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Michael Weekes

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Nick K. Jones1,2*, Lucy Rivett1,2*, Chris Workman3, Mark Ferris3, Ashley Shaw1, Cambridge COVID-19 Collaboration1,4, Paul J. Lehner1,4, Rob Howes5, Giles Wright3, Nicholas J. Matheson1,4,6¶, Michael P. Weekes1,7¶1 Cambridge University NHS Hospitals Foundation Trust, Cambridge, UK2 Clinical Microbiology & Public Health Laboratory, Public Health England, Cambridge, UK3 Occupational Health and Wellbeing, Cambridge Biomedical Campus, Cambridge, UK4 Cambridge Institute of Therapeutic Immunology & Infectious Disease, University of Cambridge, Cambridge, UK5 Cambridge COVID-19 Testing Centre and AstraZeneca, Anne Mclaren Building, Cambridge, UK6 NHS Blood and Transplant, Cambridge, UK7 Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK*Joint first authorship¶Joint last authorshipCorrespondence: [email protected] UK has initiated mass COVID-19 immunisation, with healthcare workers (HCWs) given early priority because of the potential for workplace exposure and risk of onward transmission to patients. The UK’s Joint Committee on Vaccination and Immunisation has recommended maximising the number of people vaccinated with first doses at the expense of early booster vaccinations, based on single dose efficacy against symptomatic COVID-19 disease.1-3At the time of writing, three COVID-19 vaccines have been granted emergency use authorisation in the UK, including the BNT162b2 mRNA COVID-19 vaccine (Pfizer-BioNTech). A vital outstanding question is whether this vaccine prevents or promotes asymptomatic SARS-CoV-2 infection, rather than symptomatic COVID-19 disease, because sub-clinical infection following vaccination could continue to drive transmission. This is especially important because many UK HCWs have received this vaccine, and nosocomial COVID-19 infection has been a persistent problem.Through the implementation of a 24 h-turnaround PCR-based comprehensive HCW screening programme at Cambridge University Hospitals NHS Foundation Trust (CUHNFT), we previously demonstrated the frequent presence of pauci- and asymptomatic infection amongst HCWs during the UK’s first wave of the COVID-19 pandemic.4 Here, we evaluate the effect of first-dose BNT162b2 vaccination on test positivity rates and cycle threshold (Ct) values in the asymptomatic arm of our programme, which now offers weekly screening to all staff.Vaccination of HCWs at CUHNFT began on 8th December 2020, with mass vaccination from 8th January 2021. Here, we analyse data from the two weeks spanning 18thto 31st January 2021, during which: (a) the prevalence of COVID-19 amongst HCWs remained approximately constant; and (b) we screened comparable numbers of vaccinated and unvaccinated HCWs. Over this period, 4,408 (week 1) and 4,411 (week 2) PCR tests were performed from individuals reporting well to work. We stratified HCWs <12 days or > 12 days post-vaccination because this was the point at which protection against symptomatic infection began to appear in phase III clinical trial.226/3,252 (0·80%) tests from unvaccinated HCWs were positive (Ct<36), compared to 13/3,535 (0·37%) from HCWs <12 days post-vaccination and 4/1,989 (0·20%) tests from HCWs ≥12 days post-vaccination (p=0·023 and p=0·004, respectively; Fisher’s exact test, Figure). This suggests a four-fold decrease in the risk of asymptomatic SARS-CoV-2 infection amongst HCWs ≥12 days post-vaccination, compared to unvaccinated HCWs, with an intermediate effect amongst HCWs <12 days post-vaccination.A marked reduction in infections was also seen when analyses were repeated with: (a) inclusion of HCWs testing positive through both the symptomatic and asymptomatic arms of the programme (56/3,282 (1·71%) unvaccinated vs 8/1,997 (0·40%) ≥12 days post-vaccination, 4·3-fold reduction, p=0·00001); (b) inclusion of PCR tests which were positive at the limit of detection (Ct>36, 42/3,268 (1·29%) vs 15/2,000 (0·75%), 1·7-fold reduction, p=0·075); and (c) extension of the period of analysis to include six weeks from December 28th to February 7th 2021 (113/14,083 (0·80%) vs 5/4,872 (0·10%), 7·8-fold reduction, p=1x10-9). In addition, the median Ct value of positive tests showed a non-significant trend towards increase between unvaccinated HCWs and HCWs > 12 days post-vaccination (23·3 to 30·3, Figure), suggesting that samples from vaccinated individuals had lower viral loads.We therefore provide real-world evidence for a high level of protection against asymptomatic SARS-CoV-2 infection after a single dose of BNT162b2 vaccine, at a time of predominant transmission of the UK COVID-19 variant of concern 202012/01 (lineage B.1.1.7), and amongst a population with a relatively low frequency of prior infection (7.2% antibody positive).5This work was funded by a Wellcome Senior Clinical Research Fellowship to MPW (108070/Z/15/Z), a Wellcome Principal Research Fellowship to PJL (210688/Z/18/Z), and an MRC Clinician Scientist Fellowship (MR/P008801/1) and NHSBT workpackage (WPA15-02) to NJM. Funding was also received from Addenbrooke’s Charitable Trust and the Cambridge Biomedical Research Centre. We also acknowledge contributions from all staff at CUHNFT Occupational Health and Wellbeing and the Cambridge COVID-19 Testing Centre.

