Before and after COVID-19: Changes in symptoms and diagnoses in 13,033 adults.

BACKGROUND: Most patients with COVID-19 report experiencing one or more symptoms after acute infection subsides, known as post-acute sequelae of SARS-CoV-2 infection (PASC). Though research has examined PASC after acute COVID-19, few studies have examined PASC over a longer follow-up duration or accounted for rates of symptoms and diagnoses before COVID-19 infection, and included those not actively seeking treatment for PASC. To determine what symptoms and diagnoses are occurring at higher rates after acute COVID-19 infection from a more inclusive sample, we extracted electronic hospital records (EHR) data from 13,033 adults with previously known diagnoses and symptoms. METHODS: The sample was comprised of patients who had a positive PCR test for SARS-CoV-2 between March 1, 2020, and December 31, 2020, and follow-up was conducted through November 29, 2021. All patients in the sample had medical appointments ≥4 weeks before and ≥4 weeks after their positive PCR test. At these appointments, all ICD-10 codes recorded in the EHR were classified into 21 categories based on the literature and expert review. Conditional logistic regression models were used to quantify the odds of these symptoms and diagnostic categories following COVID-19 infection relative to visits occurring before infection. The sample was comprised of 28.0% adults over 65 and was 57.0% female. After the positive PCR test, the most recorded diagnoses and symptoms were dyspnea and respiratory failure, myositis, musculoskeletal pain/stiffness, anxiety, and depression. RESULTS: Results from regression analyses showed increased odds of diagnosis for 15 of the 21 categories following positive PCR. Relative to pre-COVID, the diagnoses and symptoms with the greatest odds after a positive PCR test were loss of smell or taste [OR (95% CI) = 6.20 (3.18-12.09)], pulmonary fibrosis [3.50 (1.59-7.68)], and dyspnea/respiratory failure [2.14 (1.92-2.40)]. Stratification of these analyses by age, gender, race, and ethnicity showed similar results. CONCLUSION: The increased symptoms and diagnoses detected in the current study match prior analyses of PASC diagnosis and treatment-seeking patients. The current research expands upon the literature by showing that these symptoms are more frequently detected following acute COVID-19 than before COVID-19. Further, our analyses provide a broad snapshot of the population as we were able to describe PASC among all patients who tested positive for COVID-19.

The effect of a multi-component behavior change technique intervention on medication adherence among individuals on primary prevention statin therapy: a dose-finding protocol.

BACKGROUND: In the USA, the primary cause of death and morbidity continues to be cardiovascular disease (CVD). Numerous trials have shown that statin medication reduces the likelihood of CVD events; it is a cornerstone of CVD prevention. However, studies have also indicated that up to 60% of the estimated 26.8 million Americans prescribed primary prevention statin treatment are nonadherent during the first year. Multi-component behavioral change technique (BCT) therapies have shown moderate promise in improving medication adherence as well as other positive health behaviors (such as physical activity). However, no research has looked at the duration of multi-component BCT intervention needed to result in a clinically significant improvement in statin adherence behaviors. This study aims to determine the necessary dose of a multi-component BCT intervention (defined as duration in weeks) to promote adherence to statin medication among those on primary prevention statin treatment by utilizing the modified time-to-event continuous reassessment method (TiTE-CRM). METHODS AND DESIGN: The study will utilize the modified TiTE-CRM in 42 participants, recruited in 14 cohorts of 3 participants each. The goal of this analysis is to identify the minimum effective dose (MED) of a multi-behavior change technique (BCT) intervention required to increase adherence to statins by 20% between baseline and follow-up periods. Using the TiTE-CRM method, the dose of the behavior intervention in weeks will be assigned to each cohort based on the performance of the prior cohort. At the end of the study, the intervention dose that has been found to be associated with a 20% increase in statin adherence among 80% of participants assigned to that dose will be identified as the MED. DISCUSSION: If successful, the current trial will provide additional guidance to researchers and clinicians seeking to increase statin medication adherence using a BCT intervention by identifying the dose (i.e., the duration) of an intervention required to meaningfully increase adherence. TRIAL REGISTRATION: ClinicalTrials.gov NCT05273736. Registered on March 10, 2022. https://www. CLINICALTRIALS: gov/ct2/show/NCT05273736.

