A long-period radio transient active for three decades.

Several long-period radio transients have recently been discovered, with strongly polarized coherent radio pulses appearing on timescales between tens to thousands of seconds1,2. In some cases, the radio pulses have been interpreted as coming from rotating neutron stars with extremely strong magnetic fields, known as magnetars; the origin of other, occasionally periodic and less-well-sampled radio transients is still debated3. Coherent periodic radio emission is usually explained by rotating dipolar magnetic fields and pair-production mechanisms, but such models do not easily predict radio emission from such slowly rotating neutron stars and maintain it for extended times. On the other hand, highly magnetic isolated white dwarfs would be expected to have long spin periodicities, but periodic coherent radio emission has not yet been directly detected from these sources. Here we report observations of a long-period (21 min) radio transient, which we have labelled GPM J1839-10. The pulses vary in brightness by two orders of magnitude, last between 30 and 300 s and have quasiperiodic substructure. The observations prompted a search of radio archives and we found that the source has been repeating since at least 1988. The archival data enabled constraint of the period derivative to <3.6 × 10-13 s s-1, which is at the very limit of any classical theoretical model that predicts dipolar radio emission from an isolated neutron star.

A radio transient with unusually slow periodic emission.

The high-frequency radio sky is bursting with synchrotron transients from massive stellar explosions and accretion events, but the low-frequency radio sky has, so far, been quiet beyond the Galactic pulsar population and the long-term scintillation of active galactic nuclei. The low-frequency band, however, is sensitive to exotic coherent and polarized radio-emission processes, such as electron-cyclotron maser emission from flaring M dwarfs1, stellar magnetospheric plasma interactions with exoplanets2 and a population of steep-spectrum pulsars3, making Galactic-plane searches a prospect for blind-transient discovery. Here we report an analysis of archival low-frequency radio data that reveals a periodic, low-frequency radio transient. We find that the source pulses every 18.18 min, an unusual periodicity that has, to our knowledge, not been observed previously. The emission is highly linearly polarized, bright, persists for 30-60 s on each occurrence and is visible across a broad frequency range. At times, the pulses comprise short-duration (<0.5 s) bursts; at others, a smoother profile is observed. These profiles evolve on timescales of hours. By measuring the dispersion of the radio pulses with respect to frequency, we have localized the source to within our own Galaxy and suggest that it could be an ultra-long-period magnetar.

Methylenetetrahydrofolate reductase deficiency and high-dose FA supplementation disrupt embryonic development of energy balance and metabolic homeostasis in zebrafish.

Folic acid (synthetic folate, FA) is consumed in excess in North America and may interact with common pathogenic variants in methylenetetrahydrofolate reductase (MTHFR); the most prevalent inborn error of folate metabolism with wide-ranging obesity-related comorbidities. While preclinical murine models have been valuable to inform on diet-gene interactions, a recent Folate Expert panel has encouraged validation of new animal models. In this study, we characterized a novel zebrafish model of mthfr deficiency and evaluated the effects of genetic loss of mthfr function and FA supplementation during embryonic development on energy homeostasis and metabolism. mthfr-deficient zebrafish were generated using CRISPR mutagenesis and supplemented with no FA (control, 0FA) or 100 µm FA (100FA) throughout embryonic development (0-5 days postfertilization). We show that the genetic loss of mthfr function in zebrafish recapitulates key biochemical hallmarks reported in MTHFR deficiency in humans and leads to greater lipid accumulation and aberrant cholesterol metabolism as reported in the Mthfr murine model. In mthfr-deficient zebrafish, energy homeostasis was also impaired as indicated by altered food intake, reduced metabolic rate and lower expression of central energy-regulatory genes. Microglia abundance, involved in healthy neuronal development, was also reduced. FA supplementation to control zebrafish mimicked many of the adverse effects of mthfr deficiency, some of which were also exacerbated in mthfr-deficient zebrafish. Together, these findings support the translatability of the mthfr-deficient zebrafish as a preclinical model in folate research.

Integrated causal-predictive machine learning models for tropical cyclone epidemiology.

