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The United States has one of the highest incarceration rates in the world. Carceral status can complicate clinical encounters in community and academic settings for an already medically vulnerable population. While it is likely physicians will encounter patients experiencing incarceration in their practice, there are few educational opportunities dedicated to ensuring delivery of healthcare that protects patient dignity, autonomy, and privacy. Professional medical associations can play a role in filling this physician knowledge gap. The goal of this analysis is to catalogue and analyze the current landscape of official medical association documents addressing healthcare of people experiencing incarceration. A systematic Internet search was conducted of American Medical Association House of Delegates associations and their existing documents. Out of 116 associations included in the systematic search, 16 groups published materials on incarceration. From these 16 associations, 44 documents were identified and coded thematically. Documents served four main purposes: education on incarceration (28/44), clinical guidance (25/44), logistical guidance (27/44), and policy advocacy (30/44). Common topics included medical conditions of people experiencing incarceration, patient factors antecedent to incarceration, and specialty or population-specific information. Few medical associations have published material on incarceration and the paucity of pragmatic clinical guidance was particularly pronounced. A lack of resources from medical associations can lead to variability and lapses in best healthcare practices when treating patients experiencing incarceration. Medical associations should consider developing guidance for clinicians to maximize this patient population’s autonomy and dignity.

Current SARS-CoV-2 containment measures rely on controlling viral transmission. Effective prioritization can be determined by understanding SARS-CoV-2 transmission dynamics. We conducted a systematic review and meta-analyses of the secondary attack rate (SAR) in household and healthcare settings. We also examined whether household transmission differed by symptom status of index case, adult and children, and relationship to index case. We searched PubMed, medRxiv, and bioRxiv databases between January 1 and July 25, 2020. High-quality studies presenting original data for calculating point estimates and 95% confidence intervals (CI) were included. Random effects models were constructed to pool SAR in household and healthcare settings. Publication bias was assessed by funnel plots and Egger's meta-regression test. 43 studies met the inclusion criteria for household SAR, 18 for healthcare SAR, and 17 for other settings. The pooled household SAR was 18.1% (95% CI: 15.7%, 20.6%), with significant heterogeneity across studies ranging from 3.9% to 54.9%. SAR of symptomatic index cases was higher than asymptomatic cases (RR: 3.23; 95% CI: 1.46, 7.14). Adults showed higher susceptibility to infection than children (RR: 1.71; 95% CI: 1.35, 2.17). Spouses of index cases were more likely to be infected compared to other household contacts (RR: 2.39; 95% CI: 1.79, 3.19). In healthcare settings, SAR was estimated at 0.7% (95% CI: 0.4%, 1.0%). While aggressive contact tracing strategies may be appropriate early in an outbreak, as it progresses, measures should transition to account for setting-specific transmission risk. Quarantine may need to cover entire communities while tracing shifts to identifying transmission hotspots and vulnerable populations. Where possible, confirmed cases should be isolated away from the household.

Attention to the overwhelming degradation in the marine environment is causing a new crisis: funding often outpaces the science, leading to myriad, often hastily planned, projects that may be accelerating the detriment of the very ecosystems they are meant to restore. We offer an unbiased assessment of this problem with a particular focus on artificial reefs, one of the most abundant and fastest growing marine infrastructure types globally, which gets particular attention because of claims of their ability to save coral reefs and fisheries. We offer solutions to safeguard against the potential of ecological harm and the distortions of greenwashing.

Atmospheric tides play a key role in coupling the lower, middle, and upper atmosphere/ionosphere. The tides reach large amplitudes in the mesosphere and lower thermosphere (MLT), where they can have significant fluxes of energy and momentum, and so strongly influence the coupling and dynamics. The tides must therefore be accurately represented in general circulation models (GCMs) that seek to model the coupling of atmospheric layers and impacts on the ionosphere. The tides consist of both migrating (sun-following) and non-migrating (not sun-following) components, both of which have important influences on the atmosphere. The Extended Unified Model (ExUM) is a recently developed version of the Met Office's GCM (the Unified Model) which has been extended to include the MLT. Here, we present the first in-depth analysis of migrating and non-migrating components in the ExUM. We show that the ExUM produces both non-migrating and migrating tides in the MLT of significant amplitude across a rich spectrum of spatial and temporal components. The dominant non-migrating components in the MLT are found to be DE3, DW2, and DW3 in the diurnal tide and S0, SW1, and SW3 in the semidiurnal tide. These components in the model can have monthly mean amplitudes at a height of 95 km as large as 35 m s−1/10 K. All the non-migrating components exhibit a strong seasonal variability in amplitude, and a significant short-term variability is evident. Both the migrating and non-migrating components exhibit notable variation with latitude. For example, the temperature and wind diurnal tides maximise at low latitudes and the semidiurnal tides include maxima at high latitudes. A comparison against published satellite and ground-based observations shows generally good agreement in latitudinal tidal structure, with more differences in seasonal tidal structure. Our results demonstrate the capability of the ExUM for modelling atmospheric migrating and non-migrating tides, and this lays the foundation for its future development into a whole atmosphere model. To this end, we make specific recommendations on further developments which would improve the capability of the model.