Guangming Wang

and 4 more

Tam Hunt

and 1 more

Tam Hunt [1], Jonathan SchoolerUniversity of California Santa Barbara Synchronization, harmonization, vibrations, or simply resonance in its most general sense seems to have an integral relationship with consciousness itself. One of the possible “neural correlates of consciousness” in mammalian brains is a combination of gamma, beta and theta synchrony. More broadly, we see similar kinds of resonance patterns in living and non-living structures of many types. What clues can resonance provide about the nature of consciousness more generally? This paper provides an overview of resonating structures in the fields of neuroscience, biology and physics and attempts to coalesce these data into a solution to what we see as the “easy part” of the Hard Problem, which is generally known as the “combination problem” or the “binding problem.” The combination problem asks: how do micro-conscious entities combine into a higher-level macro-consciousness? The proposed solution in the context of mammalian consciousness suggests that a shared resonance is what allows different parts of the brain to achieve a phase transition in the speed and bandwidth of information flows between the constituent parts. This phase transition allows for richer varieties of consciousness to arise, with the character and content of that consciousness in each moment determined by the particular set of constituent neurons. We also offer more general insights into the ontology of consciousness and suggest that consciousness manifests as a relatively smooth continuum of increasing richness in all physical processes, distinguishing our view from emergentist materialism. We refer to this approach as a (general) resonance theory of consciousness and offer some responses to Chalmers’ questions about the different kinds of “combination problem.”  At the heart of the universe is a steady, insistent beat: the sound of cycles in sync…. [T]hese feats of synchrony occur spontaneously, almost as if nature has an eerie yearning for order. Steven Strogatz, Sync: How Order Emerges From Chaos in the Universe, Nature and Daily Life (2003) If you want to find the secrets of the universe, think in terms of energy, frequency and vibration.Nikola Tesla (1942) I.               Introduction Is there an “easy part” and a “hard part” to the Hard Problem of consciousness? In this paper, we suggest that there is. The harder part is arriving at a philosophical position with respect to the relationship of matter and mind. This paper is about the “easy part” of the Hard Problem but we address the “hard part” briefly in this introduction.  We have both arrived, after much deliberation, at the position of panpsychism or panexperientialism (all matter has at least some associated mind/experience and vice versa). This is the view that all things and processes have both mental and physical aspects. Matter and mind are two sides of the same coin.  Panpsychism is one of many possible approaches that addresses the “hard part” of the Hard Problem. We adopt this position for all the reasons various authors have listed (Chalmers 1996, Griffin 1997, Hunt 2011, Goff 2017). This first step is particularly powerful if we adopt the Whiteheadian version of panpsychism (Whitehead 1929).  Reaching a position on this fundamental question of how mind relates to matter must be based on a “weight of plausibility” approach, rather than on definitive evidence, because establishing definitive evidence with respect to the presence of mind/experience is difficult. We must generally rely on examining various “behavioral correlates of consciousness” in judging whether entities other than ourselves are conscious – even with respect to other humans—since the only consciousness we can know with certainty is our own. Positing that matter and mind are two sides of the same coin explains the problem of consciousness insofar as it avoids the problems of emergence because under this approach consciousness doesn’t emerge. Consciousness is, rather, always present, at some level, even in the simplest of processes, but it “complexifies” as matter complexifies, and vice versa. Consciousness starts very simple and becomes more complex and rich under the right conditions, which in our proposed framework rely on resonance mechanisms. Matter and mind are two sides of the coin. Neither is primary; they are coequal.  We acknowledge the challenges of adopting this perspective, but encourage readers to consider the many compelling reasons to consider it that are reviewed elsewhere (Chalmers 1996, Griffin 1998, Hunt 2011, Goff 2017, Schooler, Schooler, & Hunt, 2011; Schooler, 2015).  Taking a position on the overarching ontology is the first step in addressing the Hard Problem. But this leads to the related questions: at what level of organization does consciousness reside in any particular process? Is a rock conscious? A chair? An ant? A bacterium? Or are only the smaller constituents, such as atoms or molecules, of these entities conscious? And if there is some degree of consciousness even in atoms and molecules, as panpsychism suggests (albeit of a very rudimentary nature, an important point to remember), how do these micro-conscious entities combine into the higher-level and obvious consciousness we witness in entities like humans and other mammals?  This set of questions is known as the “combination problem,” another now-classic problem in the philosophy of mind, and is what we describe here as the “easy part” of the Hard Problem. Our characterization of this part of the problem as “easy”[2] is, of course, more than a little tongue in cheek. The authors have discussed frequently with each other what part of the Hard Problem should be labeled the easier part and which the harder part. Regardless of the labels we choose, however, this paper focuses on our suggested solution to the combination problem.  Various solutions to the combination problem have been proposed but none have gained widespread acceptance. This paper further elaborates a proposed solution to the combination problem that we first described in Hunt 2011 and Schooler, Hunt, and Schooler 2011. The proposed solution rests on the idea of resonance, a shared vibratory frequency, which can also be called synchrony or field coherence. We will generally use resonance and “sync,” short for synchrony, interchangeably in this paper. We describe the approach as a general resonance theory of consciousness or just “general resonance theory” (GRT). GRT is a field theory of consciousness wherein the various specific fields associated with matter and energy are the seat of conscious awareness.  A summary of our approach appears in Appendix 1.  All things in our universe are constantly in motion, in process. Even objects that appear to be stationary are in fact vibrating, oscillating, resonating, at specific frequencies. So all things are actually processes. Resonance is a specific type of motion, characterized by synchronized oscillation between two states.  An interesting phenomenon occurs when different vibrating processes come into proximity: they will often start vibrating together at the same frequency. They “sync up,” sometimes in ways that can seem mysterious, and allow for richer and faster information and energy flows (Figure 1 offers a schematic). Examining this phenomenon leads to potentially deep insights about the nature of consciousness in both the human/mammalian context but also at a deeper ontological level.