Strategic preparedness reduces the adverse health impacts of hurricanes and tropical storms, referred to collectively as tropical cyclones (TCs), but its protective impact could be enhanced by a more comprehensive and rigorous characterization of TC epidemiology. To generate the insights and tools necessary for high-precision TC preparedness, we introduce a machine learning approach that standardizes estimation of historic TC health impacts, discovers common patterns and sources of heterogeneity in those health impacts, and enables identification of communities at highest health risk for future TCs. The model integrates (i) a causal inference component to quantify the immediate health impacts of recent historic TCs at high spatial resolution and (ii) a predictive component that captures how TC meteorological features and socioeconomic/demographic characteristics of impacted communities are associated with health impacts. We apply it to a rich data platform containing detailed historic TC exposure information and records of all-cause mortality and cardiovascular- and respiratory-related hospitalization among Medicare recipients. We report a high degree of heterogeneity in the acute health impacts of historic TCs, both within and across TCs, and, on average, substantial TC-attributable increases in respiratory hospitalizations. TC-sustained windspeeds are found to be the primary driver of mortality and respiratory risks.

Potatoes Compared with Rice in Meals with either Animal or Plant Protein Reduce Postprandial Glycemia and Increase Satiety in Healthy Adults: A Randomized Crossover Study.

BACKGROUND: Rice and pasta are recommended as healthier than potatoes on the basis of their glycemic index when eaten alone. OBJECTIVES: The study objective was to evaluate postprandial glycemia (PPG), appetite, and food intake (FI) at meals with potatoes or rice when consumed with either meatballs or their vegetarian substitute. METHODS: In a randomized, single-blinded, crossover design, 26 (13 males and 13 females) healthy adults (age: 18-45 y; body mass index [kg/m2]: 18.5-29.9) consumed isocaloric fixed amounts of either meatballs or vegetarian-substitute balls with ad libitum access to either baked French fries (BFF), instant mashed potatoes (IMPs), or rice (control). FI was measured at the meal and at an ad libitum pizza meal served 120 min later. Blood glucose (BG), appetite, and plasma insulin responses were measured within the meal (0-30 min), postmeal (30-120 min), within pizza meal (120-140 min), and post-pizza (140-170 min). Effects of protein source, carbohydrate (CHO) source, and sex and their interactions were analyzed using analysis of variance followed by Tukey's post hoc test. RESULTS: Participants consumed 23-25% less treatment meal energy (kcal), 32-34% less CHO energy (kcal), and 13-16% less total energy (kcal) after the BFF and IMP than rice meals (P < 0.0001). Postmeal BG was lower after IMP (6.76 ± 0.15; P < 0.0001) and rice (6.92 ± 0.15; P = 0.0012) compared with BFF (7.19 ± 0.15). Post-pizza BG was higher after rice (6.77 ± 0.09) than that after BFF (6.51 ± 0.09; P = 0.0012) and IMP (6.39 ± 0.09; P < 0.0001). Postmeal meaned insulin was higher after BFF (82.16 ± 8.58) and IMP (77.75 ± 8.60) compared with rice (56.44 ± 8.59; P < 0.002). Insulin during pizza meal was lower after BFF (17.14 ± 6.90) compared with both IMP (39.03 ± 6.90; P = 0.0060) and rice (34.21 ± 6.90; P = 0.0336). Meatballs led to lower BG (6.48 ± 0.09; P = 0.0076) and higher insulin (84.54 ± 5.87; P = 0.0406) post-pizza compared with their plant protein substitute (6.64 ± 0.09 and 73.18 ± 5.87, respectively). CONCLUSIONS: Adults consuming meatballs or plant-based substitute with ad libitum IMP had lower PPG post-treatment and at a later pizza meal compared with rice. Both IMP and BFF resulted in lower energy intake than after rice. This trial was registered at http://clinicaltrials.gov (https://register. CLINICALTRIALS: gov/prs/app/action/SelectProtocol?sid=S000CKIJ&selectaction=Edit&uid=U0000IA4&ts=2&cx=-uf51kf) as NCT05610124. Protocol ID: 43406 (Postprandial Glycemia and Satiety of Meals with Potatoes, with and without Protein).

