Publications by authors named "John McLaughlin"

530 Publications

Watermelon-derived extracellular vesicles influence human ex vivo placental cell behaviour by altering intestinal secretions.

Mol Nutr Food Res 2022 Aug 8:e2200013. Epub 2022 Aug 8.

Maternal and Fetal Health Research Centre, School of Medical Sciences, University of Manchester, Manchester, M13 9WL, UK.

Scope: During pregnancy, mother-to-fetus transfer of nutrients is mediated by the placenta; sub-optimal placental development and/or function results in fetal growth restriction (FGR), and the attendant risk of stillbirth, neurodevelopmental delay and non-communicable diseases in adulthood. A maternal diet high in fruit and vegetables lowers the risk of FGR but the association cannot be explained fully by known macro- and micronutrients.

Methods And Results: This study investigates if dietary-derived extracellular vesicles (EVs) can regulate placental function. We characterise the microRNA and protein cargo of EVs isolated from watermelon, show they are actively internalised by human intestinal epithelial cells in vitro, use mass spectrometry to demonstrate that they alter the intestinal secretome and bioinformatic analyses to predict the likely affected pathways in cells/tissues distal to gut. Application of the watermelon EV-modified intestinal secretome to human placental trophoblast cells and ex-vivo tissue explants affects the trophoblast proteome and key aspects of trophoblast behaviour, including migration and syncytialisation.

Conclusion: Dietary-derived plant EVs can modify intestinal communication with distal tissues, including the placenta. Harnessing the beneficial properties of dietary-derived plant EVs and/or exploiting their potential as natural delivery agents may provide new ways to improve placental function and reduce rates of FGR. This article is protected by copyright. All rights reserved.
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http://dx.doi.org/10.1002/mnfr.202200013DOI Listing
August 2022

Effectiveness Associated With BNT162b2 Vaccine Against Emergency Department and Urgent Care Encounters for Delta and Omicron SARS-CoV-2 Infection Among Adolescents Aged 12 to 17 Years.

JAMA Netw Open 2022 Aug 1;5(8):e2225162. Epub 2022 Aug 1.

Pfizer, Collegeville, Pennsylvania.

Importance: Data about the duration of protection of 2 and 3 doses of BNT162b2 in children and adolescents are needed to help inform recommendations for boosters in this age group.

Objective: To evaluate vaccine effectiveness (VE) and durability associated with 2 doses of BNT162b2 against Delta- and Omicron-related emergency department (ED) and urgent care (UC) encounters among adolescents aged 12 to 17 years and to estimate VE associated with 3 doses against these same outcomes.

Design, Setting, And Participants: This test-negative case-control study was conducted at Kaiser Permanente Southern California, an integrated health care system using electronic health records in the US. Participants included Kaiser Permanente Southern California members ages 12 to 17 years with an ED or UC encounter from November 1, 2021, through March 18, 2022, for acute respiratory infection who were tested for SARS-CoV-2 via a reverse transction-polymerase chain reaction test. Analyses were conducted from March 21 to June 22, 2022.

Exposures: BNT162b2 vaccination status ascertained from electronic health records and state registry data.

Main Outcomes And Measures: The main outcome was VE associated with BNT162b2 against ED and UC encounters related to Delta or Omicron variant SARS-CoV-2 infection.

Results: Analyses were conducted among 3168 adolescents, including 1004 with ED visits and 2164 with UC visits. Median (IQR) age was 15 (13-16) years, and 1461 (46.1%) were boys. In adjusted analyses, VE associated with 2 doses of BNT162b2 against ED or UC encounters was highest within the first 2 months for both Delta (89% [95% CI, 69% to 96%]) and Omicron (73% [95% CI, 54% to 84%]) variants but waned to 49% (95% CI, 27% to 65%) for the Delta variant and 16% (95% CI, -7% to 34%) for the Omicron variant at 6 months and beyond. A third dose of BNT162b2 was associated with improved protection against the Omicron variant (87% [95% CI, 72% to 94%]) after a median (IQR) of 19 (9-32) days after dose 3.

Conclusions And Relevance: These findings suggest that 2 doses of the BNT162b2 COVID-19 vaccine were associated with high levels of protection against ED and UC encounters related to the Delta and Omicron variants of SARS-CoV-2 in the first few months after vaccination. However, effectiveness waned over time, especially against Omicron. A third dose of BNT162b2 was associated with improved protection against Omicron beyond that seen initially after 2 doses, underscoring the importance of boosters for adolescents aged 12 to 17 years.
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http://dx.doi.org/10.1001/jamanetworkopen.2022.25162DOI Listing
August 2022

Rates of Medically Attended RSV Among US Adults: A Systematic Review and Meta-analysis.

Open Forum Infect Dis 2022 Jul 17;9(7):ofac300. Epub 2022 Jun 17.

Division of Infectious Diseases, Department of Medicine, University of Rochester, Rochester, New York, USA.

Background: Adult respiratory syncytial virus (RSV) vaccines are in the late stages of development. A comprehensive synthesis of adult RSV burden is needed to inform public health decision-making.

Methods: We performed a systematic review and meta-analysis of studies describing the incidence of medically attended RSV (MA-RSV) among US adults. We also identified studies reporting nasopharyngeal (NP) or nasal swab reverse transcription polymerase chain reaction (RT-PCR) results with paired serology (4-fold-rise) or sputum (RT-PCR) to calculate RSV detection ratios quantifying improved diagnostic yield after adding a second specimen type (ie, serology or sputum).

Results: We identified 14 studies with 15 unique MA-RSV incidence estimates, all based on NP or nasal swab RT-PCR testing alone. Pooled annual RSV-associated incidence per 100 000 adults ≥65 years of age was 178 (95% CI, 152‒204; n = 8 estimates) hospitalizations (4 prospective studies: 189; 4 model-based studies: 157), 133 (95% CI, 0‒319; n = 2) emergency department (ED) admissions, and 1519 (95% CI, 1109‒1929; n = 3) outpatient visits. Based on 6 studies, RSV detection was ∼1.5 times higher when adding paired serology or sputum. After adjustment for this increased yield, annual RSV-associated rates per 100 000 adults age ≥65 years were 267 hospitalizations (uncertainty interval [UI], 228‒306; prospective: 282; model-based: 236), 200 ED admissions (UI, 0‒478), and 2278 outpatient visits (UI, 1663‒2893). Persons <65 years with chronic medical conditions were 1.2-28 times more likely to be hospitalized for RSV depending on risk condition.