Susanne Schilling*^

and 9 more

Jessica mead

and 6 more

The construct of wellbeing has been criticised as a neoliberal construction of western individualism that ignores wider systemic issues including increasing burden of chronic disease, widening inequality, concerns over environmental degradation and anthropogenic climate change. While these criticisms overlook recent developments, there remains a need for biopsychosocial models that extend theoretical grounding beyond individual wellbeing, incorporating overlapping contextual issues relating to community and environment. Our first GENIAL model \cite{Kemp_2017} provided a more expansive view of pathways to longevity in the context of individual health and wellbeing, emphasising bidirectional links to positive social ties and the impact of sociocultural factors. In this paper, we build on these ideas and propose GENIAL 2.0, focusing on intersecting individual-community-environmental contributions to health and wellbeing, and laying an evidence-based, theoretical framework on which future research and innovative therapeutic innovations could be based. We suggest that our transdisciplinary model of wellbeing - focusing on individual, community and environmental contributions to personal wellbeing - will help to move the research field forward. In reconceptualising wellbeing, GENIAL 2.0 bridges the gap between psychological science and population health health systems, and presents opportunities for enhancing the health and wellbeing of people living with chronic conditions. Implications for future generations including the very survival of our species are discussed.  

Mark Ferris

and 14 more

IntroductionConsistent with World Health Organization (WHO) advice [1], UK Infection Protection Control guidance recommends that healthcare workers (HCWs) caring for patients with coronavirus disease 2019 (COVID-19) should use fluid resistant surgical masks type IIR (FRSMs) as respiratory protective equipment (RPE), unless aerosol generating procedures (AGPs) are being undertaken or are likely, when a filtering face piece 3 (FFP3) respirator should be used [2]. In a recent update, an FFP3 respirator is recommended if “an unacceptable risk of transmission remains following rigorous application of the hierarchy of control” [3]. Conversely, guidance from the Centers for Disease Control and Prevention (CDC) recommends that HCWs caring for patients with COVID-19 should use an N95 or higher level respirator [4]. WHO guidance suggests that a respirator, such as FFP3, may be used for HCWs in the absence of AGPs if availability or cost is not an issue [1].A recent systematic review undertaken for PHE concluded that: “patients with SARS-CoV-2 infection who are breathing, talking or coughing generate both respiratory droplets and aerosols, but FRSM (and where required, eye protection) are considered to provide adequate staff protection” [5]. Nevertheless, FFP3 respirators are more effective in preventing aerosol transmission than FRSMs, and observational data suggests that they may improve protection for HCWs [6]. It has therefore been suggested that respirators should be considered as a means of affording the best available protection [7], and some organisations have decided to provide FFP3 (or equivalent) respirators to HCWs caring for COVID-19 patients, despite a lack of mandate from local or national guidelines [8].Data from the HCW testing programme at Cambridge University Hospitals NHS Foundation Trust (CUHNFT) during the first wave of the UK severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic indicated a higher incidence of infection amongst HCWs caring for patients with COVID-19, compared with those who did not [9]. Subsequent studies have confirmed this observation [10, 11]. This disparity persisted at CUHNFT in December 2020, despite control measures consistent with PHE guidance and audits indicating good compliance. The CUHNFT infection control committee therefore implemented a change of RPE for staff on “red” (COVID-19) wards from FRSMs to FFP3 respirators. In this study, we analyse the incidence of SARS-CoV-2 infection in HCWs before and after this transition.

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Ashley Love

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Macronutrients, such as proteins and fats, play a vital role in host immunity and can influence host-pathogen dynamics, potentially through dietary effects on gut microbiota. To increase our understanding of how feeding behavior and macronutrient selection are influenced by a direct and perceived immune threat and whether shifts in macronutrient intake affect the composition of the gut microbiome, we conducted two experiments. First, we determined if zebra finches (Taeniopygia guttata) exhibit shifts in physiology and gut microbiota when fed diets differing in macronutrient ratios. Second, we simulated an infection in birds using the bacterial endotoxin lipopolysaccharide (LPS) and quantified feeding behavior in immune challenged and control individuals, as well as birds housed near either a control pair (no immune threat), or birds housed near a pair given an immune challenge with LPS (social cue of heightened infection risk). We also examined whether social cues of infection alter physiological responses relevant to responding to an immune threat, an effect that could be mediated through shifts in feeding behavior. In the first experiment, protein diets decreased the abundance of the bacterial Phylum Campylobacterota. Further, diet treatment disrupted relationships between gut microbiota alpha diversity and physiological metrics. In the second experiment, LPS induced a reduction in caloric intake driven by a decrease in protein, but not fat consumption. No evidence was found for socially induced shifts in feeding behavior, physiology, or gut microbiota. However, fat consumption decreased gut microbial diversity regardless of treatment. Our findings carry implications for host health, as sickness-induced anorexia and diet-induced shifts in the microbiome could shape host-pathogen interactions.