Glowing wonders: exploring the diversity and ecological significance of bioluminescent organisms in Brazil.

Bioluminescence, the emission of light by living organisms, is a captivating and widespread phenomenon with diverse ecological functions. This comprehensive review explores the biodiversity, mechanisms, ecological roles, and conservation challenges of bioluminescent organisms in Brazil, a country known for its vast and diverse ecosystems. From the enchanting glow of fireflies and glow-in-the-dark mushrooms to the mesmerizing displays of marine dinoflagellates and cnidarians, Brazil showcases a remarkable array of bioluminescent species. Understanding the biochemical mechanisms and enzymes involved in bioluminescence enhances our knowledge of their evolutionary adaptations and ecological functions. However, habitat loss, climate change, and photopollution pose significant threats to these bioluminescent organisms. Conservation measures, interdisciplinary collaborations, and responsible lighting practices are crucial for their survival. Future research should focus on identifying endemic species, studying environmental factors influencing bioluminescence, and developing effective conservation strategies. Through interdisciplinary collaborations, advanced technologies, and increased funding, Brazil can unravel the mysteries of its bioluminescent biodiversity, drive scientific advancements, and ensure the long-term preservation of these captivating organisms.

Health implications of urban tree canopy policy scenarios in Denver and Phoenix: A quantitative health impact assessment.

BACKGROUND: Urban tree canopy (UTC) goals are a popular policy to increase urban vegetation, support climate strategies, and encourage a healthy environment. Health studies related to UTC are needed across cities to support evidence-based decision-making. METHODS: We used a quantitative Health Impact Assessment (HIA) to model the annual number of premature deaths prevented, and the number of stroke and dementia cases, under UTC goals in Denver, Colorado, and Phoenix, Arizona, USA, using standing policy goals (20% and 25% UTC, respectively) and 50% ("half-way") attainment scenarios from current levels (16.5% and 13% UTC, respectively), using publicly accessible national datasets, and a proportional representation of UTC change to standardize across methodologies. We estimated UTC health impacts by relating UTC with scenario-based changes in the Normalized Difference Vegetation Index (NDVI) and considered health equity in UTC distributions and benefits. RESULTS: We projected that at 2020 populations, uniform 20% UTC attainment across Denver block groups would avert 200 (95% uncertainty interval: (UI) 100, 306) annual premature deaths among adults 18 and older, along with 4.1 (95% UI: 2.2, 6.7) annual cases of stroke (adults ≥35), and 2.6 (95% UI: 1.5, 4.1) cases of dementia (adults ≥65), with "halfway" attainment from current levels (16.5% UTC) capturing ∼64% of these benefits. In Phoenix, uniform 25% UTC would annually prevent 368 (95% UI: 181, 558) premature deaths, 8.7 (95% UI: 4.7, 13.9) cases of stroke, and 5,1 (95% UI: 2.9, 8.0) of dementia, with the "halfway" scenario (17% UTC) achieving ∼44% of these results. Both cities saw significantly different greenspace exposures and health outcomes by socioeconomic vulnerability. Denver had more spatially and socioeconomically heterogeneous projected health benefits than Phoenix. CONCLUSIONS: Implementing UTC goals can prevent excess mortality and chronic diseases among urban residents. UTC goals can be used as a health promotion and prevention tool.

Comparing Video Analysis to Computerized Detection of Limb Position for the Diagnosis of Movement Control during Back Squat Exercise with Overload.

Incorrect limb position while lifting heavy weights might compromise athlete success during weightlifting performance, similar to the way that it increases the risk of muscle injuries during resistance exercises, regardless of the individual's level of experience. However, practitioners might not have the necessary background knowledge for self-supervision of limb position and adjustment of the lifting position when improper movement occurs. Therefore, the computerized analysis of movement patterns might assist people in detecting changes in limb position during exercises with different loads or enhance the analysis of an observer with expertise in weightlifting exercises. In this study, hidden Markov models (HMMs) were employed to automate the detection of joint position and barbell trajectory during back squat exercises. Ten volunteers performed three lift movements each with a 0, 50, and 75% load based on body weight. A smartphone was used to record the movements in the sagittal plane, providing information for the analysis of variance and identifying significant position changes by video analysis (p < 0.05). Data from individuals performing the same movements with no added weight load were used to train the HMMs to identify changes in the pattern. A comparison of HMMs and human experts revealed between 40% and 90% agreement, indicating the reliability of HMMs for identifying changes in the control of movements with added weight load. In addition, the results highlighted that HMMs can detect changes imperceptible to the human visual analysis.