Accumulation and transport of nutrient and pollutant elements in riparian soils, sediments, and river waters across the Thames River Watershed, Connecticut, USA.

Understanding drivers of nutrient and pollutant elements (NPEs) in soils, sediments, and river water is important for protecting water resources and aquatic ecosystems. The objectives of this study were to quantify accumulation and transport of NPEs (P, As, Cd, Cu, Ni, Pb, and Zn) in riparian soils, sediments, river water, and watershed-scale exports within seven post-industrial subwatersheds of the Thames River, Connecticut, USA. Suspended sediments and river water samples were collected from February 2019 to January 2020. Arsenic concentrations in soil (6 to 18 mg kg-1) and sediments (8 to 85 mg kg-1) generally exceeded state and federal EPA quality targets but not river water. Elevated Pb 'hot spots' occurred in some riparian soils (>2000 mg kg-1) and sediments (>200 mg kg-1), but the other NPEs concentrations were below toxic thresholds. Riparian soil concentrations and watershed land cover were generally weak predictors for NPE concentrations in bottom sediments, suspended sediments, and river water. DOC, Mn, and Fe concentrations were important predictors for area-normalized dissolved and sediment-bound export of NPEs across the seven watersheds. Dissolved export was greater than sediment export for Mn, P, As, Cd, Cu, and Ni but not for Fe, Pb, and Zn. Watersheds with higher farmland had higher P river water concentrations, but the larger, more urbanized watershed had the highest total and area-normalized P export. An estuarine sediment core that captures sediment from the whole watershed and spans pre-industrial conditions through present shows that export of most NPEs has decreased since its peak, but all remain above baseline throughout the Thames River watershed. Future constraints on surface soil-river exchange and erosion inputs are needed to investigate rates of NPE sourcing to the watersheds.

The effect of a multi-component behavior change technique intervention on physical activity among individuals on primary prevention statin therapy: A dose-finding trial protocol.

BACKGROUND: Statin therapy is a mainstay of cardiovascular disease (CVD) prevention, but research shows that statin therapy alone is insufficient for preventing incident CVD and mortality. Combining statin medication with increased physical activity (PA) can lower mortality risk more than either statin or PA alone. However, PA levels often remain the same and may even decline following statin prescription. Additional information is needed to identify how to increase PA among statin users and determine the minimal length of an intervention (i.e., intervention dose) necessary to increase PA. OBJECTIVE: The study aims to identify the required dose of a behavior change technique (BCT) intervention to increase PA among individuals on primary prevention statin therapy who have an elevated risk for cardiovascular disease (CVD). METHODS: The study will utilize the modified time-to-event continual reassessment method (TiTE-CRM) in 42 participants. We expect insights relating to dose-efficacy models and BCTs (Behavior Change Techniques) to improve PA in adults at risk for CVD. This trial will also examine potential mechanisms of action (MoAs) for interventions to increase PA, identify any effect a PA intervention may have on medication adherence, and determine whether participants respond uniformly to their respective behavioral interventions. ETHICS AND DISSEMINATION: This trial was approved by the Northwell Health Institutional Review Board (IRB) and all participants will complete informed consent. The trial results will be published in a peer-reviewed journal. All publications resulting from this series of personalized trials will follow the CONSORT reporting guidelines. REGISTRATION DETAILS: This trial is registered on www. CLINICALTRIALS: gov (Number NCT05273723).

Mechanical ventilation for COVID-19: Outcomes following discharge from inpatient treatment.

