publications, government documents, organizational documents, and school climate measurement instruments. RESULTS: We found that studies on the impact of physical environmental factors (air, lighting, and thermal comfort) on health and occupant performance are largely independent of research on the social climate. The current literature precludes the formation of understanding the causal relation among school facilities, social climate, occupant health, and occupant performance. CONCLUSIONS: Given the average age of current school facilities in the United States, construction of new school facilities or retrofits of older facilities will be a major infrastructure investment for many municipalities over the next several decades. Multidisciplinary research that seeks to understand the impact of sustainable design on the health and performance of occupants will need to include both an environmental science and social science perspective to inform best practices and quantification of benefits that go beyond general measures of costs savings from energy efficiencies.

Improving Sensitivity and Reproducibility of SERS Sensing in Microenvironments Using Individual, Optically Trapped Surface-Enhanced Raman Spectroscopy(SERS) Probes.

Surface-enhanced Raman spectroscopy (SERS) sensors offer many advantages for chemical analyses, including the ability to provide chemical specific information and multiplexed detection capability at specific locations. However, to have operative SERS sensors for probing microenvironments, probes with high signal enhancement and reproducibility are necessary. To this end, dynamic enhancement of SERS (i.e., in-situ amplification of signal-to-noise and signal-to-background ratios) from individual probes has been explored. In this paper, we characterize the use of optical tweezers to amplify SERS signals as well as suppress background signals via trapping of individual SERS active probes. This amplification is achieved through a steady presence of a single "hot" particle in the focus of the excitation laser. In addition to increases in signal and concomitant decreases in non-SERS backgrounds, optical trapping results in an eightfold increase in the stability of the signal as well. This enhancement strategy was demonstrated using both single and multilayered SERS sub-micron probes, producing combined signal enhancements of 24-fold (beyond the native 106 SERS enhancement) for a three-layered geometry. The ability to dynamically control the enhancement offers the possibility to develop SERS-based sensors and probes with tailored sensitivities. In addition, since this trapping enhancement can be used to observe individual probes with low laser fluences, it could offer particular interest in probing the composition of microenvironments not amenable to tip-enhanced Raman spectroscopy or other scanning probe methods (e.g., intracellular analyses, etc.).

Understanding Recession and Self-Rated Health with the Partial Proportional Odds Model: An Analysis of 26 Countries.

INTRODUCTION: Self-rated health is demonstrated to vary substantially by both personal socio-economic status and national economic conditions. However, studies investigating the combined influence of individual and country level economic indicators across several countries in the context of recent global recession are limited. This paper furthers our knowledge of the effect of recession on health at both the individual and national level. METHODS: Using the Life in Transition II study, which provides data from 19,759 individuals across 26 European nations, we examine the relationship between self-rated health, personal economic experiences, and macro-economic change. Data analyses include, but are not limited to, the partial proportional odds model which permits the effect of predictors to vary across different levels of our dependent variable. RESULTS: Household experiences with recession, especially a loss of staple good consumption, are associated with lower self-rated health. Most individual-level experiences with recession, such as a job loss, have relatively small negative effects on perceived health; the effect of individual or household economic hardship is strongest in high income nations. Our findings also suggest that macroeconomic growth improves self-rated health in low-income nations but has no effect in high-income nations. Individuals with the greatest probability of "good" self-rated health reside in wealthy countries ($23,910 to $50, 870 GNI per capita). CONCLUSION: Both individual and national economic variables are predictive of self-rated health. Personal and household experiences are most consequential for self-rated health in high income nations, while macroeconomic growth is most consequential in low-income nations.

The impact of chronic network hyperexcitability on developing glutamatergic synapses.

The effects recurring seizures have on the developing brain are an important area of debate because many forms of human epilepsy arise in early life when the central nervous system is undergoing dramatic developmental changes. To examine effects on glutamatergic synaptogenesis, epileptiform activity was induced by chronic treatment with GABAa receptor antagonists in slice cultures made from infant rat hippocampus. Experiments in control cultures showed that molecular markers for glutamatergic and GABAergic synapses recapitulated developmental milestones reported previously in vivo. Following a 1-week treatment with bicuculline, the intensity of epileptiform activity that could be induced in cultures was greatly diminished, suggesting induction of an adaptive response. In keeping with this notion, immunoblotting revealed the expression of NMDA and AMPA receptor subunits was dramatically reduced along with the scaffolding proteins, PSD95 and Homer. These effects could not be attributed to neuronal cell death, were reversible, and were not observed in slices taken from older animals. Co-treating slices with APV or TTX abolished the effects of bicuculline suggesting that effects were dependent on NMDA receptors and neuronal activity. Neurophysiological recordings supported the biochemical findings and demonstrated decreases in both the amplitude and frequency of NMDA and AMPA receptor-mediated miniature EPSCs (mEPSCs). Taken together these results suggest that neuronal network hyperexcitability interferes with the normal maturation of glutamatergic synapses, which could have implications for cognitive deficits commonly associated with the severe epilepsies of early childhood.