Ten simple rules for finding and selecting R packages.

R is an increasingly preferred software environment for data analytics and statistical computing among scientists and practitioners. Packages markedly extend R's utility and ameliorate inefficient solutions to data science problems. We outline 10 simple rules for finding relevant packages and determining which package is best for your desired use. We begin in Rule 1 with tips on how to consider your purpose, which will guide your search to follow, where, in Rule 2, you'll learn best practices for finding and collecting options. Rules 3 and 4 will help you navigate packages' profiles and explore the extent of their online resources, so that you can be confident in the quality of the package you choose and assured that you'll be able to access support. In Rules 5 and 6, you'll become familiar with how the R Community evaluates packages and learn how to assess the popularity and utility of packages for yourself. Rules 7 and 8 will teach you how to investigate and track package development processes, so you can further evaluate their merit. We end in Rules 9 and 10 with more hands-on approaches, which involve digging into package code.

The effect of the exercise environment and the level of involvement on bone mineral health.

INTRODUCTION: This study aimed to compare athletes practicing exercise in different environments with non-active young and elderly men and women regarding bone mineral density (BMD), hypothesizing that BMD values differ between athletes according to the environment of exercise practice, but those training in a low-gravitational environment have no different stimuli to BMD increasing if compared with healthy peers experiencing reduced exercise involvement, whatever the age group and sex. MATERIALS AND METHODS: 104 participants of both sexes were selected according to the environment of exercise practice [swimmers (N = 26) and judo fighters (N = 26)], and exercise level of involvement [non-active young (N = 26) and older adults (N = 26)]. Dual-energy X-ray absorptiometry provided BMD, lean mass, and fat mass (FM) for the whole body (WB), upper (UL), and lower limbs (LL). RESULTS: For the BMD in WB, UL and LL no effects of group and sex were observed (p > 0.05). Post-hoc analyses detected higher values of BMD in UL for female swimmers compared to non-active older adults (p < 0.05), while judo fighters showed higher BMD in WB, UL, and LL than other participants whatever the sex (p < 0.01). Lower FM was observed for WB, UL, and LL when swimmers and judo fighters were compared to non-active young and older female peers (p < 0.01). CONCLUSION: The findings emphasized that BMD stimuli with swimming are reduced when compared to judo, and despite the stimuli in swimming is not distinguishable from that affecting BMD in WB, UL and LL of non-active young, it is effective in differing BMD in UL among non-active older for women.

Hurricanes and Mortality among Patients Receiving Dialysis.

BACKGROUND: Hurricanes are severe weather events that can disrupt power, water, and transportation systems. These disruptions may be deadly for patients requiring maintenance dialysis. We hypothesized that the mortality risk among patients requiring maintenance dialysis would be increased in the 30 days after a hurricane. METHODS: Patients registered as requiring maintenance dialysis in the United States Renal Data System who initiated treatment between January 1, 1997 and December 31, 2017 in one of 108 hurricane-afflicted counties were followed from dialysis initiation until transplantation, dialysis discontinuation, a move to a nonafflicted county, or death. Hurricane exposure was determined as a tropical cyclone event with peak local wind speeds ≥64 knots in the county of a patient's residence. The risk of death after the hurricane was estimated using time-varying Cox proportional hazards models. RESULTS: The median age of the 187,388 patients was 65 years (IQR, 53-75) and 43.7% were female. There were 27 hurricanes and 105,398 deaths in 529,339 person-years of follow-up on dialysis. In total, 29,849 patients were exposed to at least one hurricane. Hurricane exposure was associated with a significantly higher mortality after adjusting for demographic and socioeconomic covariates (hazard ratio, 1.13; 95% confidence interval, 1.05 to 1.22). The association persisted when adjusting for seasonality. CONCLUSIONS: Patients requiring maintenance dialysis have a higher mortality risk in the 30 days after a hurricane.

