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Maternal sun exposure in gestation and throughout the lifetime is necessary for vitamin D synthesis, and living near the sea is a population level index of seafood consumption. The aim of this study was to estimate the incidence rate of multiple sclerosis (MS) in Wales and examine its association with sun exposure, coastal living, and latitude. The study used a database of MS hospital visits and admissions in Wales between 2002 and 2013. For the 1,909 lower layer super output areas (LSOAs) in Wales, coastal status, population, longitude/latitude, and average sunshine hours per day were obtained. Age-specific and age-standardised MS incidence were calculated and modelled using Poisson regression. The distribution of births by month was compared between MS cases and the combined England and Wales population. There were 3,557 new MS cases between 2002 and 2013, with an average annual incidence of 8.14 (95% CI: 7.69-8.59) among males and 12.97 (95% CI: 12.44-13.50) among females per 100,000 population. The female-to-male ratio was 1.86:1. For both sexes combined, the average annual incidence rate was 9.10 (95% CI: 8.80-9.40). All figures are age-standardized to the 1976 European standard population. Compared to the combined England and Wales population, more people with MS were born in April, observed-to-expected ratio: 1.21 (95% CI: 1.08-1.36). MS incidence varied directly with latitude and inversely with sunshine hours. Proximity to the coast was associated with lower MS incidence only in easterly areas. This study shows that MS incidence rate in Wales is comparable to the rate in Scotland and is associated with environmental factors that probably represent levels of vitamin D.

Empirical evidence suggesting colour influences object recognition is mixed; leading to conclusions that colour may not always be represented in object memory. Positive evidence for the representation of colour in episodic object memory is often complicated by the possibility that encoding specificity may be responsible for such observations. The current thesis examined whether colour is represented and makes an independent contribution of shape in episodic memory for familiar and novel objects, using a modified paradigm based on the typical retrieval- practice task (e.g., Anderson, Bjork, & Bjork, 1994). Participants studied pictures of objects, presented one at a time. In a subsequent practice phase, participants either performed Old/New recognition with a subset of the studied objects and their distractors (Experiments 1-7), or they rated a subset of the studied objects for attractiveness, complexity, and usefulness (Experiments 8 and 9). The critical manipulation concerned the nature of unpracticed objects. Unpracticed objects shared either shape only (Rp- Shape), colour only (Rp-Colour), both shape and colour (Rp-Both), or neither shape nor colour (Rp-Neither), with the practiced objects. Interference effects in memory between practiced and unpracticed items are revealed m the forgetting of related unpracticed items - retrieval-induced forgetting (RIF). If both shape and colour information is explicit in the object representations in episodic memory, then there would be significant RIF for unpracticed objects sharing shape only and colour only with the practiced objects. RIF was significant for Rp-Shape and Rp-Colour objects, suggesting that shape and colour are represented and independently drive competition effects in episodic object memory. The use of RIF to probe those representations improves on previous evidence, because it bypasses alternative encoding specificity explanations. The current work provides proof of concept for a modified retrieval-practice paradigm and establishes it as a tool to probe feature- based representations that do not easily lend themselves to retrieval practice.

Empirical evidence suggesting colour influences object recognition is mixed; leading to conclusions that colour may not always be represented in object memory. Positive evidence for the representation of colour in episodic object memory is often complicated by the possibility that encoding specificity may be responsible for such observations. The current thesis examined whether colour is represented and makes an independent contribution of shape in episodic memory for familiar and novel objects, using a modified paradigm based on the typical retrieval- practice task (e.g., Anderson, Bjork, & Bjork, 1994). Participants studied pictures of objects, presented one at a time. In a subsequent practice phase, participants either performed Old/New recognition with a subset of the studied objects and their distractors (Experiments 1-7), or they rated a subset of the studied objects for attractiveness, complexity, and usefulness (Experiments 8 and 9). The critical manipulation concerned the nature of unpracticed objects. Unpracticed objects shared either shape only (Rp- Shape), colour only (Rp-Colour), both shape and colour (Rp-Both), or neither shape nor colour (Rp-Neither), with the practiced objects. Interference effects in memory between practiced and unpracticed items are revealed m the forgetting of related unpracticed items - retrieval-induced forgetting (RIF). If both shape and colour information is explicit in the object representations in episodic memory, then there would be significant RIF for unpracticed objects sharing shape only and colour only with the practiced objects. RIF was significant for Rp-Shape and Rp-Colour objects, suggesting that shape and colour are represented and independently drive competition effects in episodic object memory. The use of RIF to probe those representations improves on previous evidence, because it bypasses alternative encoding specificity explanations. The current work provides proof of concept for a modified retrieval-practice paradigm and establishes it as a tool to probe feature- based representations that do not easily lend themselves to retrieval practice.

