The United States has the highest number of coronavirus disease 2019 (COVID-19) in the world, with high variability in cases and mortality between communities. We aimed to quantify the associations ...between socio-economic status and COVID-19–related cases and mortality in the U.S.
The study design includes nationwide COVID-19 data at the county level that were paired with the Distressed Communities Index (DCI) and its component metrics of socio-economic status.
Severely distressed communities were classified by DCI>75 for univariate analyses. Adjusted rate ratios were calculated for cases and fatalities per 100,000 persons using hierarchical linear mixed models.
This cohort included 1,089,999 cases and 62,298 deaths in 3127 counties for a case fatality rate of 5.7%. Severely distressed counties had significantly fewer deaths from COVID-19 but higher number of deaths per 100,000 persons. In risk-adjusted analysis, the two socio-economic determinants of health with the strongest association with both higher cases per 100,000 persons and higher fatalities per 100,000 persons were the percentage of adults without a high school degree (cases: RR 1.10; fatalities: RR 1.08) and proportion of black residents (cases and fatalities: Relative risk(RR) 1.03). The percentage of the population aged older than 65 years was also highly predictive for fatalities per 100,000 persons (RR 1.07).
Lower education levels and greater percentages of black residents are strongly associated with higher rates of both COVID-19 cases and fatalities. Socio-economic factors should be considered when implementing public health interventions to ameliorate the disparities in the impact of COVID-19 on distressed communities.
•Socio-economic factors play an important role in coronavirus disease 2019 (COVID-19) prevalence and mortality.•Lower education level was the strongest association with both cases and fatalities.•The higher proportion of Black residents was also associated with cases and fatalities.•The poverty rate and median income were also associated with COVID-19 cases.•Median income and change in employment were also associated with COVID-19 fatalities.
Saving freshwater from salts Cañedo-Argüelles, M.; Hawkins, C. P.; Kefford, B. J. ...
Science (American Association for the Advancement of Science),
02/2016, Letnik:
351, Številka:
6276
Journal Article
Recenzirano
Ion-specific standards are needed to protect biodiversity
Many human activities—like agriculture and resource extraction—are increasing the total concentration of dissolved inorganic salts (i.e., ...salinity) in freshwaters. Increasing salinity can have adverse effects on human health (
1
); increase the costs of water treatment for human consumption; and damage infrastructure e.g., amounting to $700 million per year in the Border Rivers catchment, Australia (
2
). It can also reduce freshwater biodiversity (
3
); alter ecosystem functions (
4
); and affect economic well-being by altering ecosystem goods and services (e.g., fisheries collapse). Yet water-quality legislation and regulations that target salinity typically focus on drinking water and irrigation water, which does not automatically protect biodiversity. For example, specific electrical conductivities (a proxy for salinity) of 2 mS/cm can be acceptable for drinking and irrigation but could extirpate many freshwater insect species (
3
). We argue that salinity standards for specific ions and ion mixtures, not just for total salinity, should be developed and legally enforced to protect freshwater life and ecosystem services. We identify barriers to setting such standards and recommend management guidelines.
Tissue biopsy is the standard diagnostic procedure for cancer. Biopsy may also provide material for genotyping, which can assist in the diagnosis and selection of targeted therapies but may fall ...short in cases of inadequate sampling, particularly from highly heterogeneous tumors. Traditional tissue biopsy suffers greater limitations in its prognostic capability over the course of disease, most obviously as an invasive procedure with potential complications, but also with respect to probable tumor clonal evolution and metastasis over time from initial biopsy evaluation. Recent work highlights circulating tumor DNA (ctDNA) present in the blood as a supplemental, or perhaps an alternative, source of DNA to identify the clinically relevant cancer mutational landscape. Indeed, this noninvasive approach may facilitate repeated monitoring of disease progression and treatment response, serving as a means to guide targeted therapies based on detected actionable mutations in patients with advanced or metastatic solid tumors. Notably, ctDNA is heralding a revolution in the range of genomic profiling and molecular mechanisms to be utilized in the battle against cancer. This review will discuss the biology of ctDNA, current methods of detection and potential applications of this information in tumor diagnosis, treatment, and disease prognosis. Conventional classification of tumors to describe cancer stage follow the TNM notation system, heavily weighting local tumor extent (T), lymph node invasion (N), and detectable metastasis (M). With recent advancements in genomics and bioinformatics, it is conceivable that routine analysis of ctDNA from liquid biopsy (B) may make cancer diagnosis, treatment, and prognosis more accurate for individual patients. We put forward the futuristic concept of TNMB tumor classification, opening a new horizon for precision medicine with the hope of creating better outcomes for cancer patients.