Sustainable Cellulose Nanofibers-Mediated Synthesis of Uniform Spinel Zn-Ferrites Nanocorals for High Performances in Supercapacitors.

Spinel ferrites are versatile, low-cost, and abundant metal oxides with remarkable electronic and magnetic properties, which find several applications. Among them, they have been considered part of the next generation of electrochemical energy storage materials due to their variable oxidation states, low environmental toxicity, and possible synthesis through simple green chemical processing. However, most traditional procedures lead to the formation of poorly controlled materials (in terms of size, shape, composition, and/or crystalline structure). Thus, we report herein a cellulose nanofibers-mediated green procedure to prepare controlled highly porous nanocorals comprised of spinel Zn-ferrites. Then, they presented remarkable applications as electrodes in supercapacitors, which were thoroughly and critically discussed. The spinel Zn-ferrites nanocorals supercapacitor showed a much higher maximum specific capacitance (2031.81 F g-1 at a current density of 1 A g-1) than Fe2O3 and ZnO counterparts prepared by a similar approach (189.74 and 24.39 F g-1 at a current density of 1 A g-1). Its cyclic stability was also scrutinized via galvanostatic charging/discharging and electrochemical impedance spectroscopy, indicating excellent long-term stability. In addition, we manufactured an asymmetric supercapacitor device, which offered a high energy density value of 18.1 Wh kg-1 at a power density of 2609.2 W kg-1 (at 1 A g-1 in 2.0 mol L-1 KOH electrolyte). Based on our findings, we believe that higher performances observed for spinel Zn-ferrites nanocorals could be explained by their unique crystal structure and electronic configuration based on crystal field stabilization energy, which provides an electrostatic repulsion between the d electrons and the p orbitals of the surrounding oxygen anions, creating a level of energy that determines their final supercapacitance then evidenced, which is a very interesting property that could be explored for the production of clean energy storage devices.

Conjugated Dienoic Acid Peroxides as Substrates in Chaetopterus Bioluminescence System.

Biochemistry of bioluminescence of the marine parchment tubeworm Chaetopterus has been in research focus for over a century; however, the results obtained by various groups contradict each other. Here, we report the isolation and structural elucidation of three compounds from Chaetomorpha linum algae, which demonstrate bioluminescence activity with Chaetopterus luciferase in the presence of Fe2+ ions. These compounds are derivatives of polyunsaturated fatty acid peroxides. We have also obtained their structural analogues and demonstrated their activity in the bioluminescence reaction, thus confirming the broad substrate specificity of the luciferase.

Discovery of amivantamab (JNJ-61186372), a bispecific antibody targeting EGFR and MET.

A bispecific antibody (BsAb) targeting the epidermal growth factor receptor (EGFR) and mesenchymal-epithelial transition factor (MET) pathways represents a novel approach to overcome resistance to targeted therapies in patients with non-small cell lung cancer. In this study, we sequentially screened a panel of BsAbs in a combinatorial approach to select the optimal bispecific molecule. The BsAbs were derived from different EGFR and MET parental monoclonal antibodies. Initially, molecules were screened for EGFR and MET binding on tumor cell lines and lack of agonistic activity toward MET. Hits were identified and further screened based on their potential to induce untoward cell proliferation and cross-phosphorylation of EGFR by MET via receptor colocalization in the absence of ligand. After the final step, we selected the EGFR and MET arms for the lead BsAb and added low fucose Fc engineering to generate amivantamab (JNJ-61186372). The crystal structure of the anti-MET Fab of amivantamab bound to MET was solved, and the interaction between the two molecules in atomic details was elucidated. Amivantamab antagonized the hepatocyte growth factor (HGF)-induced signaling by binding to MET Sema domain and thereby blocking HGF ß-chain-Sema engagement. The amivantamab EGFR epitope was mapped to EGFR domain III and residues K443, K465, I467, and S468. Furthermore, amivantamab showed superior antitumor activity over small molecule EGFR and MET inhibitors in the HCC827-HGF in vivo model. Based on its unique mode of action, amivantamab may provide benefit to patients with malignancies associated with aberrant EGFR and MET signaling.