Building on the resource-based view, this paper examines the meta-analytic relationships between Human Resource Management (HRM) systems and different types of firm innovation (innovation in products or services, innovation in processes, and innovation in people and organizations) and the moderating role of sampled industries and sampled cultural clusters in these relationships. With 119 records from 57 unique papers published between 2000 and 2020, this study found that HRM systems positively contribute to innovation in products or services, innovation in processes, and innovation in people and organizations. Sampled industries and cultural clusters significantly moderate the relationships between HRM systems and innovation in products or services. These results may be biased because most empirical researchers focused on innovation in products or services instead of innovation in processes or innovation in people and organizations. Despite the dynamism of HRM systems, researchers are most like to include compensation, training, and performance appraisal while studying HRM systems and firm innovation.

Background. Three full doses of RTS,S/AS01 malaria vaccine provides partial protection against controlled human malaria parasite infection (CHMI) and natural exposure. Immunization regimens, including a delayed fractional third dose, were assessed for potential increased protection against malaria and immunologie responses. Methods. In a phase 2a, controlled, open-label, study of healthy malaria-naive adults, 16 subjects vaccinated with a 0-, 1-, and 2-month full-dose regimen (012M) and 30 subjects who received a 0-, 1-, and 7-month regimen, including a fractional third dose (FxO17M), underwent CHMI 3 weeks after the last dose. Plasmablast heavy and light chain immunoglobulin messenger RNA sequencing and antibody avidity were evaluated. Protection against repeat CHMI was evaluated after 8 months. Results. A total of 26 of 30 subjects in the FxO17M group (vaccine efficacy [VE], 86.7% [95% confidence interval [CI], 66.8%-94.6%]; P<.0001) and 10 of 16 in the 012M group (VE, 62.5% [95% CI, 29.4%-80.1%]; P=.0009) were protected against infection, and protection differed between schedules (P=.040, by the log rank test). The fractional dose boosting increased antibody somatic hypermutation and avidity and sustained high protection upon rechallenge. Discussions. A delayed third fractional vaccine dose improved immunogenicity and protection against infection. Optimization of the RTS,S/AS01 immunization regimen may lead to improved approaches against malaria. Clinical Trials Registration. NCT01857869.

BackgroundInhaled corticosteroid (ICS) use among patients with COPD increases the risk of pneumonia and other complications. Current recommendations limit ICS use to patients with frequent or severe COPD exacerbations. However, use of ICS among patients with COPD is common and may be occurring both among those with mild disease (overuse) and those misdiagnosed with COPD (misuse).ObjectiveTo identify patients without identifiable indication for ICS and assess patient and provider characteristics associated with potentially inappropriate to targeted in de-implementation effortsDesignWe performed a cross-sectional study of patients with COPD in the Veterans Affairs (VA) system with recent spirometry.ParticipantsAfter setting an index date, we identified individuals with a clinical diagnosis of COPD who had spirometry completed in the prior 5 years. We excluded individuals with an appropriate indication for ICS based on the 2017 GOLD statement, including asthma and a recent history of frequent or severe exacerbations.Main MeasuresICS use without identifiable indicationKey ResultsWe identified 26,536 patients with COPD without an identifiable indication for ICS. Nearly ¼ of patients (n = 6330) filled ≥2 prescriptions for ICS in the year prior to the index date. We found that older age (adjusted prevalence ratio [APR] 1.06 per decade, 95% confidence interval [CI] 1.04–1.08), white race (APR 1.11, 95% CI 1.05–1.19), and more primary care visits (APR 1.05 per visit, 95% CI 1.03–1.07) were associated with increased likelihood of potentially inappropriate use. Primary care clinic complexity and provider training were not associated with ICS use. Among patients misdiagnosed with COPD, we found that 14% used ICS.ConclusionsPotentially inappropriate ICS use is common among patients with and without airflow obstruction who are diagnosed with COPD. We identified patient comorbidities and patterns of healthcare utilization that increase the likelihood of ICS use that could be targeted for system-level de-implementation interventions.

We report early findings from COVID-19 cases in Brunei suggesting a remarkably high proportion of asymptomatic (12%) and presymptomatic (30%) cases. This proportion was even higher in imported cases. These have implications for measures to prevent onward local transmission and should prompt reconsideration of current testing protocols and safe de-escalation of social distancing measures.

Organic semiconductors have emerged as promising neural interfacing materials due to their innate biocompatibility, soft mechanical properties, and mixed electron/ion conduction. One exciting application is their use as artificial photosensors for retinal prostheses via optically induced neuromodulation. In this study, the optoelectronic and neural interfacing properties of six organic semiconductor polymers and small molecules, split into donor/acceptor pairs that form promising candidates for a trichromatic artificial retina that closely mimics the native response of the human eye are presented. The biocompatibility of these materials using primary human retinal cell cultures by systematic measurement of both cell viability and morphological analysis of retinal ganglion cell neurite elongation over time is investigated. Comparable cell viability between human retinal cell cultures established on all the organic semiconductors and a glass control, which is a standard measurement for biocompatibility in materials science is observed. In contrast, differences in the morphological biocompatibility between the organic semiconductor materials and glass control are detected by analyzing neurite elongation with specific immunomarkers. The difference in the two results has implications for the future assessment of material biocompatibility for bioelectronics, and optimal methodology for assessing morphological biocompatibility in neural interface devices is discussed. This work establishes new materials design rules for printable organic semiconducting neural interfaces and demonstrates the importance of assessing both anatomical and functional biocompatibility with application‐specific neural tissue. The results are presented in the context of an artificial retina capable of optical neuromodulation to mimic color vision, though are generally applicable to other neural interfacing applications.