Electrochemical disinfection (ECD) has become an important blackwater disinfection technology. ECD is a promising solution for the 2 billion people without access to conventional sanitation practices ...and in areas deficient in basic utilities (e.g., sewers, electricity, waste treatment). Here, we report on the disinfection of blackwater using potential cycling compared to potentiostatic treatment methods in chloride-containing and chloride-free solutions of blackwater (i.e., untreated wastewater containing feces, urine, and flushwater from a toilet). Potentiodynamic treatment is demonstrated to improve disinfection energy efficiency of blackwater by 24% and 124% compared to static oxidation and reduction methods, respectively. The result is shown to be caused by electrochemical advanced oxidation processes (EAOP) and regeneration of sp2-surface-bonded carbon functional groups that serve the dual purpose of catalysts and adsorption sites of oxidant intermediates. Following 24 h electrolysis in blackwater, electrode fouling is shown to be minimized by the potential cycling method when compared to equivalent potentiostatic methods. The potential cycling current density is 40% higher than both the static oxidative and reductive methods. This work enhances the understanding of oxygen reduction catalysts using functionalized carbon materials and electrochemical disinfection anodes, both of which have the potential to bring a cost-effective, energy efficient, and practical solution to the problem of disinfecting blackwater.
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•Demonstration of improved blackwater disinfection using potentiodynamic methods.•Improvement is linked to control of electrode surface chemistry.•A surface chemical mechanism is proposed for different electrolytes.•Method shown to be far more efficient than static potential methods.
It is demonstrated that the surviving fraction of a population of cells with heterogeneous radio sensitivity, like that composing most malignant tumors, conforms to a different linear quadratic ...survival relation for dose less than about 3–5Gy and dose greater than about 7–9Gy. In the intermediate range of dose the survival relation for the population, as a whole, is not linear quadratic. Consequently, the value of the alpha beta ratio and the associated biologically effective dose calculation are different for the low and high dose range for most malignant tumors.
Normal tissue cell populations responsible for organ function also have heterogeneous radio sensitivity, though to less degree than most malignant tumors. Consequently, the alpha beta ratio and associated biologically effective dose calculation related to the development of some acute early and chronic late developing radiation injuries are not the same in the low and high dose range.
Variance of the distribution of α of a heterogeneous cell population lowers the effective value of the quadratic survival constant β of the population, as a whole, and increases the α/β ratio in the low dose range. Heterogeneous appearance of tumor cells (pleomorphism) and necrosis on biopsy or imaging studies reflect heterogeneity of the radio sensitivity of the cells. Greater heterogeneity implies a tendency to higher α/β ratio. This may furnish a clinically accessible way to estimate a value of the α/β ratio specific to an individual patient and tumor.
Carbon-ion radiotherapy treatment plans are designed on the assumption that the beams are delivered instantaneously, irrespective of actual dose-delivery time structure in a treatment session. As the ...beam lines are fixed in the vertical and horizontal directions at our facility, beam delivery is interrupted in multi-field treatment due to the necessity of patient repositioning within the fields. Single-fractionated treatment for non-small cell lung cancer (NSCLC) is such a case, in which four treatment fields in multiple directions are delivered in one session with patient repositioning during the session. The purpose of this study was to investigate the effects of the period of dose delivery, including interruptions due to patient repositioning, on tumor control probability (TCP) of NSCLC. All clinical doses were weighted by relative biological effectiveness (RBE) evaluated for instantaneous irradiation. The rate equations defined in the microdosimetric kinetic model (MKM) for primary lesions induced in DNA were applied to the single-fractionated treatment of NSCLC. Treatment plans were made for an NSCLC case for various prescribed doses ranging from 25 to 50 Gy (RBE), on the assumption of instantaneous beam delivery. These plans were recalculated by varying the interruption time τ ranging from 0 to 120 min between the second and third fields for continuous irradiations of 3 min per field based on the MKM. The curative doses that would result in a TCP of 90% were deduced for the respective interruption times. The curative dose was 34.5 Gy (RBE) for instantaneous irradiation and 36.6 Gy (RBE), 39.2 Gy (RBE), 41.2 Gy (RBE), 43.3 Gy (RBE) and 44.4 Gy (RBE) for τ = 0 min, 15 min, 30 min, 60 min and 120 min, respectively. The realistic biological effectiveness of therapeutic carbon-ion beam decreased with increasing interruption time. These data suggest that the curative dose can increase by 20% or more compared to the planned dose if the interruption time extends to 30 min or longer. These effects should be considered in carbon-ion radiotherapy treatment planning if a longer dose-delivery procedure time is anticipated.