Conclusions: The true burden of RSV has been underestimated and is significant among older adults and individuals with chronic medical conditions. A highly effective adult RSV vaccine would have substantial public health impact.
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http://dx.doi.org/10.1093/ofid/ofac300DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9301578PMC
July 2022

US County-Level COVID-19 Vaccine Uptake and Rates of Omicron Cases and Deaths.

Open Forum Infect Dis 2022 Jul 17;9(7):ofac299. Epub 2022 Jun 17.

Pfizer Inc., New York, New York, USA.

The population-level impact of vaccination on Omicron-related disease is not well described. We fit negative binomial models to estimate the relationship between US county-level vaccine coverage and rates of coronavirus disease 2019. Increased booster dose uptake was associated with lower rates of Omicron cases and deaths and is critical to combat future severe acute respiratory syndrome coronavirus 2 waves.
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http://dx.doi.org/10.1093/ofid/ofac299DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9301577PMC
July 2022

The current use of ultrasound to measure skeletal muscle and its ability to predict clinical outcomes: a systematic review.

J Cachexia Sarcopenia Muscle 2022 Jul 19. Epub 2022 Jul 19.

Department of Oesophagogastric Surgery, Salford Royal NHS Foundation Trust, Salford, UK.

Quantification and monitoring of lean body mass is an important component of nutrition assessment to determine nutrition status and muscle loss. The negative impact of reduced muscle mass and muscle function is increasingly evident across acute and chronic disease states but is particularly pronounced in patients with cancer. Ultrasound is emerging as a promising tool to directly measure skeletal muscle mass and quality. Unlike other ionizing imaging techniques, ultrasound can be used repeatedly at the bedside and may compliment nutritional risk assessment. This review aims to describe the current use of skeletal muscle ultrasound (SMUS) to measure muscle mass and quality in patients with acute and chronic clinical conditions and its ability to predict functional capacity, severity of malnutrition, hospital admission, and survival. Databases were searched from their inception to August 2021 for full-text articles in English. Relevant articles were included if SMUS was investigated in acute or chronic clinical contexts and correlated with a defined clinical outcome measure. Data were synthesized for narrative review due to heterogeneity between studies. This review analysed 37 studies (3100 patients), which met the inclusion criteria. Most studies (n = 22) were conducted in critical care. The clinical outcomes investigated included functional status at discharge (intensive care unit-acquired weakness), nutritional status, and length of stay. SMUS was also utilized in chronic conditions such as chronic obstructive pulmonary disease, chronic heart failure, and chronic renal failure to predict hospital readmission and disease severity. Only two studies investigated the use of SMUS in patients with cancer. Of the 37 studies, 28 (76%) found that SMUS (cross-sectional area, muscle thickness, and echointensity) showed significant associations with functional capacity, length of stay, readmission, and survival. There was significant heterogeneity in terms of ultrasound technique and outcome measurement across the included studies. This review highlights that SMUS continues to gain momentum as a potential tool for skeletal muscle assessment and predicting clinically important outcomes. Further work is required to standardize the technique in nutritionally vulnerable patients, such as those with cancer, before SMUS can be widely adopted as a bedside prognostic tool.
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http://dx.doi.org/10.1002/jcsm.13041DOI Listing
July 2022

Understanding the development and function of the gut microbiota in health and inflammation.

Frontline Gastroenterol 2022 15;13(e1):e13-e21. Epub 2022 Jun 15.

Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, UK.

The gut microbiota is known to play an important role in maintaining gut health through a symbiotic relationship with the host. Altered gut microbiota is a common feature of several diseases of the gastrointestinal tract; however, the causal relationship between microbiota and disease pathogenesis is poorly understood. Necrotising enterocolitis (NEC) and inflammatory bowel disease (IBD) are both severe inflammatory diseases affecting the gastrointestinal tract. Although they affect very different patient populations, with NEC primarily being a disease of prematurity and IBD predominantly affecting adults although children can be affected, they both demonstrate common features of gut microbial dysbiosis and a dysregulated host immune response. By comparing and contrasting the changes in gut microbiota, host immune response and function, we aim to highlight common features in diseases that may seem clinically unrelated. Key areas of interest are the role of pattern recognition receptors in altered recognition and responses to the gut microbiota by the host immune system and the associated dysfunctional gut epithelial barrier. The challenge of identifying causal relationships between microbiota and disease is ever-present; however, considering a disease-agnostic approach may help to identify mechanistic pathways shared across several clinical diseases.
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http://dx.doi.org/10.1136/flgastro-2022-102119DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9234741PMC
June 2022

Food webs for three burn severities after wildfire in the Eldorado National Forest, California.

Sci Data 2022 07 7;9(1):384. Epub 2022 Jul 7.

Department of Wildlife, Fish, and Conservation Biology, University of California, Davis, CA, 95616, USA.

Wildfire dynamics are changing around the world and understanding their effects on ecological communities and landscapes is urgent and important. We report detailed food webs for unburned, low-to-moderate and high severity burned habitats three years post-fire in the Eldorado National Forest, California. The cumulative cross-habitat food web contains 3,084 ontogenetic stages (nodes) or plant parts comprising 849 species (including 107 primary producers, 634 invertebrates, 94 vertebrates). There were 178,655 trophic interactions between these nodes. We provide information on taxonomy, body size, biomass density and trophic interactions under each of the three burn conditions. We detail 19 sampling methods deployed across 27 sites (nine in each burn condition) used to estimate the richness, body size, abundance and biomass density estimates in the node lists. We provide the R code and raw data to estimate summarized node densities and assign trophic links.
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http://dx.doi.org/10.1038/s41597-022-01220-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9262949PMC
July 2022

The impact of treatment with bile acid sequestrants on quality of life in patients with bile acid diarrhoea.

BMC Gastroenterol 2022 Jul 2;22(1):325. Epub 2022 Jul 2.

The Royal Wolverhampton NHS Trust, Wolverhampton Road, Wolverhampton, WV10 0QP, UK.

Background: Bile acid diarrhoea (BAD) can be severely debilitating and negatively affect patients' quality of life (QoL). We carried out a multi-centre prospective study exploring QoL outcomes in patients with BAD after treatment with colesevelam.

Methods: Patients with or without a positive 23-seleno-25-homotaurocholic acid (SeHCAT) scan were recruited and categorised into four groups: SeHCAT negative control group (CG), idiopathic BAD, post-cholecystectomy (PC) and post-terminal ileal resection for Crohn's disease (CD). Patients with a positive SeHCAT were treated with colesevelam and dosing was titrated to symptomatic response. Patients were reviewed at 4- and 8-weekly intervals and QoL was evaluated by EQ-5D-3L, SF-36, IBDQ-32 at each visit (where relevant). Patients with a negative SeHCAT (CG cohort) completed one set of questionnaires before being discharged from the study.