Though mechanical ventilation (MV) is used to treat patients with severe coronavirus disease 2019 (COVID-19), little is known about the long-term health implications of this treatment. Our objective was to determine the association between MV for treatment of COVID-19 and likelihood of hospital readmission, all-cause mortality, and reason for readmission. This study was a longitudinal observational design with electronic health record (EHR) data collected between 3/1/2020 and 1/31/2021. Participants included 17,652 patients hospitalized for COVID-19 during this period who were followed through 6/30/2021. The primary outcome was readmission to inpatient care following discharge. Secondary outcomes included all-cause mortality and reason for readmission. Rates of readmission and mortality were compared between ventilated and non-ventilated patients using Cox proportional hazards regression models. Differences in reasons for readmission by MV status were compared using multinomial logistic regression. Patient characteristics and measures of illness severity were balanced between those who were mechanically ventilated and those who were not utilizing 1-to-1 propensity score matching. The sample had a median age of 63 and was 47.1% female. There were 1,131 (6.4%) patients who required MV during their initial hospitalization. Rates (32.1% versus 9.9%) and hazard of readmission were greater for patients requiring MV in the propensity score-matched samples [hazard ratio (95% confidence interval) = 3.34 (2.72-4.10)]. Rates (15.3% versus 3.4%) and hazard [hazard ratio (95% confidence interval) = 3.12 (2.32-4.20)] of all-cause mortality were also associated with MV status. Ventilated patients were more likely to be readmitted for reasons which were classified as COVID-19, infectious diseases, and respiratory diagnoses compared to non-ventilated patients. Mechanical ventilation is a necessary treatment for severely ill patients. However, it may be associated with adverse outcomes including hospital readmission and death. More intense post-discharge monitoring may be warranted to decrease this associational finding.

Feasibility Test of Personalized (N-of-1) Trials for Increasing Middle-Aged and Older Adults' Physical Activity.

Purpose: To test the feasibility of a remotely-delivered intervention to increase low-intensity physical activity (walking) in middle-aged and older adults. Design: This study used a Personalized (N-of-1) trial design. Setting: This study took place at a major healthcare system from November 2021 to February 2022. Subjects: Sixty adults (45-75 years, 92% female, 80% white) were recruited. Intervention: A 10-week study comprising a 2-week baseline, followed by four 2-week periods where 4 Behavior Change Techniques (BCTs) - self-monitoring, goal setting, action planning and feedback - were delivered one at a time in random order. Measures: Activity was measured by a Fitbit, and intervention components delivered by email/text. Average daily steps were compared between baseline and intervention. Participants completed satisfaction items derived from the System Usability Scale and reported attitudes and opinions about personalized trials. Results: Participants rated personalized trial components as feasible and acceptable. Changes in steps between baseline and intervention were not significant, but a large heterogeneity of treatment effects existed, suggesting some participants significantly increased walking while others significantly decreased. Conclusions: Our intervention was well-accepted but use of BCTs delivered individually did not result in a significant increase in steps. Feasibility and heterogeneity of treatment effects support adopting a personalized trial approach to optimize intervention results.

Telephone-based depression self-management in Hispanic adults with epilepsy: a pilot randomized controlled trial.