The demography and individual performance of species at their range edges provide important insight into how climate warming is impacting species distributions. The boreal limpet Patella vulgata and ...the Lusitanian limpet P. depressa have overlapping geographic ranges and local distributions in Britain. We measured individual performance at the 2 leading edges of P. depressa distribution (North Wales and South/South-east England) and in non-range edge populations in South-west England. Individuals of P. depressa towards both leading edges were expected to have reduced growth rates and higher mortality rates when compared with non-range edge populations. Conversely, P. vulgata was expected to have equivalent performance across regions, coinciding with the centre of its range. Tagged individuals did not show between-species differences in growth and mortality over a 12 mo period. Nonetheless, individual growth rates and population mortality rates of both Patella species were higher towards the range edge of P. depressa in South/South-east England, when compared with populations at its poleward edge and those in South-west England. Further analysis showed that growth and mortality rates were higher in denser populations for both P. depressa and P. vulgata, with equivalent site-specific performance patterns for both species in all regions. Thus, performance patterns of P. depressa reflected local factors in the same way as P. vulgata, overriding patterns of declining performance expected towards species borders. Comparisons between key congeneric species and their unexpected patterns of performance across their ranges provide insights into processes setting species boundaries and thereby their responses to climate change.
We report the results of spectroscopic and photometric observations of the emission-line object AS 386. For the first time we found that it exhibits the Be phenomenon and fits the definition of an FS ...CMa type object. The optical spectrum shows the presence of a B-type star with the following properties: Teff = 11,000 500 K, log L/L = 3.7 0.3, a mass of 7 1 M , and a distance D = 2.4 0.3 kpc from the Sun. We detected regular radial velocity variations of both absorption and emission lines with the following orbital parameters: Porb =131.27 0.09 days, semiamplitude K1 = 51.7 3.0 km s−1, systemic radial velocity γ = −31.8 2.6 km s−1, and a mass function of f(m) = 1.9 0.3 M . AS 386 exhibits irregular variations of the optical brightness (V = 10.92 0.05 mag), while the near-IR brightness varies up to ∼0.3 mag following the spectroscopic period. We explain this behavior by a variable illumination of the dusty disk inner rim by the B-type component. Doppler tomography based on the orbital variations of emission-line profiles shows that the material is distributed near the B-type component and in a circumbinary disk. We conclude that the system has undergone a strong mass transfer that created the circumstellar material and increased the B-type component mass. The absence of any traces of a secondary component, whose mass should be ≥7 M , suggests that it is most likely a black hole.
Uptake of nitrogen (N) by sequential root regions in six tree species was measured in roots of 16- to 26-month-old seedlings at 50 and 1500 µM NH4NO3 concentration, at the cell level using ...oscillating microelectrodes and at the root region level using enriched 15N application. Our objective was to determine the root regions making the greatest contribution to total N uptake in each species as measured by the two contrasting techniques. White and condensed tannin zones were the regions with the smallest surface area in all species, but these zones often had the highest net flux of NH4
+ and NO3
−. For most species, little variation was found among root regions in N flux calculated using a 15N mass balance approach, but where significant differences existed, high N flux was observed in white, cork or woody zones. When N fluxes measured by each of the two methods were multiplied by the estimated surface area or biomass of each root region, the effect of root region size had the greatest influence on regional N uptake. Root regions of greatest overall N uptake were the cork and woody zones, on average. Total N uptake may thus be greatest in older regions of tree seedling roots, despite low rates of uptake per unit area.
Thromboelastography (TEG) is a viscoelastic test that allows rapid evaluation of clot formation and fibrinolysis from a sample of whole blood. TEG is increasingly utilized to guide blood product ...resuscitation in surgical patients and transfusions for liver transplant patients. Patients with severe liver failure have significant derangement of their clotting function due to impaired production of procoagulant and anticoagulant factors. Traditional coagulation studies are limited by the short time needed for the result and provide little information about the dynamics and strength of clot formation. In addition, traditional coagulation studies do not correlate well with bleeding episodes and may lead to over-transfusion of various blood products. Evidence is less robust regarding the use of TEG for transfusion management decisions in severe liver failure patients awaiting, undergoing, or immediately after liver transplant surgery. However, the available evidence suggests that systematic implementation of TEG rather than traditional coagulation studies results in the administration of fewer blood products without increased mortality or complications. The purpose of this study is to review the literature regarding the use of TEG in liver failure patients prior to liver transplant, intraoperatively, and postoperatively. Additional high-quality randomized controlled studies should be performed to evaluate the use of TEG to guide transfusion decisions, particularly in the postoperative period following liver transplantation.
•Thromboelastography has emerged as a useful tool for evaluating the dynamics of clot formation, clot strength, and clot dissolution.•Thromboelastography has not been well studied as a tool for guiding transfusions in the perioperative setting for liver transplantations.•Available evidence suggests that routine use of thromboelastography perioperatively can reduce the amount of blood products transfused without negatively affecting mortality.
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