Results: 47 patients (BAD = 24, PC = 12, CD = 11) completed paired QoL questionnaires before and after treatment and 30 CG patients completed a baseline questionnaire. There was a significant improvement in IBDQ-32 mean scores before and after treatment in CD patients [134.6 (95%CI 112.5-156.6) and 158.4 (136.1-180.6), respectively (p = 0.007). Following treatment, BAD patients had significantly improved mean SF-36 scores in the "Role limitation due to physical health" dimension (p = 0.02) and in the overall mental component summary (p = 0.03). Prior to starting treatment, BAD patients had the lowest scores in the 'activity' dimension of the EQ-5D-3L (p = 0.04), which improved significantly after treatment (p = 0.002). Overall, the BAD and CD cohort showed improved mean scores with treatment in all components of the SF-36 and EQ-5D-3L, while the PC cohort showed a general decline in mean scores after treatment. 55% of patients clinically responded to treatment of which 41.7%, 58.3% and 81.8% responded from the BAD, PC and CD groups respectively. Correlations between those deemed as responders with improvements on the SF-36 and EQ-5D dimensions were not statistically significant.

Conclusion: Our results demonstrate improved QoL in the BAD and CD cohort with treatment. Further larger studies are recommended specifically investigating the PC cohort and whether patients may improve with newer treatments such as FXR agonists. Trial registration Ethical approval REC Ref: 16/LO/1325.
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http://dx.doi.org/10.1186/s12876-022-02404-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9250209PMC
July 2022

Deciphering associations between three RNA splicing-related genetic variants and lung cancer risk.

NPJ Precis Oncol 2022 Jun 30;6(1):48. Epub 2022 Jun 30.

Duke Cancer Institute, Duke University Medical Center, Durham, NC, 27710, USA.

Limited efforts have been made in assessing the effect of genome-wide profiling of RNA splicing-related variation on lung cancer risk. In the present study, we first identified RNA splicing-related genetic variants linked to lung cancer in a genome-wide profiling analysis and then conducted a two-stage (discovery and replication) association study in populations of European ancestry. Discovery and validation were conducted sequentially with a total of 29,266 cases and 56,450 controls from both the Transdisciplinary Research in Cancer of the Lung and the International Lung Cancer Consortium as well as the OncoArray database. For those variants identified as significant in the two datasets, we further performed stratified analyses by smoking status and histological type and investigated their effects on gene expression and potential regulatory mechanisms. We identified three genetic variants significantly associated with lung cancer risk: rs329118 in JADE2 (P = 8.80E-09), rs2285521 in GGA2 (P = 4.43E-08), and rs198459 in MYRF (P = 1.60E-06). The combined effects of all three SNPs were more evident in lung squamous cell carcinomas (P = 1.81E-08, P = 6.21E-08, and P = 7.93E-04, respectively) than in lung adenocarcinomas and in ever smokers (P = 9.80E-05, P = 2.70E-04, and P = 2.90E-05, respectively) than in never smokers. Gene expression quantitative trait analysis suggested a role for the SNPs in regulating transcriptional expression of the corresponding target genes. In conclusion, we report that three RNA splicing-related genetic variants contribute to lung cancer susceptibility in European populations. However, additional validation is needed, and specific splicing mechanisms of the target genes underlying the observed associations also warrants further exploration.
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http://dx.doi.org/10.1038/s41698-022-00281-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9247007PMC
June 2022

Double-blinded randomised placebo controlled trial of enterosgel (polymethylsiloxane polyhydrate) for the treatment of IBS with diarrhoea (IBS-D).

Gut 2022 Jun 27. Epub 2022 Jun 27.

Department of Gastroenterology, County Durham and Darlington NHS Foundation Trust, Darlington, UK

Objective: Irritable bowel syndrome with diarrhoea (IBS-D) is a common and challenging condition that significantly reduces quality of life. Enterosgel (polymethylsiloxane polyhydrate) is an intestinal adsorbent which sequesters harmful molecules and is safe and effective in acute infective diarrhoea. This randomised controlled multicentre trial aimed to investigate its safety and efficacy in patients with IBS-D.

Design: After a 2-week screening phase, participants were randomised into an 8-week double-blind phase, followed by an 8-week open-label and follow-up phase. Participants recorded stool consistency, pain and global symptoms in e-diaries and questionnaires. The primary outcome was the percentage of responders on a composite abdominal pain (≥30% decrease in the weekly score) and stool consistency (50% reduction in days per week with at least one stool of BSFS type 6 or 7) score during at least 4 weeks of the treatment period.

Results: 440 patients with IBS-D were randomised to the double-blind phase with 393 continuing to the open-label phase. The Primary outcome responder rate by intention-to-treat for enterosgel versus placebo was 37.4% vs 24.3% (OR 1.95, NNT 8, p=0.002). Enterosgel also improved stool consistency (48.5% vs 32.5%, p<0.0001) abdominal pain (53.3% vs 40.2%, p=0.003), stool frequency (treatment effect -0.32 (-0.62 to -0.02)) and urgency (treatment effect -0.59 (-0.85 to -0.33)). 60% of patients reported adequate relief of symptoms after open-label treatment. Adverse event frequency was similar in both groups, with no serious events attributable to enterosgel.

Conclusion: Enterosgel is safe and effective in IBS-D, providing an alternative to the limited current treatment options.

Trial Registration Number: ISRCTN17149988.
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http://dx.doi.org/10.1136/gutjnl-2022-327293DOI Listing
June 2022

Guts UK is 50 years old.

Frontline Gastroenterol 2022 13;13(4):352-354. Epub 2021 Sep 13.

Guts UK, London, UK.

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http://dx.doi.org/10.1136/flgastro-2021-101971DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9186055PMC
September 2021

Impact of germline mutations in cancer-predisposing genes on long-term survival in patients with epithelial ovarian cancer.

Br J Cancer 2022 Jun 16. Epub 2022 Jun 16.

Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, Canada.

Background: Several clinical and tumour factors impact on ovarian cancer survival. It is important to evaluate if germline mutations impact long-term outcomes among patients with epithelial ovarian cancer.

Methods: We followed 1422 Ontario women with ovarian cancer. Clinical information was obtained from medical records and vital status was determined by registry linkage. Germline genetic testing was performed for 12 susceptibility genes. We estimated 20-year cancer-specific survival according to various factors.