Anti-Müllerian hormone-mediated preantral follicle atresia is a key determinant of antral follicle count in mice.

STUDY QUESTION: Does anti-Müllerian hormone (AMH) induce preantral follicle atresia in mice? SUMMARY ANSWER: The present findings suggest that AMH-mediated follicle atresia only occurs in early follicles before they become sensitive to FSH. WHAT IS KNOWN ALREADY: Most prior studies have investigated the ability of AMH to inhibit primordial follicle activation. Our previous study showed that AMH-overexpressing mice had fewer preantral follicles than expected after accounting for primordial follicle inhibition but the reason for this was not determined. STUDY DESIGN, SIZE, DURATION: Cross-sectional-control versus transgenic/knockout mouse studies were carried out. PARTICIPANTS/MATERIALS, SETTING, METHODS: Studies were conducted on female wild-type (Amh+/+), AMH-knockout (Amh-/-) and AMH overexpressing (Thy1.2-AMHTg/0) mice on a C57Bl/6J background (age: 42-120 days). The follicle counts were conducted for primordial, transitioning, primary, secondary and antral follicles in Amh-/- and Amh+/+ mice. After confirming that follicle development speeds were identical (proliferating cell nuclear antigen immunohistochemistry), the ratio of follicles surviving beyond each stage of folliculogenesis was determined in both genotypes. Evidence for increased rates of preantral follicle atresia was assessed by active caspase-3 immunohistochemistry in wild-type and Thy1.2-AMHTg/0 mice. MAIN RESULTS AND THE ROLE OF CHANCE: Amh -/- mice at 100-120 days of age had lower primordial follicle counts but higher primordial follicle activation rates compared to Amh+/+ mice. These counteracting effects led to equivalent numbers of primordial follicles transitioning to the primary stage in Amh+/+ and Amh-/- mice. Despite this, Amh+/+ mice had fewer primary, secondary, small antral and medium antral follicles than Amh-/- mice indicating differing rates of developing follicle atresia between genotypes. Cleaved caspase-3 immunohistochemistry in Thy1.2-AMHTg/0 ovaries revealed high rates of granulosa cell and oocyte apoptosis in late primary/early secondary follicles of Thy1.2-AMHTg/0 mice. LARGE SCALE DATA: N/A. LIMITATIONS, REASONS FOR CAUTION: The findings were shown only in one species and additional research will be required to determine generalizability to other species. WIDER IMPLICATIONS OF THE FINDINGS: This study is consistent with prior studies showing that Amh-/- mice have increased primordial follicle activation but these new findings demonstrate that AMH-mediated preantral follicle atresia is a predominant cause of the increased small antral follicle counts in Amh-/- mice. This suggests that the role of AMH is not to conserve the ovarian reserve to prolong fertility, but instead to prevent the antral follicle pool from becoming too large. While this study may demonstrate a new function for AMH, the biological purpose of this function requires further investigation, particularly in mono-ovulatory species. STUDY FUNDING/COMPETING INTEREST(S): This study was funded by the Health Research Council of New Zealand and the University of Otago. No competing interests to declare.

Tracking the transmission dynamics of COVID-19 with a time-varying coefficient state-space model.