Hedvig Nordeng

and 3 more

Purpose Pregnancies ending before gestational week 12 are common but not notified to the Medical Birth Registry of Norway. Our goal was to develop an algorithm that more completely detects and dates pregnancy outcomes by using diagnostic codes from primary and secondary care registries to complement information from the birth registry. Methods We used nationwide linked registry data between 2008 and 2018 in a hierarchical manner: We developed an algorithm to arrive at unique pregnancy outcomes, considering codes within 56 days as the same event. To infer gestational age of pregnancy outcomes before gestational week 12, we used the median gestational week of pregnancy markers (45 ICD-10 codes and 9 ICPC-2 codes). When no pregnancy markers were available, we assigned outcome-specific gestational age estimates. The performance of the algorithm was assessed by blinded clinicians. Results Using only the medical birth registry, we identified 649,703 pregnancies, including 1,369 (0.2%) miscarriages and 3,058 (0.5%) elective terminations. With the new algorithm, we detected 859,449 pregnancies, including 642,712 live-births (74.8%), 112,257 miscarriages (13.1%), 94,664 elective terminations (11.0%), 6,429 ectopic pregnancies (0.7%), 2,564 stillbirths (0.3%), and 823 molar pregnancies (0.1%). The median gestational age was 10 +0 weeks (IQR 10 +0-11 +3) for miscarriages and 8 +0 weeks (IQR 8 +0-9 +6) for elective terminations. Gestational age could be inferred using pregnancy markers for 66.3% of miscarriages and 47.2% of elective terminations. Conclusion The pregnancy algorithm improved the detection and dating of early non-live pregnancy outcomes that would have gone unnoticed if relying solely on the medical birth registry information.

Salome Fabri-Ruiz

and 6 more

The Mediterranean Sea is a region threatened by fast environmental changes and high coastal human impacts. Over the last decade, recurrent blooms of the harmful dinoflagellate Ostreopsis cf. ovata have been recorded in many Mediterranean beaches. Here we investigate whether the spatial-temporal distribution of this microalga and the frequency of its blooms could be altered in future regional climate change scenarios, with a special focus in the Western basin. An ecological niche model forced by physical and biogeochemical high-resolution climate change simulations under the strong greenhouse gas emission trajectory (RCP8.5) was used to characterize how O. cf. ovata may respond to projected conditions and how its distribution could shift in this plausible future. Before being applied to the niche model, the future climate change simulations are further refined by using a statistical adaptation method (Cumulative Distribution Function transform) to improve the representativity of the environmental parameters. Our results depict that O. cf. ovata abundances are driven by temperature (optimum 23-26 °C), high salinity (> 38 psu) and high inorganic nutrient concentrations (nitrate > 0.25 mmol N·m-3 and phosphate > 0.035 mmol P·m-3). Future projections suggest no changes in bloom intensity for mid- and end-century. Nevertheless high spatial disparities in future abundances are observed.. Namely, O. cf. ovata abundances could increase in the Mediterranean coasts of France, Spain and the Adriatic Sea while a decrease is expected in the Tyrrhenian Sea. The bloom period could also be enlarged, starting earlier and extending later in the year, which could have important consequences on marine ecosystems, human health and economy. From a methodological point of view, this study highlights good practices of ecological niche models in the context of climate change to identify sensitive areas for current and future harmful algal blooms.