Depression is associated with adverse outcomes in epilepsy but is undertreated in this population. Project UPLIFT, a telephone-based depression self-management program, was developed for adults with epilepsy and has been shown to reduce depressive symptoms in English-speaking patients. There remains an unmet need for accessible mental health programs for Hispanic adults with epilepsy. The purpose of this study was to evaluate the feasibility, acceptability, and effects on depressive symptoms of a culturally adapted version of UPLIFT for the Hispanic community. Hispanic patients with elevated depressive symptoms (n = 72) were enrolled from epilepsy clinics in New York City and randomized to UPLIFT or usual care. UPLIFT was delivered in English or Spanish to small groups in eight weekly telephone sessions. Feasibility was assessed by recruitment, retention, and adherence rates and acceptability was assessed by self-reported satisfaction with the intervention. Depressive symptoms (PHQ-9 scores) were compared between study arms over 12 months. The mean age was 43.3±11.3, 71% of participants were female and 67% were primary Spanish speakers. Recruitment (76% consent rate) and retention rates (86-93%) were high. UPLIFT participants completed a median of six out of eight sessions and satisfaction ratings were high, but rates of long-term practice were low. Rates of clinically significant depressive symptoms (PHQ-9 ≥5) were lower in UPLIFT versus usual care throughout follow-up (63% vs. 72%, 8 weeks; 40% vs. 70%, 6 months; 47% vs. 70%, 12 months). Multivariable-adjusted regressions demonstrated statistically significant differences at 6 months (OR = 0.24, 95% CI, 0.06-0.93), which were slightly reduced at 12 months (OR = 0.30, 95% CI, 0.08-1.16). Results suggest that UPLIFT is feasible and acceptable among Hispanic adults with epilepsy and demonstrate promising effects on depressive symptoms. Larger trials in geographically diverse samples are warranted.

Oceanographic features and limited dispersal shape the population genetic structure of the vase sponge Ircinia campana in the Greater Caribbean.

Understanding population genetic structure can help us to infer dispersal patterns, predict population resilience and design effective management strategies. For sessile species with limited dispersal, this is especially pertinent because genetic diversity and connectivity are key aspects of their resilience to environmental stressors. Here, we describe the population structure of Ircinia campana, a common Caribbean sponge subject to mass mortalities and disease. Microsatellites were used to genotype 440 individuals from 19 sites throughout the Greater Caribbean. We found strong genetic structure across the region, and significant isolation by distance across the Lesser Antilles, highlighting the influence of limited larval dispersal. We also observed spatial genetic structure patterns congruent with oceanography. This includes evidence of connectivity between sponges in the Florida Keys and the southeast coast of the United States (>700 km away) where the oceanographic environment is dominated by the strong Florida Current. Conversely, the population in southern Belize was strongly differentiated from all other sites, consistent with the presence of dispersal-limiting oceanographic features, including the Gulf of Honduras gyre. At smaller spatial scales (<100 km), sites showed heterogeneous patterns of low-level but significant genetic differentiation (chaotic genetic patchiness), indicative of temporal variability in recruitment or local selective pressures. Genetic diversity was similar across sites, but there was evidence of a genetic bottleneck at one site in Florida where past mass mortalities have occurred. These findings underscore the relationship between regional oceanography and weak larval dispersal in explaining population genetic patterns, and could inform conservation management of the species.

Herbivorous Crabs Reverse the Seaweed Dilemma on Coral Reefs.

Coral reefs are on a steep trajectory of decline, with natural recovery in many areas unlikely.1-3 Eutrophication, overfishing, climate change, and disease have fueled the supremacy of seaweeds on reefs,4,5 particularly in the Caribbean, where many reefs have undergone an ecological phase shift so that seaweeds now dominate previously coral-rich reefs.6-8 Discovery of the powerful grazing capability of the Caribbean's largest herbivorous crab (Maguimithrax spinosissimus)9 led us to test the effectiveness of their grazing on seaweed removal and coral reef recovery in two experiments conducted sequentially at separate locations 15 km apart in the Florida Keys (USA). In those experiments, we transplanted crabs onto several patch reefs, leaving others as controls (n = 24 reefs total; each 10-20 m2 in area) and then monitored benthic cover, coral recruitment, and fish community structure on each patch reef for a year. We also compared the effectiveness of crab herbivory to scrubbing reefs by hand to remove algae. Crabs reduced the cover of seaweeds by 50%-80%, resulting in a commensurate 3-5-fold increase in coral recruitment and reef fish community abundance and diversity. Although laborious hand scrubbing of reefs also reduced algal cover, that effect was transitory unless maintained by the addition of herbivorous crabs. With the persistence of Caribbean coral reefs in the balance, our findings demonstrate that large-scale restoration that includes enhancement of invertebrate herbivores can reverse the ecological phase shift on coral reefs away from seaweed dominance.