The spread of COVID-19 has been greatly impacted by regulatory policies and behavior patterns that vary across counties, states, and countries. Population-level dynamics of COVID-19 can generally be described using a set of ordinary differential equations, but these deterministic equations are insufficient for modeling the observed case rates, which can vary due to local testing and case reporting policies and nonhomogeneous behavior among individuals. To assess the impact of population mobility on the spread of COVID-19, we have developed a novel Bayesian time-varying coefficient state-space model for infectious disease transmission. The foundation of this model is a time-varying coefficient compartment model to recapitulate the dynamics among susceptible, exposed, undetected infectious, detected infectious, undetected removed, hospitalized, detected recovered, and detected deceased individuals. The infectiousness and detection parameters are modeled to vary by time, and the infectiousness component in the model incorporates information on multiple sources of population mobility. Along with this compartment model, a multiplicative process model is introduced to allow for deviation from the deterministic dynamics. We apply this model to observed COVID-19 cases and deaths in several U.S. states and Colorado counties. We find that population mobility measures are highly correlated with transmission rates and can explain complicated temporal variation in infectiousness in these regions. Additionally, the inferred connections between mobility and epidemiological parameters, varying across locations, have revealed the heterogeneous effects of different policies on the dynamics of COVID-19.

The association between patient activation and healthcare resources utilization: a systematic review and meta-analysis.

OBJECTIVES: To measure the association between patient activation and hospitalization or emergency department (ED) visits among adults with chronic diseases. STUDY DESIGN: Systematic review and meta-analysis. METHODS: A systematic review of English articles was performed using the following databases: PubMed, Cochrane Library, Web of Science, PsycINFO, and Embase. Articles were searched from 2005 until July 2021. Observational studies that measured the association between patient activation, measured by the Patient Activation Measure (PAM), and hospitalization or ED visits among adults with chronic or multichronic diseases were included. Pairs of reviewers independently screened the studies and extracted data for qualitative and quantitative synthesis. The methodological quality was assessed using the Quality in Prognostic Studies (QUIPS) tool. RESULTS: A total of nine observational studies (153,121 participants) were included in the qualitative synthesis, whereas six were pooled in the quantitative synthesis (151,359 participants). High levels of patient activation were significantly associated with a reduced risk for both hospitalizations (RR [95% CI] = 0.69 [0.61; 0.77], I2 = 78%) and ED visits (RR [95% CI] = 0.76 [0.70; 0.84], I2 = 72%). CONCLUSIONS: Our findings suggest the existence of an inverse association between patient activation and healthcare resources utilization. Further observational studies are needed to fully comprehend the magnitude of this association.

Association of Tropical Cyclones With County-Level Mortality in the US.

Importance: Tropical cyclones have a devastating effect on society, but a comprehensive assessment of their association with cause-specific mortality over multiple years of study is lacking. Objective: To comprehensively evaluate the association of county-level tropical cyclone exposure and death rates from various causes in the US. Design, Setting, and Participants: A retrospective observational study using a Bayesian conditional quasi-Poisson model to examine how tropical cyclones were associated with monthly death rates. Data from 33.6 million deaths in the US were collected from the National Center for Health Statistics over 31 years (1988-2018), including residents of the 1206 counties in the US that experienced at least 1 tropical cyclone during the study period. Exposures: Tropical cyclone days per county-month, defined as number of days in a month with a sustained maximal wind speed 34 knots or greater. Main Outcomes and Measures: Monthly cause-specific county-level death rates by 6 underlying causes of death: cancers, cardiovascular diseases, infectious and parasitic diseases, injuries, neuropsychiatric conditions, and respiratory diseases. The model yielded information about the association between each additional cyclone day per month and monthly county-level mortality compared with the same county-month in different years, up to 6 months after tropical cyclones, and how these estimated associations varied by age, sex, and social vulnerability. The unit of analysis was county-month. Results: There were 33 619 393 deaths in total (16 691 681 females and 16 927 712 males; 8 587 033 aged 0-64 years and 25 032 360 aged 65 years or older) from the 6 causes recorded in 1206 US counties. There was a median of 2 tropical cyclone days experienced in total in included US counties. Each additional cyclone day was associated with increased death rates in the month following the cyclone for injuries (3.7% [95% credible interval {CrI}, 2.5%-4.9%]; 2.0 [95% CrI, 1.3-2.7] additional deaths per 1 000 000 for 2018 monthly age-standardized median rate [DPM]; 54.3 to 56.3 DPM), infectious and parasitic diseases (1.8% [95% CrI, 0.1%-3.6%]; 0.2 [95% CrI, 0.0-0.4] additional DPM; 11.7 to 11.9 DPM), respiratory diseases (1.3% [95% CrI, 0.2%-2.4%]; 0.6 [95% CrI, 0.1-1.1] additional DPM; 44.9 to 45.5 DPM), cardiovascular diseases (1.2% [95% CrI, 0.6%-1.7%]; 1.5 [95% CrI, 0.8-2.2] additional DPM; 129.6 to 131.1 DPM), neuropsychiatric conditions (1.2% [95% CrI, 0.1%-2.4%]; 0.6 [95% CrI, 0.1-1.2] additional DPM; 52.1 to 52.7 DPM), with no change for cancers (-0.3% [95% CrI, -0.9% to 0.3%]; -0.3 [95% CrI, -0.9 to 0.3] additional DPM; 100.4 to 100.1 DPM). Conclusions and Relevance: Among US counties that experienced at least 1 tropical cyclone from 1988-2018, each additional cyclone day per month was associated with modestly higher death rates in the months following the cyclone for several causes of death, including injuries, infectious and parasitic diseases, cardiovascular diseases, neuropsychiatric conditions, and respiratory diseases.