Coastal dunes are the highest natural features on the beach. They protect the beach communities and low-energy environments from storms by virtue of their elevation. Their formation is a result of delicate coupling between accretional and erosional processes. Here we study the influence of vegetation on dune growth and recovery under water-driven erosion utilizing a process-based coastal model under a stochastic framework. An equivalence of this model is first established with a recently developed stochastic model of dune evolution under water-erosional stress. From the model vegetation parameters: the vegetation growth time and colonization time are quantified and their relation with characteristic dune growth times is established. Vegetation causes an initial lag in dune formation due to the colonization time. Also, the dune growth under the influence of vegetation is found to be divided into two regimes, stable and mobile. Within the stable regime, the influence of vegetation on dune recovery is quantified by the colonization time, and its competition with water-driven erosion is analyzed. This leads to the development of a phase space relating to flooding frequency, intensity, dune growth, and dune establishment times. The dune state transitions from high to barren based on the competing dune recovery time controlled by vegetation and the flooding frequency. Finally, a vulnerability indicator is obtained from the transition threshold as a minimum base elevation after an overwash required by the beach for vegetation to recover and establish dunes that overcome frequent flooding.
This study analyzes how national intersectoral public policy experiences have been adopted and implemented using a Health in All Policies (HiAP) approach in the past two decades. It seeks to provide evidence on enabling factors that triggered three effective intersectoral public policies to improve population health in Mexico by improving nutritional, educational, and healthcare access conditions, reducing road traffic injuries, and addressing obesogenic feeding practices. We followed a qualitative approach to analyze the three intersectoral public policies selected as case studies. First, we designed an analytical framework to assess how intersectoral public policies are adopted, implemented, and sustained. The proposed framework is based on peer-reviewed articles and grey public policy literature. Second, we used information from eleven semi-structured interviews to key stakeholders conducted in previous research to identify more specific enablers and barriers of the three intersectoral policies selected according to predefined analytical categories used in the questionnaire. The analysis showed three overall key findings. First, sound empirical evidence is essential for adopting a HiAP approach. Second effective intersectoral mechanisms enhance implementation feasibility. Third, results-based monitoring and evaluation contribute to the continuity of the analyzed intersectoral public policies. Finally, political support is needed throughout the policy process to maintain governance capacity and deliver results. Finally, we drew five global policy lessons that may be applicable in similar public policy settings in other countries. First, both technical and political enablers help set the intersectoral agenda. Second, effective communication is instrumental in convincing all stakeholders to address public health-related policy issues. Third, political support at the highest level possible and the federal government’s capacity are essential to implement sound policies. Fourth, several enablers exist for enhancing collaboration between ministries during implementation. Finally, monitoring and evaluation results are necessary for sustaining intersectoral policies beyond administrations.