Conserving spawning stocks through harvest slot limits and no-take protected areas.

The key to the conservation of harvested species is the maintenance of reproductive success. Yet for many marine species large, old, individuals are targeted despite their disproportionate contribution to reproduction. We hypothesized that a combination of no-take marine protected areas (MPAs) and harvest slot limits (maximum and minimum size limits) would result in the conservation of large spawning individuals under heavy harvest. We tested this approach under different harvest intensities with a 2-sex, stage-structured metapopulation model for the Caribbean spiny lobster (Panulirus argus). P. argus is intensively harvested in the Caribbean, and in many localities large, mature individuals no longer exist. No-take MPAs and harvest slot limits combined, rebuilt and maintained large mature individuals even under high harvest pressure. The most conservative model (a 30% MPA and harvest slot limit of 75-105 mm) increased spawner abundance by 5.53E12 compared with the fishing status quo at the end of 30 years. Spawning stock abundance also increased by 2.76-9.56E12 individuals at a high harvest intensity over 30 years with MPAs alone. Our results demonstrate the potential of MPAs and harvest slot limits for the conservation of large breeding individuals in some marine and freshwater environments. Decisions on which management strategy best suits a fishery, however, requires balancing what is ecologically desirable with what is economically and socially feasible.

Conservación de Stocks Reproductivos por medio de Límites de Espacios de Producción y Áreas Protegidas de Cero Captura Resumen La clave para la conservación de las especies en criaderos es la manutención del éxito reproductivo. Aún así, para muchas especies marinas los individuos grandes y viejos son seleccionados a pesar de su contribución desproporcionada para la reproducción. Nuestra hipótesis supone que una combinación de áreas marinas protegidas (AMPs) de cero captura y los límites de espacio de producción (límites máximos y mínimos de tamaño) resultaría en la conservación de individuos reproductivos grandes durante una producción intensiva. Probamos esta estrategia bajo diferentes intensidades de crianza con un modelo metapoblacional de dos sexos y estructurado por etapas aplicado a la langosta espinosa del Caribe (Panulirus argus). P. argus es producida intensivamente en el Caribe y en muchas de las localidades, los individuos grandes y maduros ya no existen. La combinación de las AMPs de cero captura y los límites de espacio de producción regeneró y mantuvo individuos grandes y maduros incluso bajo una presión alta de producción. El modelo más conservador (un 30% de MPA y un límite de espacio de producción de 75-105 mm) incrementó la abundancia de individuos reproductivos por 5.53E12 comparado con el status quo de la pesca después de treinta años. La abundancia del stock reproductivo también incrementó por 2.76-9.56E12 individuos en una intensidad alta de producción durante 30 años sólo con las AMPs. Nuestros resultados demuestran el potencial de las AMPs y los límites de espacio de producción para la conservación de individuos reproductivos grandes en algunos ambientes marinos y de agua dulce. Sin embargo, las decisiones sobre cuál es la mejor estrategia de manejo para una pesquería requieren del equilibrio entre lo que es ecológicamente deseable y lo que es económica y socialmente factible.

Chromium, manganese, nickel, and cobalt mobility and bioavailability from mafic-to-ultramafic mine spoil weathering in western Massachusetts, USA.