Bioluminescent Dinoflagellates as a Bioassay for Toxicity Assessment.

Dinoflagellates bioluminescence mechanism depends upon a luciferin-luciferase reaction that promotes blue light emission (480 nm) in specialized luminogenic organelles called scintillons. The scintillons contain luciferin, luciferase and, in some cases, a luciferin-binding protein (LBP), which prevents luciferin from non-enzymatic oxidation in vivo. Even though dinoflagellate bioluminescence has been studied since the 1950s, there is still a lack of mechanistic understanding on whether the light emission process involves a peroxidic intermediate or not. Still, bioassays employing luminous dinoflagellates, usually from Gonyaulax or Pyrocystis genus, can be used to assess the toxicity of metals or organic compounds. In these dinoflagellates, the response to toxicity is observed as a change in luminescence, which is linked to cellular respiration. As a result, these changes can be used to calculate a percentage of light inhibition that correlates directly with toxicity. This current approach, which lies in between fast bacterial assays and more complex toxicity tests involving vertebrates and invertebrates, can provide a valuable tool for detecting certain pollutants, e.g., metals, in marine sediment and seawater. Thus, the present review focuses on how the dinoflagellates bioluminescence can be applied to evaluate the risks caused by contaminants in the marine environment.

Tropical Cyclone Exposures and Risks of Emergency Medicare Hospital Admission for Cardiorespiratory Diseases in 175 Urban United States Counties, 1999-2010.

BACKGROUND: Although injuries experienced during hurricanes and other tropical cyclones have been relatively well-characterized through traditional surveillance, less is known about tropical cyclones' impacts on noninjury morbidity, which can be triggered through pathways that include psychosocial stress or interruption in medical treatment. METHODS: We investigated daily emergency Medicare hospitalizations (1999-2010) in 180 US counties, drawing on an existing cohort of high-population counties. We classified counties as exposed to tropical cyclones when storm-associated peak sustained winds were ≥21 m/s at the county center; secondary analyses considered other wind thresholds and hazards. We matched storm-exposed days to unexposed days by county and seasonality. We estimated change in tropical cyclone-associated hospitalizations over a storm period from 2 days before to 7 days after the storm's closest approach, compared to unexposed days, using generalized linear mixed-effect models. RESULTS: For 1999-2010, 175 study counties had at least one tropical cyclone exposure. Cardiovascular hospitalizations decreased on the storm day, then increased following the storm, while respiratory hospitalizations were elevated throughout the storm period. Over the 10-day storm period, cardiovascular hospitalizations increased 3% (95% confidence interval = 2%, 5%) and respiratory hospitalizations increased 16% (95% confidence interval = 13%, 20%) compared to matched unexposed periods. Relative risks varied across tropical cyclone exposures, with strongest association for the most restrictive wind-based exposure metric. CONCLUSIONS: In this study, tropical cyclone exposures were associated with a short-term increase in cardiorespiratory hospitalization risk among the elderly, based on a multi-year/multi-site investigation of US Medicare beneficiaries ≥65 years.