New York prosecutors subpoena Steve Bannon's allies in borderwall probe. A government watchdog is now reviewing the FDA's actionson the baby formula recall. The FDA has announced additional formulashipments from Germany to the U.S. Jose Andres is interviewed aboutthe food shortage that is looming as the war blocks the Black Seashipping. Queen Elizabeth misses the thanksgiving service afterexperiencing discomfort on day one of her platinum jubileecelebrations. GUESTS: Jose Andres

The frequency of, and risk factors for, long COVID are unclear among community-based individuals with a history of COVID-19. To elucidate the burden and possible causes of long COVID in the community, we coordinated analyses of survey data from 6907 individuals with self-reported COVID-19 from 10 UK longitudinal study (LS) samples and 1.1 million individuals with COVID-19 diagnostic codes in electronic healthcare records (EHR) collected by spring 2021. Proportions of presumed COVID-19 cases in LS reporting any symptoms for 12+ weeks ranged from 7.8% and 17% (with 1.2 to 4.8% reporting debilitating symptoms). Increasing age, female sex, white ethnicity, poor pre-pandemic general and mental health, overweight/obesity, and asthma were associated with prolonged symptoms in both LS and EHR data, but findings for other factors, such as cardio-metabolic parameters, were inconclusive. Current understanding of Long COVID is limited, in part, due to lack of evidence from population-representative studies. Here, the authors analyse data from ten UK population-based studies and electronic health records, and find wide variation in the frequency of Long COVID between studies but some consistent risk factors.

Background Invasive alien species (IAS) cause significant economic losses in all parts of the world. Although IAS are widespread in Africa and cause serious negative impacts on livelihoods as a result of yield losses and increased labour costs associated with IAS management, few data on the impacts are available in the literature and the magnitude and extent of the costs are largely unknown. We estimated the cost of IAS to agriculture, the most important economic sector in Africa. Methods Data on the monetary costs of IAS to mainland Africa as well as information about the presence and abundance of the most important IAS were collected through literature review and an online survey among a wide variety of stakeholders. Using this and additional data from publicly available sources we estimated yield losses and management costs due to IAS in agriculture for individual countries and the entire continent. Where the data allowed, the costs for selected IAS or crops were estimated separately. The estimates were extrapolated using production and distribution data and/or matching of agro-ecological zones. Results The total estimated annual cost of IAS to agriculture in Africa is USD 65.58 Bn. Management costs (comprising mainly labour costs associated with weeding), crop yield losses and reductions in livestock derived income constitute the majority of the estimated cost (55.42, 44.31 and 0.26 percent, respectively). The IAS causing the highest yield losses was Spodoptera frugiperda (USD 9.4 Bn). Conclusions This study reveals the extent and scale of the economic impacts of IAS in the agricultural sector in one of the least studied continents. Although the cost estimate presented here is significant, IAS also cause major costs to other sectors which could not be assessed due to data deficit. The results highlight the need for pre-emptive management options, such as prevention and early detection and rapid response to reduce huge potential future costs, as well as measures that contribute to large-scale control of widely established IAS at little cost to farmers and other affected land users, to reduce losses and improve livelihoods.

Osteoarthritis and spinal pain are common and burdensome conditions; however, the majority of patients with these conditions do not receive care that is consistent with clinical practice guidelines. Telehealth models of care have the potential to improve care for osteoarthritis and spinal pain patients. The aim of this review was to assess the effectiveness of verbal real-time telehealth interventions, including telephone-based and videoconferencing interventions to reduce pain intensity and disability in patients with osteoarthritis of the knee or hip and spinal pain (back or neck pain). We searched seven electronic databases from inception to May 2018. Randomised controlled trials (RCTs), cluster-RCTs, and non-randomised controlled trials were included. Two review authors independently extracted data for each included study. Primary outcomes were pain intensity and disability. We conducted primary meta-analyses combining all conditions with similar interventions and comparators. Standardised mean difference (SMD) and 95% confidence intervals (CIs) were calculated using random effects models. We used the Cochrane Risk of Bias tool to assess risk of bias, and GRADE to evaluate the quality of evidence. We included 23 studies with 56 trial arms and 4,994 participants. All studies utilised telephone-based interventions. Only two studies used a telephone only approach and the remainder included educational materials and/or face-to-face components. We found no studies utilising videoconferencing. Meta-analysis showed telephone-based interventions (with educational materials) for osteoarthritis and spinal pain improved pain intensity ( = 5 trials, = 1,357 participants, SMD -0.27, 95% CI [-0.53, -0.01], Tau = 0.06, = 74%; moderate-quality evidence) and disability ( = 7 trials, = 1,537 participants, SMD -0.21, 95% CI [-0.40, -0.02], Tau = 0.03, = 56%; moderate-quality evidence) compared to usual care. Meta-analyses found telephone with face-to-face interventions does not improve pain and disability compared to usual care or face-to-face care alone. We are moderately confident that telephone-based interventions reduce pain intensity and disability in patients with osteoarthritis and spinal pain compared to usual care, but telephone plus face-to-face interventions are no more effective than usual care or face-to-face interventions alone.