Fragmented ultramafic bodies in New England were important mineral resources until the early twentieth century, yet few studies have addressed their potential to release trace metals to terrestrial and aquatic environments. Here, we evaluate the release of four trace metals (Cr, Co, Mn, and Ni) from a historic serpentine-talc "soapstone" quarry in Blandford, MA, USA. Soil pits, sediment and rock samples, and stream water samples were collected from upslope undisturbed areas, within the mine spoils and mine face, and downslope of the mine. In order to provide a bottom-up approach for understanding metal release, careful petrographic analysis, electron-dispersive spectroscopy, and wavelength-dispersive spectroscopy were employed to provide first-order insight into the mineralogy of the deposit and a determination of potential metal-bearing phases. Trace metals were primarily observed in ultramafic sheet silicates, primary Fe-oxides, and interstitial weathering-related sulfates. Bulk rock concentrations were Cr (1550 mg kg-1), Co (230 mg kg-1), Mn (1100 mg kg-1), and Ni (1960 mg kg1); Cr, Co, and Ni were elevated relative to the surrounding country rock. However, soils and sediments total concentrations were comparable to background soil concentrations: Cr (119 mg kg-1), Co (73 mg kg-1), Mn (894 mg kg-1), and Ni (65 mg kg-1). Moreover, < 0.5% of the total concentrations were bioavailable (0.1 M ammonium acetate extraction), implying that metals are present as insoluble forms. However, ~ 20% of the total Cr, Mn, Ni, and Co concentrations were strong acid extractable, suggesting mobilization over the coming decades. Stream water concentrations of Mn and Cr were < 50 µg L-1, below concentrations outlined by USEPA drinking water standards, and WHO water guidelines for Ni. These results suggest that transport of Cr, Mn, Ni, and Co from the serpentine-talc as dissolved compounds or sediments is limited by retention within silicate and oxides.

Gender Differences in Acculturative Stress and Habitual Sleep Duration in Korean American Immigrants.

Korean American immigrants (KAIs) face diverse sociocultural stressors in the acculturation process. While stress is known to cause short sleep, little is known about how acculturative stress affects sleep differently for KAI men and women. The purpose of this cross-sectional study was to examine gender differences in the association between diverse domains of acculturative stress and sleep duration among KAIs. Middle-aged KAIs were recruited in community settings and online. KAIs completed validated measures of acculturative stress (homesickness, social isolation, employment barriers, discrimination, civic disengagement, and family problems) and sleep duration. Multiple linear regression analysis was performed and stratified by gender. 343 KAIs participated (mean age = 41 ± 10 years, 47% female, 11% short sleepers [< 6 h]). After adjustment for covariates, higher homesickness (ß = - 23.19, p < 0.05) and lower civic disengagement (ß = 17.75, p < 0.05) were associated with shorter sleep duration in women, while higher isolation was associated with shorter sleep duration in men (ß = - 13.73, p < 0.05). Discussion: Results suggest gender-specific associations between acculturative stress and sleep duration. Future research should take into account gender differences in the experience and effects of acculturative stress when developing interventions to improve sleep health in KAIs.

Association Between High Perceived Stress Over Time and Incident Hypertension in Black Adults: Findings From the Jackson Heart Study.

Background Chronic psychological stress has been associated with hypertension, but few studies have examined this relationship in blacks. We examined the association between perceived stress levels assessed annually for up to 13 years and incident hypertension in the Jackson Heart Study, a community-based cohort of blacks. Methods and Results Analyses included 1829 participants without hypertension at baseline (Exam 1, 2000-2004). Incident hypertension was defined as blood pressure≥140/90 mm Hg or antihypertensive medication use at Exam 2 (2005-2008) or Exam 3 (2009-2012). Each follow-up interval at risk of hypertension was categorized as low, moderate, or high perceived stress based on the number of annual assessments between exams in which participants reported "a lot" or "extreme" stress over the previous year (low, 0 high stress ratings; moderate, 1 high stress rating; high, ≥2 high stress ratings). During follow-up (median, 7.0 years), hypertension incidence was 48.5%. Hypertension developed in 30.6% of intervals with low perceived stress, 34.6% of intervals with moderate perceived stress, and 38.2% of intervals with high perceived stress. Age-, sex-, and time-adjusted risk ratios (95% CI) associated with moderate and high perceived stress versus low perceived stress were 1.19 (1.04-1.37) and 1.37 (1.20-1.57), respectively (P trend<0.001). The association was present after adjustment for demographic, clinical, and behavioral factors and baseline stress (P trend=0.001). Conclusions In a community-based cohort of blacks, higher perceived stress over time was associated with an increased risk of developing hypertension. Evaluating stress levels over time and intervening when high perceived stress is persistent may reduce hypertension risk.