Results: Twenty-year survival was inferior for women with serous cancers vs. other types (22.3% vs. 68.6%; P < 0.0001). Of the 1422 patients, 248 (17.4%) carried a germline mutation; 119 BRCA1; 75 BRCA2; 7 in a mismatch repair (MMR) gene and 47 in one of seven other genes. Among serous patients, 20-year survival was 28.9% for similar for women with a BRCA1 (28.9%), BRCA2 (21.2%) or no mutation (21.6%). Among endometrioid patients, 20-year survival was poor for women with a BRCA vs. no mutation (47.3% vs. 70.4%; P = 0.004). Six of the seven MMR mutation carriers are currently alive, while all three PALB2 mutation carriers died within 3 years of diagnosis. Among women with Stage III/IV serous cancers, 20-year survival was 9.4% for those with vs. 46.5% for those with no residual disease (HR = 2.91; 95% CI 2.12-4.09, P < 0.0001).

Conclusions: The most important predictor of long-term survival was no residual disease post surgery. BRCA mutation status was not predictive of long-term survival while those with MMR mutations had excellent survival. Larger studies on PALB2 carriers are needed.
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http://dx.doi.org/10.1038/s41416-022-01840-4DOI Listing
June 2022

A single faecal bile acid stool test demonstrates potential efficacy in replacing SeHCAT testing for bile acid diarrhoea in selected patients.

Sci Rep 2022 05 18;12(1):8313. Epub 2022 May 18.

Clinical Chemistry, Black Country Pathology Services, The Royal Wolverhampton NHS Trust, Wolverhampton, UK.

This study examines the validity of measuring faecal bile acids (FBA) in a single stool sample as a diagnostic tool for bile acid diarrhoea (BAD) by direct comparison to the selenium-homotaurocholic acid (SeHCAT) scan. A prospective observational study was undertaken. Patients with chronic diarrhoea (> 6 weeks) being investigated for potential BAD with SeHCAT scan provided stool samples for measurement of FBA, using an enzyme-linked immunosorbent assay. Patients were characterised into four groups: SeHCAT negative control group, post-cholecystectomy, idiopathic BAD and post-operative terminal ileal resected Crohn's disease. Stool samples were collected at baseline and 8-weeks post treatment to determine whether FBA measurement could be used to monitor therapeutic response. 113 patients had a stool sample to directly compare with their SeHCAT result. FBA concentrations (μmol/g) and interquartile ranges in patients in the control group (2.8; 1.6-4.2), BAD (3.6; 1.9-7.2) and post-cholecystectomy cohort 3.8 (2.3-6.8) were similar, but all were significantly lower (p < 0.001) compared to the Crohn's disease cohort (11.8; 10.1-16.2). FBA concentrations in patients with SeHCAT retention of < 15% (4.95; 2.6-10.5) and < 5% (9.9; 4.8-15.4) were significantly higher than those with a SeHCAT retention > 15% (2.6; 1.6-4.2); (p < 0.001 and p < 0.0001, respectively). The sensitivity and specificity using FBA cut-off of 1.6 μmol/g (using ≤ 15% SeHCAT retention as diagnostic of BAD) were 90% and 25% respectively. A single random stool sample may have potential use in diagnosing severe BAD or BAD in Crohn's patients. Larger studies are now needed to confirm the potential efficacy of this test to accurately diagnose BAD in the absence of SeHCAT testing.
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http://dx.doi.org/10.1038/s41598-022-12003-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9117305PMC
May 2022

Immersive In-Person Field Courses during the Pandemic: Minimizing Risk while Maximizing Efficacy.

Authors:
John McLaughlin

Bull Ecol Soc Am 2022 Mar 29:e01984. Epub 2022 Mar 29.

Department of Environmental Sciences College of the Environment Western Washington University Bellingham Washington 98225 USA.

Field courses can provide formative experiences that also reduce disparities in STEM education. Impacts of the ongoing COVID-19 pandemic on-field programs have been particularly severe, as many institutions shifted to online instruction. Some courses retained in-person field experiences during the pandemic, and achieved high student learning outcomes. Here, I describe an approach to mitigating risk of COVID-19 and other hazards during expedition-based field courses, and student learning outcomes achieved using that approach. I applied comprehensive risk management to in-person field expeditions that treated COVID-19 as a hazard, requiring mitigation to maintain an acceptable low level of risk. Prior to broad availability of COVID-19 vaccines, we applied a coronavirus-free "bubble" strategy in which all participants passed a COVID-19 PCR test immediately before departure and then avoided contact with people outside our bubble. In the future, vaccination can reduce risk further. We implemented additional safety factors to reduce risk of incidents that could require evacuation into medical facilities overloaded with COVID-19 patients. The courses were successful: we had no infections or other serious incidents and student learning outcomes were transformative. The approach provides a model for conducting immersive field courses during the pandemic and beyond. Several field course networks are implementing similar approaches to restore valuable field education opportunities that have declined during the pandemic.
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http://dx.doi.org/10.1002/bes2.1984DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9073994PMC
March 2022

Neighborhood Socioeconomic Disadvantage Associated With Increased Healthcare Utilization After Total Hip Arthroplasty.

J Arthroplasty 2022 May 6. Epub 2022 May 6.

Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.

Background: The multifaceted effects of socioeconomic status on healthcare outcomes can be difficult to quantify. The Area Deprivation Index (ADI) quantifies a socioeconomic disadvantage with higher scores indicating more disadvantaged groups. The present study aimed to describe the ADI distribution for primary total hip arthroplasty (THA) patients stratified by patient demographics and to characterize the association of ADI with healthcare utilization (discharge disposition and length of stay [LOS]), 90-day emergency department (ED) visits, and 90-day all cause readmissions.

Methods: Two thousand three hundred and ninety one patients who underwent primary elective THA over a 13-month period were included. A multivariable binary logistic regression analysis with outcomes of nonhome discharge, prolonged LOS (>3 days), 90-day ED visits, and 90-day readmission were performed using predictors of ADI, gender, race, smoking status, body mass index, insurance status, and Charlson comorbidity index. Plots of restricted cubic splines were used to graph associations between ADI as a continuous variable and the outcomes of interest using odds ratios.

Results: In the multivariable regression model, there were statistically significant higher odds of nonhome discharge (OR, 1.82; 95% CI, 1.19-2.77, P = .005) for individuals in the 61-80 ADI quintile as compared to the reference group of 21-40. Individuals in the highest ADI quintile, 81-100, had the greatest odds of nonhome discharge (OR, 2.20; 95% CI, 1.39-3.49, P < .001) and prolonged LOS (OR, 1.91, 95% CI, 1.28-2.84, P = .001).