Chen Wang

and 1 more

Comment on Nemet et al.Chen Wang, MD, MSc1; Jian-Te Lee, MD, MPH1,21Harvard T.H. Chan School of Public Health, Boston, Massachusetts2Department of Pediatrics, National Taiwan University Hospital, Yunlin Branch, Yunlin, TaiwanTo the editor,We read with great interest the article entitled ‘Food-induced anaphylaxis during infancy is associated with later sleeping and eating disorders’ by Nemet and colleagues1. The retrospective study suggests that food-induced anaphylaxis (FIA) diagnosis in the first 3 years of life is associated with an increased risk of developing eating and sleeping disorders in the following average of 6.5 years. We congratulate the authors for their findings; however, several methodological issues should be addressed before applying the result to clinical suggestions.First, the authors include parameters such as sex, age, ethnicity, and socio-economic status for propensity score matching in Table 11. However, several other factors may lead to potential confounding. Tsai et al.2 reported familial aggregation of IgE-mediated food allergy and heritability of food-specific IgE, indicating genetic factors may play a role in developing FIA. Pettersson et al.3 suggested genetic and environmental roles in the etiology of psychiatric disorders. We suggest adding the patient’s family history of psychological disorders (PDs) and food allergies as matching characteristics. Dietary patterns and antibiotic use4,5 could also contribute to residual confounding.As the authors stated, one of the limitations is that the study does not include atopic dermatitis and asthma. It is noted that allergic rhinitis should also be considered an important confounding factor6. On the other hand, primary caregivers’ strict compliance with children’s diet restrictions and behavioral education could serve as secondary stress for developing psychological disorders1. This raises the question of whether the association between FIA and eating and sleeping disorders is due to biological factors or behavioral causes.In addition, analyzing the patients’ age categories into <3 and 3– 18 years could result in heterogeneity of the study population. Gupta et al.5 reported that a history of skin infection and eczema is associated with an increased prevalence of food allergy. This shows children with different ages of FIA onset may represent varied immune states and biological characteristics. Categorizing 3 to 18 years into one age group could miss information related to health state changes across different ages. We recommend separating the 3 to 18 age groups into preadolescence (4 to 12 years) and adolescence (12 to 18 years) when evaluating controls and patients with FIA, with and without psychological disorders, to minimize population heterogeneity.The Kaplan-Meier curves in Figure 11 showing the incidences of psychological disorders, sleeping, and eating disorders over the study period are questionable. Patients with FIA demonstrate higher cumulative risks of psychological disorders from the beginning, especially for any PDs and eating disorders, implicating the two study groups may have different baseline characteristics. Possible reasons include selection bias and residual confounding in propensity score matching. Moreover, although the 1:10 referent matching on the propensity score increases statistical power, higher referent matches could narrow the selection of the target population, losing subjects of interest. Thus, it might be inaccurate to transport the average treatment effect on the treated (ATT) of FIA to the unmatched population7. This needs to be considered when making generalizable references to the research conclusion.Finally, this retrospective study includes data from 2001 through 2021, with 20 years of range. We suggest the authors provide secular FIA diagnostic rates across these years. The FIA diagnostic rates may change over time, leading to biased exposure estimates and an underestimation or overestimation of the association between FIA and PDs. Additionally, there has been a steep increase in the prevalence of food allergy worldwide in the past years, indicating that altered dietary patterns and environmental factors could result in different FIA incidences through the years4. We suggest the authors divide the 20-year study period into 5-year time blocks to observe exposure changes related to the association of FIA and PDs.To conclude, the study shows an important result of food-induced anaphylaxis and psychological disorders. We should be careful when evaluating the association between FIA and PDs, the generalizability of the study result, and whether it should be restricted to the Jewish and Arab populations. Finally, health education on FIA management and the psychological well-being of the children and caregivers should hold equal importance as accurately diagnosing FIA.(680 words)References1. Nemet S, Elbirt D, Mahlab-Guri K, et al. Food-induced anaphylaxis during infancy is associated with later sleeping and eating disorders.Pediatr Allergy Immunol Off Publ Eur Soc Pediatr Allergy Immunol . 2023;34(12):e14061.2. Tsai HJ, Kumar R, Pongracic J, et al. Familial aggregation of food allergy and sensitization to food allergens: a family-based study.Clin Exp Allergy J Br Soc Allergy Clin Immunol . 2009;39(1):101-109.3. Pettersson E, Lichtenstein P, Larsson H, et al. Genetic influences on eight psychiatric disorders based on family data of 4 408 646 full and half-siblings, and genetic data of 333 748 cases and controls.Psychol Med . 2019;49(7):1166-1173.4. Zhang Q, Zhang C, Zhang Y, et al. Early-life risk factors for food allergy: Dietary and environmental factors revisited. Compr Rev Food Sci Food Saf . 2023;22(6):4355-4377.5. Gupta RS, Singh AM, Walkner M, et al. Hygiene factors associated with childhood food allergy and asthma. Allergy Asthma Proc . 2016;37(6):e140-e146.6. Muliol J, Maurer M, Bousquet J. Sleep and allergic rhinitis. J Investig Allergol Clin Immunol . 2008;18(6):415-419.7. Kurth T, Walker AM, Glynn RJ, et al. Results of Multivariable Logistic Regression, Propensity Matching, Propensity Adjustment, and Propensity-based Weighting under Conditions of Nonuniform Effect.Am J Epidemiol . 2006;163(3):262-270.