Host genetics and geography influence microbiome composition in the sponge Ircinia campana.

Marine sponges are hosts to large, diverse communities of microorganisms. These microbiomes are distinct among sponge species and from seawater bacterial communities, indicating a key role of host identity in shaping its resident microbial community. However, the factors governing intraspecific microbiome variability are underexplored and may shed light on the evolutionary and ecological relationships between host and microbiome. Here, we examined the influence of genetic variation and geographic location on the composition of the Ircinia campana microbiome. We developed new microsatellite markers to genotype I. campana from two locations in the Florida Keys, USA, and characterized their microbiomes using V4 16S rRNA amplicon sequencing. We show that microbial community composition and diversity is influenced by host genotype, with more genetically similar sponges hosting more similar microbial communities. We also found that although I. campana was not genetically differentiated between sites, microbiome composition differed by location. Our results demonstrate that both host genetics and geography influence the composition of the sponge microbiome. Host genotypic influence on microbiome composition may be due to stable vertical transmission of the microbial community from parent to offspring, making microbiomes more similar by descent. Alternatively, sponge genotypic variation may reflect variation in functional traits that influence the acquisition of environmental microbes. This study reveals drivers of microbiome variation within and among locations, and shows the importance of intraspecific variability in mediating eco-evolutionary dynamics of host-associated microbiomes.

Adherence to antihypertensive medications and associations with blood pressure among African Americans with hypertension in the Jackson Heart Study.

The purpose of this study was to test the association between a self-report measure of 24-hour adherence to antihypertensive medication and blood pressure (BP) among African Americans. The primary analysis included 3558 Jackson Heart Study participants taking antihypertensive medication who had adherence data for at least one study examination. Nonadherence was defined by self-report of not taking one or more prescribed antihypertensive medications, identified during pill bottle review, in the past 24 hours. Nonadherence and clinic BP were assessed at Exam 1 (2000-2004), Exam 2 (2005-2008), and Exam 3 (2009-2013). Associations of nonadherence with clinic BP and uncontrolled BP (systolic BP ≥ 140 mm Hg or diastolic BP ≥ 90 mm Hg) were evaluated using unadjusted and adjusted linear and Poisson repeated measures regression models. The prevalence of nonadherence to antihypertensive medications was 25.4% at Exam 1, 28.7% at Exam 2, and 28.5% at Exam 3. Nonadherence was associated with higher systolic BP (3.38 mm Hg) and diastolic BP (1.47 mm Hg) in fully adjusted repeated measures analysis. Nonadherence was also associated with uncontrolled BP (prevalence ratio = 1.26; 95% confidence interval = 1.16-1.37). This new self-report measure may be useful for identifying nonadherence to antihypertensive medication in future epidemiologic studies.

Behavioral Immunity Suppresses an Epizootic in Caribbean Spiny Lobsters.

Sociality has evolved in a wide range of animal taxa but infectious diseases spread rapidly in populations of aggregated individuals, potentially negating the advantages of their social interactions. To disengage from the coevolutionary struggle with pathogens, some hosts have evolved various forms of "behavioral immunity"; yet, the effectiveness of such behaviors in controlling epizootics in the wild is untested. Here we show how one form of behavioral immunity (i.e., the aversion of diseased conspecifics) practiced by Caribbean spiny lobsters (Panulirus argus) when subject to the socially transmitted PaV1 virus, appears to have prevented an epizootic over a large seascape. We capitalized on a "natural experiment" in which a die-off of sponges in the Florida Keys (USA) resulted in a loss of shelters for juvenile lobsters over a ~2500km2 region. Lobsters were thus concentrated in the few remaining shelters, presumably increasing their exposure to the contagious virus. Despite this spatial reorganization of the population, viral prevalence in lobsters remained unchanged after the sponge die-off and for years thereafter. A field experiment in which we introduced either a healthy or PaV1-infected lobster into lobster aggregations in natural dens confirmed that spiny lobsters practice behavioral immunity. Healthy lobsters vacated dens occupied by PaV1-infected lobsters despite the scarcity of alternative shelters and the higher risk of predation they faced when searching for a new den. Simulations from a spatially-explicit, individual-based model confirmed our empirical results, demonstrating the efficacy of behavioral immunity in preventing epizootics in this system.