Conclusions: Higher ADI is associated with an increased healthcare utilization within 90 days of THA.
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http://dx.doi.org/10.1016/j.arth.2022.04.041DOI Listing
May 2022

Durability of BNT162b2 vaccine against hospital and emergency department admissions due to the omicron and delta variants in a large health system in the USA: a test-negative case-control study.

Lancet Respir Med 2022 07 22;10(7):689-699. Epub 2022 Apr 22.

Pfizer, Collegeville, PA, USA.

Background: The duration of protection against the omicron (B.1.1.529) variant for current COVID-19 vaccines is not well characterised. Vaccine-specific estimates are especially needed. We aimed to evaluate the effectiveness and durability of two and three doses of the BNT162b2 (Pfizer-BioNTech) mRNA vaccine against hospital and emergency department admissions due to the delta (B.1.617.2) and omicron variants.

Methods: In this case-control study with a test-negative design, we analysed electronic health records of members of Kaiser Permanente Southern California (KPSC), a large integrated health system in California, USA, from Dec 1, 2021, to Feb 6, 2022. Vaccine effectiveness was calculated in KPSC patients aged 18 years and older admitted to hospital or an emergency department (without a subsequent hospital admission) with a diagnosis of acute respiratory infection and tested for SARS-CoV-2 via PCR. Adjusted vaccine effectiveness was estimated with odds ratios from adjusted logistic regression models. This study is registered with ClinicalTrials.gov (NCT04848584).

Findings: Analyses were done for 11 123 hospital or emergency department admissions. In adjusted analyses, effectiveness of two doses of the BNT162b2 vaccine against the omicron variant was 41% (95% CI 21-55) against hospital admission and 31% (16-43) against emergency department admission at 9 months or longer after the second dose. After three doses, effectiveness of BNT162b2 against hospital admission due to the omicron variant was 85% (95% CI 80-89) at less than 3 months but fell to 55% (28-71) at 3 months or longer, although confidence intervals were wide for the latter estimate. Against emergency department admission, the effectiveness of three doses of BNT162b2 against the omicron variant was 77% (72-81) at less than 3 months but fell to 53% (36-66) at 3 months or longer. Trends in waning against SARS-CoV-2 outcomes due to the delta variant were generally similar, but with higher effectiveness estimates at each timepoint than those seen for the omicron variant.

Interpretation: Three doses of BNT162b2 conferred high protection against hospital and emergency department admission due to both the delta and omicron variants in the first 3 months after vaccination. However, 3 months after receipt of a third dose, waning was apparent against SARS-CoV-2 outcomes due to the omicron variant, including hospital admission. Additional doses of current, adapted, or novel COVD-19 vaccines might be needed to maintain high levels of protection against subsequent waves of SARS-CoV-2 caused by the omicron variant or future variants with similar escape potential.

Funding: Pfizer.
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http://dx.doi.org/10.1016/S2213-2600(22)00101-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9033225PMC
July 2022

Occupational Exposure to Polycyclic Aromatic Hydrocarbons and Lung Cancer Risk: Results from a Pooled Analysis of Case-Control Studies (SYNERGY).

Cancer Epidemiol Biomarkers Prev 2022 Jul;31(7):1433-1441

Epidemiology Unit, Department of Cancer Epidemiology and Prevention, M. Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.

Background: Exposure to polycyclic aromatic hydrocarbons (PAH) occurs widely in occupational settings. We investigated the association between occupational exposure to PAH and lung cancer risk and joint effects with smoking within the SYNERGY project.

Methods: We pooled 14 case-control studies with information on lifetime occupational and smoking histories conducted between 1985 and 2010 in Europe and Canada. Exposure to benzo[a]pyrene (BaP) was used as a proxy of PAH and estimated from a quantitative general population job-exposure matrix. Multivariable unconditional logistic regression models, adjusted for smoking and exposure to other occupational lung carcinogens, estimated ORs, and 95% confidence intervals (CI).

Results: We included 16,901 lung cancer cases and 20,965 frequency-matched controls. Adjusted OR for PAH exposure (ever) was 1.08 (CI, 1.02-1.15) in men and 1.20 (CI, 1.04-1.38) in women. When stratified by smoking status and histologic subtype, the OR for cumulative exposure ≥0.24 BaP μg/m3-years in men was higher in never smokers overall [1.31 (CI, 0.98-1.75)], for small cell [2.53 (CI, 1.28-4.99)] and squamous cell cancers [1.33 (CI, 0.80-2.21)]. Joint effects between PAH and smoking were observed. Restricting analysis to the most recent studies showed no increased risk.

Conclusions: Elevated lung cancer risk associated with PAH exposure was observed in both sexes, particularly for small cell and squamous cell cancers, after accounting for cigarette smoking and exposure to other occupational lung carcinogens.

Impact: The lack of association between PAH and lung cancer in more recent studies merits further research under today's exposure conditions and worker protection measures.
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http://dx.doi.org/10.1158/1055-9965.EPI-21-1428DOI Listing
July 2022

Cell-Selective Adeno-Associated Virus-Mediated Gene Regulation Therapy Rescues Mortality and Seizure Phenotypes in a Dravet Syndrome Mouse Model and Is Well Tolerated in Nonhuman Primates.

Hum Gene Ther 2022 06;33(11-12):579-597

Encoded Therapeutics, Inc., South San Francisco, California, USA.