ObjectiveChronic obstructive pulmonary disease (COPD) is a major cause of global illness and death, most commonly caused by cigarette smoke. The mechanisms of pathogenesis remain poorly understood, limiting the development of effective therapies. The gastrointestinal microbiome has been implicated in chronic lung diseases via the gut-lung axis, but its role is unclear.DesignUsing an in vivo mouse model of cigarette smoke (CS)-induced COPD and faecal microbial transfer (FMT), we characterised the faecal microbiota using metagenomics, proteomics and metabolomics. Findings were correlated with airway and systemic inflammation, lung and gut histopathology and lung function. Complex carbohydrates were assessed in mice using a high resistant starch diet, and in 16 patients with COPD using a randomised, double-blind, placebo-controlled pilot study of inulin supplementation.ResultsFMT alleviated hallmark features of COPD (inflammation, alveolar destruction, impaired lung function), gastrointestinal pathology and systemic immune changes. Protective effects were additive to smoking cessation, and transfer of CS-associated microbiota after antibiotic-induced microbiome depletion was sufficient to increase lung inflammation while suppressing colonic immunity in the absence of CS exposure. Disease features correlated with the relative abundance of Muribaculaceae, Desulfovibrionaceae and Lachnospiraceae family members. Proteomics and metabolomics identified downregulation of glucose and starch metabolism in CS-associated microbiota, and supplementation of mice or human patients with complex carbohydrates improved disease outcomes.ConclusionThe gut microbiome contributes to COPD pathogenesis and can be targeted therapeutically.

Severe coronavirus disease in neonates is rare. We analyzed clinical, laboratory, and autopsy findings from a neonate in the United States who was delivered at 25 weeks of gestation and died 4 days after birth; the mother had asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and preeclampsia. We observed severe diffuse alveolar damage and localized SARS-CoV-2 by immunohistochemistry, in situ hybridization, and electron microscopy of the lungs of the neonate. We localized SARS-CoV-2 RNA in neonatal heart and liver vascular endothelium by using in situ hybridization and detected SARS-CoV-2 RNA in neonatal and placental tissues by using reverse transcription PCR. Subgenomic reverse transcription PCR suggested viral replication in lung/airway, heart, and liver. These findings indicate that in utero SARS-CoV-2 transmission contributed to this neonatal death.

Background The prevalence of knee osteoarthritis is increasing worldwide. Obesity is an important modifiable risk factor for both the incidence and progression of knee osteoarthritis. Consequently, international guidelines recommend all patients with knee osteoarthritis who are overweight receive support to lose weight. However, few overweight patients with this condition receive care to support weight loss. Telephone-based interventions are one potential solution to provide scalable care to the many patients with knee osteoarthritis. The objective of this study is to evaluate, from a societal perspective, the cost-utility and cost-effectiveness of a telephone-based weight management and healthy lifestyle service for patients with knee osteoarthritis, who are overweight or obese. Methods An economic evaluation was undertaken alongside a pragmatic randomised controlled trial. Between May 19 and June 30, 2015, 120 patients with knee osteoarthritis were randomly assigned to an intervention or usual care control group in a 1:1 ratio. Participants in the intervention group received a referral to an existing non-disease specific 6-month telephone-based weight management and healthy lifestyle service. Quality-adjusted life years (QALYs) was the utility measure and knee pain intensity, disability, weight, and body mass index (BMI) were the clinical measures of effect. Costs included intervention costs, healthcare utilisation costs (healthcare services and medication use) and absenteeism costs due to knee pain. Data was collected at baseline, 6 weeks and 26 weeks. The primary cost-effectiveness analysis was performed from the societal perspective. Results Mean cost differences between groups (intervention minus control) were $493 (95%CI: -3513 to 5363) for healthcare costs, $-32 (95%CI: -73 to 13) for medication costs, and $125 (95%CI: -151 to 486) for absenteeism costs. The total mean difference in societal costs was $1197 (95%CI: -2887 to 6106). For QALYs and all clinical measures of effect, the probability of the intervention being cost-effective compared with usual care was less than 0.36 at all willingness-to-pay values. Conclusions From a societal perspective, telephone-based weight loss support, provided using an existing non-disease specific 6-month weight management and healthy lifestyle service was not cost-effective in comparison with usual care for overweight and obese patients with knee osteoarthritis. Trial registration number ACTRN12615000490572 , registered 18th May 2015