Host behavior alters spiny lobster-viral disease dynamics: a simulation study.

Social behavior confers numerous benefits to animals but also risks, among them an increase in the spread of pathogenic diseases. We examined the trade-off between risk of predation and disease transmission under different scenarios of host spatial structure and disease avoidance behavior using a spatially explicit, individual-based model of the host pathogen interaction between juvenile Caribbean spiny lobster (Panulirus argus) and Panulirus argus Virus 1 (PaV1). Spiny lobsters are normally social but modify their behavior to avoid diseased conspecifics, a potentially effective means of reducing transmission but one rarely observed in the wild. We found that without lobster avoidance of diseased conspecifics, viral outbreaks grew in intensity and duration in simulations until the virus was maintained continuously at unrealistically high levels. However, when we invoked disease avoidance at empirically observed levels, the intensity and duration of outbreaks was reduced and the disease extirpated within five years. Increased lobster (host) spatial aggregation mimicking that which occurs when sponge shelters for lobsters are diminished by harmful algal blooms, did not significantly increase PaV1 transmission or persistence in lobster populations. On the contrary, behavioral aversion of diseased conspecifics effectively reduced viral prevalence, even when shelters were limited, which reduced shelter availability for all lobsters but increased predation, especially of infected lobsters. Therefore, avoidance of diseased conspecifics selects against transmission by contact, promotes alternative modes of transmission, and results in a more resilient host-pathogen system.

Larval connectivity and the international management of fisheries.

Predicting the oceanic dispersal of planktonic larvae that connect scattered marine animal populations is difficult, yet crucial for management of species whose movements transcend international boundaries. Using multi-scale biophysical modeling techniques coupled with empirical estimates of larval behavior and gamete production, we predict and empirically verify spatio-temporal patterns of larval supply and describe the Caribbean-wide pattern of larval connectivity for the Caribbean spiny lobster (Panulirus argus), an iconic coral reef species whose commercial value approaches $1 billion USD annually. Our results provide long sought information needed for international cooperation in the management of marine resources by identifying lobster larval connectivity and dispersal pathways throughout the Caribbean. Moreover, we outline how large-scale fishery management could explicitly recognize metapopulation structure by considering larval transport dynamics and pelagic larval sanctuaries.

Distribution, prevalence, and genetic analysis of Panulirus argus virus 1 (PaV1) from the Caribbean Sea.

The pathogenic virus Panulirus argus virus 1 (PaV1) was first discovered in Caribbean spiny lobsters Panulirus argus from the Florida Keys (USA) in 1999 and has since been reported in Belize, Mexico, and Cuba; its distribution in the wider Caribbean is unknown. We collected tissue samples from adult spiny lobsters from 30 locations in 14 countries bordering the Caribbean Sea and used molecular diagnostics to assay for the presence of PaV1. PaV1 occurred primarily in the northern areas of the Caribbean, where its prevalence was highest. The virus was not found in lobsters from the southeastern Caribbean, and its prevalence was lowest in the southwestern Caribbean. DNA sequence analysis was performed on a fragment of the viral DNA to examine the genetic diversity of PaV1 on a Caribbean-wide scale. Sequence variation in the viral DNA fragment was high, with 61 unique alleles identified from 9 areas. The sharing of viral alleles in lobsters from distant locations supports the hypothesis of a strong genetic connectivity among lobsters within the Caribbean, and further supports the hypothesis that postlarvae infected with PaV1 may serve to disperse the virus over long distances.