Dravet syndrome (DS) is a developmental and epileptic encephalopathy caused by monoallelic loss-of-function variants in the gene. encodes for the alpha subunit of the voltage-gated type I sodium channel (Na1.1), the primary voltage-gated sodium channel responsible for generation of action potentials in GABAergic inhibitory interneurons. In these studies, we tested the efficacy of an adeno-associated virus serotype 9 (AAV9) gene regulation therapy, AAV9-RE-eTF, designed to target transgene expression to GABAergic inhibitory neurons and reduce off-target expression within excitatory cells, in the mouse model of DS. Biodistribution and preliminary safety were evaluated in nonhuman primates (NHPs). AAV9-RE-eTF was engineered to upregulate expression levels within GABAergic inhibitory interneurons to correct the underlying haploinsufficiency and circuit dysfunction. A single bilateral intracerebroventricular (ICV) injection of AAV9-RE-eTF in postnatal day 1 mice led to increased mRNA transcripts, specifically within GABAergic inhibitory interneurons, and Na1.1 protein levels in the brain. This was associated with a significant decrease in the occurrence of spontaneous and hyperthermia-induced seizures, and prolonged survival for over a year. In NHPs, delivery of AAV9-RE-eTF by unilateral ICV injection led to widespread vector biodistribution and transgene expression throughout the brain, including key structures involved in epilepsy and cognitive behaviors, such as hippocampus and cortex. AAV9-RE-eTF was well tolerated, with no adverse events during administration, no detectable changes in clinical observations, no adverse findings in histopathology, and no dorsal root ganglion-related toxicity. Our results support the clinical development of AAV9-RE-eTF (ETX101) as an effective and targeted disease-modifying approach to SCN1A DS.
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http://dx.doi.org/10.1089/hum.2022.037DOI Listing
June 2022

COVID-19 Vaccine Effectiveness: A Review of the First 6 Months of COVID-19 Vaccine Availability (1 January-30 June 2021).

Vaccines (Basel) 2022 Mar 3;10(3). Epub 2022 Mar 3.

RTI International, Research Triangle Park, NC 27709, USA.

Observational studies are needed to demonstrate real-world vaccine effectiveness (VE) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outcomes. Our objective was to conduct a review of published SARS-CoV-2 VE articles, supplemented by preprints, during the first 6 months of COVID-19 vaccine availability. This review compares the effectiveness of completing the primary COVID-19 vaccination series against multiple SARS-CoV-2 disease presentations and disease severity outcomes in three population groups (general population, frontline workers, and older adults). Four hundred and seventy-one published articles and 47 preprints were identified. After title and abstract screening and full article review, 50 studies (28 published articles, 22 preprints) were included. VE results were reported for five COVID-19 vaccines and four combinations of COVID-19 vaccines. VE results for BNT162b2 were reported in 70.6% of all studies. Seventeen studies reported variant specific VE estimates; Alpha was the most common. This comprehensive review demonstrates that COVID-19 vaccination is an important tool for preventing COVID-19 morbidity and mortality among fully vaccinated persons aged 16 years and older and serves as an important baseline from which to follow future trends in COVID-19 evolution and effectiveness of new and updated vaccines.
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http://dx.doi.org/10.3390/vaccines10030393DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8951318PMC
March 2022

Multi-objective optimisation of ultrasonically welded dissimilar joints through machine learning.

J Intell Manuf 2022 12;33(4):1125-1138. Epub 2022 Feb 12.

Confirm Smart Manufacturing Research Centre, Limerick, Ireland.

The use of composite materials is increasing in industry sectors such as renewable energy generation and storage, transport (including automotive, aerospace and agri-machinery) and construction. This is a result of the various advantages of composite materials over their monolithic counterparts, such as high strength-to-weight ratio, corrosion resistance, and superior fatigue performance. However, there is a lack of detailed knowledge in relation to fusion joining techniques for composite materials. In this work, ultrasonic welding is carried out on a carbon fibre/PEKK composite material bonded to carbon fibre/epoxy composite to investigate the influence of weld process parameters on the joint's lap shear strength (LSS), the process repeatability, and the process induced defects. A 3 parametric study is carried out and a robust machine learning model is developed using a hybrid genetic algorithm-artificial neural network (GA-ANN) trained on the experimental data. Bayesian optimisation is employed to determine the most suitable GA-ANN hyperparameters and the resulting GA-ANN surrogate model is exploited to optimise the welding process, where the process performance metrics are LSS, repeatability and joint visual quality. The prediction for the optimal LSS was subsequently validated through a further set of experiments, which resulted in a prediction error of just 3%.
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http://dx.doi.org/10.1007/s10845-022-01911-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8924134PMC
February 2022

Incidence and Estimated Vaccine Effectiveness Against Hospitalizations for All-Cause Pneumonia Among Older US Adults Who Were Vaccinated and Not Vaccinated With 13-Valent Pneumococcal Conjugate Vaccine.

JAMA Netw Open 2022 03 1;5(3):e221111. Epub 2022 Mar 1.

Kaiser Permanente Vaccine Study Center, Oakland, California.

Importance: Following routine use of 13-valent pneumococcal conjugate vaccine (PCV13) in children in 2010, invasive pneumococcal disease rates have decreased substantially in children and adults. In 2014, the Advisory Committee for Immunization Practices recommended routine use of PCV13 among adults aged 65 years or older; previously only 23-valent pneumococcal polysaccharide vaccine (PPV23) was recommended.

Objective: To estimate the association between the incidence of hospitalized all-cause pneumonia and lower respiratory tract infections (LRTI) and PCV13 vaccination among older adults at Kaiser Permanente Northern California (KPNC).

Design, Setting, And Participants: This retrospective cohort study included adults at KPNC aged 65 years or older between July 1, 2015, and June 30, 2018, born after 1936 with no known history of PPV23 or PCV13 receipt before age 65. The study took place at an integrated health care system with an annual membership more than 4 million individuals, approximately 15% of whom are 65 years or older and broadly representative of the region. Data analysis took place from July 2018 to December 2021, and data collection took place from November 2016 to June 2018.

Exposures: PCV13 vaccination status was ascertained from the electronic medical record (EMR). Individuals were considered vaccinated 14 days following immunization.

Main Outcomes And Measures: First hospitalized all-cause pneumonia was identified in the EMR using primary/secondary discharge diagnosis International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. First hospitalized LRTI was identified using pneumonia codes and acute bronchitis codes. Relative risk (RR) of first pneumonia or LRTI hospitalization of individuals who were PCV13 vaccinated vs PCV13 unvaccinated was estimated using Poisson regressions adjusted for sex, race, ethnicity, age, influenza vaccine receipt, PPV23 receipt since age 65, pneumonia risk factors, health care use, and season. Vaccine effectiveness (VE) was estimated as (1-RR) × 100%.

Results: Of 192 061 adults, 107 957 (56%) were female and 139 024 (72%) were White individuals. PCV13 coverage increased from 0 in 2014 to 135 608 (76.9%) by 2018. There were 3488 individuals with 3766 pneumonia hospitalizations and 3846 individuals with 4173 LRTI hospitalizations. PCV13 was associated with an adjusted VE of 10.0% (95% CI, 2.4-17.0; P = .01) against hospitalized pneumonia and 9.4% (95% CI, 2.1-16.1; P = .01) against hospitalized LRTI.