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Karma Norbu

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Introduction: Scrub typhus is a neglected life threatening acute febrile illness caused by bacteria Orientia tsutsugamushi and it is a vector-borne zoonotic disease. In 2009, scrub typhus outbreak at Gedu has awakened Bhutan on the awareness and testing of the disease.Information and data of the study highlights the need for in depth surveillance, awareness among prescribers and initiate preventive measures in the country. Methods: We used retrospective descriptive study through review of laboratory registers across three health centres in Zhemgang district, south central Bhutan. The laboratories registers have been transcribed into CSV file using Microsoft excel. Variables of interest were collected from the registers and then analysed using open statistical software R, (R Core Team (2020). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria.) And use of mStats package, (MyoMinnOo (2020). mStats: Epidemiological DataAnalysis. R package version 3.4.0.) Results: Of the total 922 tests prescribed for suspected scrub typhus in the three health centers in Zhemgang, only 8.2 % (n=76) were tested positive. Of these, Panbang Hospital had highest reported positive for scrub typhus with 56.6 %( n=43) followed by Yebilaptsa Hospital 35.5 %( n=27) and Zhemgang Hospital with 7.9 %( n=6). The female gender is comparably more affected as opposed to male with 57.9% (n=44) of the positive cases being female. The prevalence of scrub typhus seems to be affected by the seasonal variation as the months of Spring, Summer and Autumn together accounts for 98.7%(n=75) of total positive cases. The year 2019 noted significant scrub typhus cases accounting to 89.5 %(n=68) of the total positive cases over the two years. Conclusions:The overall tests tested positive of the scrub typhus infection within two years was 8.2%.

Selahattin Semiz

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