Conclusions And Relevance: In the context of a robust pediatric PCV13 immunization program, PCV13 vaccination of adults aged 65 years or older was associated with significant reductions in hospitalizations for all-cause pneumonia and LRTI. Vaccinating older adults with PCVs may provide broader public health benefit against pneumonia hospitalizations.
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http://dx.doi.org/10.1001/jamanetworkopen.2022.1111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8933738PMC
March 2022

Myeloid sarcoma mimicking suprasellar meningioma in acute promyelocytic leukaemia.

Pathology 2022 Mar 3. Epub 2022 Mar 3.

Department of Pathology and Laboratory Medicine, Temple University Hospital, Philadelphia, PA, USA. Electronic address:

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http://dx.doi.org/10.1016/j.pathol.2021.12.291DOI Listing
March 2022

When is Surgery Performed? Trends, Demographic Associations, and Phenotypical Characterization of Baseline Patient-Reported Outcomes Before Total Hip Arthroplasty.

J Arthroplasty 2022 06 22;37(6):1083-1091.e3. Epub 2022 Feb 22.

Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH.

Background: Evaluating trends and drivers of baseline patient-reported outcome measures (PROMs) is critical to understanding when patients and providers elect to undergo surgery. We aimed to assess the following: (1) 5-year trends in baseline PROMs pre-THA (total hip arthroplasty) stratified by patient determinants; (2) patient factor associated with poor preoperative hip pain/function; (3) phenotypes of combined pain/function PROMs at baseline; and (4) intersurgeon variability in PROM thresholds at surgery.

Methods: A prospective cohort of 6,902 primary THAs was enrolled (January 2016 to December 2020). Patient/surgeon details and PROMs were collected at point of care preoperatively. Outcomes included trends (5 years; 20 quarters) in Hip disability and Osteoarthritis Outcome Score (HOOS)-Pain and HOOS-PS (Physical Function Short-Form), stratified by patient demographics. Patients were further classified into phenotype categories of above or equal to median pain/function (P+PS+); below median pain/function (P-PS-); above or equal to median pain but below median function (P+PS-); and below median pain but above or equal to median function (P-PS+).

Results: Baseline HOOS-Pain was consistent across the study period (P-trend = .166), while HOOS-PS demonstrated increasing function (P-trend = .015). Such trends were appreciable in males, females, and White (P-trend < .001, each) but not Black patients (P-trend = .67). Higher odds ratio (OR) of low baseline HOOS-Pain and HOOS-PS were detected among females (HOOS-Pain: OR 1.75, 95% confidence interval [CI] 1.55-1.98, P < .001; HOOS-PS: OR 1.56, 95% CI 1.38-1.77, P < .001), Black patients (HOOS-Pain: OR 1.64, 95% CI 1.35-2.82, P < .001; HOOS-PS: OR 1.59, 95% CI 1.34-1.89, P < .001), and smokers (HOOS-Pain: OR 1.56, 95% CI 1.29-1.89, P < .001; HOOS-PS: OR 1.52, 95% CI 1.25-1.85, P < .001). The P-PS- cohort (32.4%) had lowest age (65.2 ± 11.1 years), highest body mass index (31.6 ± 6.9 kg/m), females (64.8%), Black (15.8%), and current smokers (12.2%). There was significant intersurgeon preoperative PROM variation in HOOS-Pain and HOOS-PS (P < .001, each).

Conclusion: In contrast to the general population, Black patients have consistently received THA at lower functional levels throughout the 5-year period. Females, smokers, and Black patients were more likely to have poorer pain and function at THA. PROMs assessment as combined pain-function phenotypes may provide a more comprehensive interpretation of patient status preoperatively.
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http://dx.doi.org/10.1016/j.arth.2022.02.063DOI Listing
June 2022

Developing patient-orientated Barrett's oesophagus services: the role of dedicated services.

BMJ Open Gastroenterol 2022 02;9(1)

School of Medical Sciences, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK.

Introduction: Barrett's oesophagus (BO) is common and is a precursor to oesophageal adenocarcinoma with a 0.33% per annum risk of progression. Surveillance and follow-up services for BO have been shown to be lacking, with studies showing inadequate adherence to guidelines and patients reporting a need for greater disease-specific knowledge. This review explores the emerging role of dedicated services for patients with BO.

Methods: A literature search of PubMed, MEDLINE, Embase, Emcare, HMIC, BNI, CiNAHL, AMED and PsycINFO in regard to dedicated BO care pathways was undertaken.

Results: Prospective multicentre and randomised trials were lacking. Published cohort data are encouraging with improvements in guideline adherence with dedicated services, with one published study showing significant improvements in dysplasia detection rates. Accuracy of allocation to surveillance endoscopy has been shown to hold cost savings, and a study of a dedicated clinic showed increased discharges from unnecessary surveillance. Training modalities for BO surveillance and dysplasia detection exist, which could be used to educate a BO workforce. Qualitative and quantitative studies have shown patients report high levels of cancer worry and poor disease-specific knowledge, but few studies have explored follow-up care models despite being a patient and clinician priority for research.

Conclusions: Cost-benefit analysis for dedicated services, considering both financial and environmental impacts, and more robust clinical data must be obtained to support this model of care in the wider health service. Greater understanding is needed of the root causes for poor guideline adherence, and disease-specific models of care should be designed around clinical and patient-reported outcomes to address the unmet needs of patients with BO.
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http://dx.doi.org/10.1136/bmjgast-2021-000829DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8867250PMC
February 2022

Effectiveness of a third dose of BNT162b2 mRNA COVID-19 vaccine in a large US health system: A retrospective cohort study.

Lancet Reg Health Am 2022 May 14;9:100198. Epub 2022 Feb 14.

Pfizer Inc., Collegeville, PA, USA.

Background: Globally, recommendations are expanding for third (booster) doses of BNT162b2 (Pfizer-BioNTech). In the United States, as of November 19, 2021, boosters were recommended for all adults aged 18 years and older. We evaluated the effectiveness of a third dose of BNT162b2 among adults in a large US integrated health system.

Methods: In this retrospective cohort study, we analyzed electronic health records from Kaiser Permanente Southern California between Dec 14, 2020 and Dec 5, 2021 to assess vaccine effectiveness (VE) of two and three doses of BNT162b2 against SARS-CoV-2 infections (without hospital admission) andCOVID-19-related hospital admission. VE was calculated using hazards ratios from adjusted Cox models.

Findings: After only two doses, VE against infection declined from 85% (95% CI 83-86) during the first month to 49% (46-51) ≥ 7 months following vaccination. Overall VE against hospitalization was 90% (95% CI 86-92) within one month and did not wane, however, effectiveness against hospitalization appeared to wane among immunocompromised individuals but was not statistically significant (93% [72-98] at 1 month to 74% [45-88] after ≥ 7 months; p=0·490). Three-dose VE (median follow-up 1·3 months [SD 0·6]) was 88% (95% CI 86-89) against infection and 97% (95-98) against hospitalization. Effectiveness after three doses was higher than that seen one month after receiving only two doses for both outcomes. Relative VE of three doses compared to two (with at least six months after the second dose) was 75% (95% CI 71-78) against infections and 70% (48-83) against hospital admissions.

Interpretation: These data support the benefit of broad BNT162b2 booster recommendations, as three doses confers comparable, if not better, protection against SARS-CoV-2 infections and hospital admission as was seen soon after receiving two doses.

Funding: Pfizer Inc.
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http://dx.doi.org/10.1016/j.lana.2022.100198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8841530PMC
May 2022

County-level vaccination coverage and rates of COVID-19 cases and deaths in the United States: An ecological analysis.

Lancet Reg Health Am 2022 May 31;9:100191. Epub 2022 Jan 31.

Pfizer Vaccines, 500 Arcola Rd., Collegeville, PA, USA.

Background: On Dec 14, 2020, the United States initiated a nationwide COVID-19 vaccination campaign. Demonstrating clear population-level impact following vaccine introduction helps to further elucidate and quantify the public-health benefits of vaccination.

Methods: Using a negative binomial regression model we evaluated the ecological association between county-level COVID-19 vaccine uptake and rates of COVID-19 cases and deaths in the United States from April 1, 2021 through October 31, 2021 controlling for a broad set of county-level environmental, sociodemographic, economic, and health-status-related characteristics. County-level data were obtained from several publicly available databases that were merged for analysis.

Findings: After adjustment for county-level characteristics, US counties with ≥ 80% of their residents ≥ 12 years of age fully vaccinated against COVID-19 had 30% (95% CI: 25-35; < .001) and 46% (38-52; < .001) lower rates of COVID-19 cases and deaths, respectively, versus those with <50% coverage (reference group). A dose response was observed: counties with 70-79% uptake had 20% (95% CI: 16-24; < .001) and 35% (29-40; < .001) lower rates of cases and deaths, respectively; counties with 60-69% uptake had 8% (5-11; < .001) and 20% (15-24; < .001) lower rates; and counties with 50-59% uptake had 2% (0-4; =.09) and 8% (4-12; < .001) lower rates. Restricting the analysis to the period when the Delta variant was predominant (June 1, 2021 ‒ October 31, 2021) showed similar findings.

Interpretation: Our results showed that US counties with higher proportions of persons ≥ 12 years of age fully vaccinated against COVID-19 had substantially lower rates of COVID-19 cases and deaths-a finding that showed dose response and persisted even in the period when Delta was predominant.

Funding: Pfizer.
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http://dx.doi.org/10.1016/j.lana.2022.100191DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8802692PMC
May 2022

Estimates of Presumed Population Immunity to SARS-CoV-2 by State in the United States, August 2021.

Open Forum Infect Dis 2022 Feb 17;9(2):ofab647. Epub 2022 Jan 17.

RTI International, Research Triangle Park, North Carolina, USA.

Background: Information is needed to monitor progress toward a level of population immunity to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sufficient to disrupt viral transmission. We estimated the percentage of the US population with presumed immunity to SARS-CoV-2 due to vaccination, natural infection, or both as of August 26, 2021.

Methods: Publicly available data as of August 26, 2021, from the Centers for Disease Control and Prevention were used to calculate presumed population immunity by state. Seroprevalence data were used to estimate the percentage of the population previously infected with SARS-CoV-2, with adjustments for underreporting. Vaccination coverage data for both fully and partially vaccinated persons were used to calculate presumed immunity from vaccination. Finally, we estimated the percentage of the total population in each state with presumed immunity to SARS-CoV-2, with a sensitivity analysis to account for waning immunity, and compared these estimates with a range of population immunity thresholds.

Results: In our main analysis, which was the most optimistic scenario, presumed population immunity varied among states (43.1% to 70.6%), with 19 states with ≤60% of their population having been infected or vaccinated. Four states had presumed immunity greater than thresholds estimated to be sufficient to disrupt transmission of less infectious variants (67%), and none were greater than the threshold estimated for more infectious variants (≥78%).

Conclusions: The United States remains a distance below the threshold sufficient to disrupt viral transmission, with some states remarkably low. As more infectious variants emerge, it is critical that vaccination efforts intensify across all states and ages for which the vaccines are approved.
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http://dx.doi.org/10.1093/ofid/ofab647DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8774091PMC
February 2022

Transforming Palmyra Atoll to native-tree dominance will increase net carbon storage and reduce dissolved organic carbon reef runoff.

PLoS One 2022 21;17(1):e0262621. Epub 2022 Jan 21.

The Nature Conservancy, Sacramento, California, United States of America.

Native forests on tropical islands have been displaced by non-native species, leading to calls for their transformation. Simultaneously, there is increasing recognition that tropical forests can help sequester carbon that would otherwise enter the atmosphere. However, it is unclear if native forests sequester more or less carbon than human-altered landscapes. At Palmyra Atoll, efforts are underway to transform the rainforest composition from coconut palm (Cocos nucifera) dominated to native mixed-species. To better understand how this landscape-level change will alter the atoll's carbon dynamics, we used field sampling, remote sensing, and parameter estimates from the literature to model the total carbon accumulation potential of Palmyra's forest before and after transformation. The model predicted that replacing the C. nucifera plantation with native species would reduce aboveground biomass from 692.6 to 433.3 Mg C. However, expansion of the native Pisonia grandis and Heliotropium foertherianum forest community projected an increase in soil carbon to at least 13,590.8 Mg C, thereby increasing the atoll's overall terrestrial carbon storage potential by 11.6%. Nearshore sites adjacent to C. nucifera canopy had a higher dissolved organic carbon (DOC) concentration (110.0 μMC) than sites adjacent to native forest (81.5 μMC), suggesting that, in conjunction with an increase in terrestrial carbon storage, replacing C. nucifera with native forest will reduce the DOC exported from the forest into in nearshore marine habitats. Lower DOC levels have potential benefits for corals and coral dependent communities. For tropical islands like Palmyra, reverting from C. nucifera dominance to native tree dominance could buffer projected climate change impacts by increasing carbon storage and reducing coral disease.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0262621PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8782295PMC
February 2022
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