Dan Li

Over the past decade, ambient air pollutant concentrations have increased, largely attributed to escalating energy consumption. Emerging evidence suggests that prolonged or repeated exposure to air pollutants may significantly accelerate the onset and progression of cognitive impairment, with studies reporting up to a 64% increase in systemic stress biomarkers and measurable cognitive deficits occurring within minutes of inhalation. Accordingly, this scoping review aimed to synthesize evidence from controlled human exposure studies investigating the relationship between acute air pollution exposure and neurological outcomes in healthy adults. To address this aim, eligible studies included literature examining exposure to airborne pollutants and assessing cognitive and neurobiological outcomes in human participants. A systematic search of PubMed was conducted using predefined MeSH terms and title/abstract keywords related to air pollution and cognition. Only full-text, English-language randomized clinical trials involving young adults were included. The study selection process was documented in accordance with the PRISMA guidelines, and methodological quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tool. Due to heterogeneity across studies, results were synthesized descriptively. Six clinical trials published between 2008 and 2024 met the inclusion criteria, with sample sizes ranging from 12 to 72 participants. Pollutants investigated included particulate matter, diesel exhaust, and elevated carbon dioxide concentrations. Across the included studies, these exposures were associated with impairments in executive function, attention, memory, and reaction time. Diesel exhaust exposure was associated with slower reaction times, while carbon dioxide inhalation increased working memory errors. Exposure to particulate matter was also associated with elevations in stress-related biomarkers. In contrast, filtered air conditions were associated with improved cognitive performance. Overall, acute exposure to air pollutants may produce measurable cognitive and neurobiological effects even in healthy adults, suggesting potential neurological vulnerability regardless of pre-existing conditions. However, the current evidence base remains limited. Future research should prioritize large-scale, ecologically valid studies to better define the mechanisms through which air pollutants disrupt neurological processes.

Thrombophilic conditions, conditions where blood has a tendency to form thrombi due to abnormal coagulatory processes, can affect the trajectory of diseases such as Post-Acute Sequelae of SARS-CoV-2 Infection, better known as Long COVID (LC), by worsening symptoms and complicating outlooks. As a comorbidity in pro-coagulatory diseases such as COVID-19 and LC, patients with thrombophilic conditions may experience worse symptoms than their peers, due to this elevated level of hypercoagulation. A 15-week literature review through the public PubMed database was conducted to investigate the severity, mechanisms, and symptom profiles of thrombophilic patients with LC. Papers were only included if samples included participants with pre-existing tendencies for hypercoagulable states, and confirmation of SARS-CoV-2 infection via a Polymerase Chain Reaction test. Each paper included in this review was analyzed by topic and assessed for eligibility against the Joanna Briggs Institute’s Critical Appraisal tool. Each paper was also assessed for biases. Results from the 6 papers included in this review showed that LC could be predicted following COVID-19 illness by a hypercoagulable blood profile, indicating that LC may be linked to chronic hypercoagulation and inflammation post-infection. Additionally, symptoms linked to microthrombi formation, such as hair loss, arrhythmia, and dizziness, were exhibited more frequently in patients with thrombophilia and/or thrombophilic conditions, indicating that those with thrombophilic conditions may exhibit unique LC symptom profiles compared to healthy controls. This paper’s research is preliminary and thus is limited in the strength of its findings; However, further research into LC and its interactions with co-morbidities like thrombophilic conditions would aid in the development of better treatment plans for patients, such as the usage of anticoagulants or screening for hypercoagulable blood profiles post-COVID-19 to assess patient risk.

Obesity reflects excessive fat deposits. At-risk individuals are guided by healthcare professionals to eat fewer calories and exercise more, often using body mass index (BMI; weight/height²) thresholds for screening and to guide progress and prognosis. By conducting a mini-narrative review of original articles, websites, editorials, commentaries, and guidelines, we sought to place BMI in the context of its appropriate use in population health, clinical screening, and monitoring in clinical care. The review covers studies and publications through 2023, encompassing consensus reviews and relevant literature. Recent consensus reviews suggest that BMI is a valuable tool for population surveys and primary healthcare screening but has limitations in predicting the risk of chronic diseases and assessing excess fat. BMI can guide nutritional and exercise counseling, even if it is inadequate for reliable individual risk prediction. BMI cut-offs must be reconsidered in populations of varying body build, age, and/or ethnicity. Since BMI-diagnosed overweight persons are sometimes physically and physiologically fit by other indicators, persons who are overweight on BMI should be more fully evaluated, diagnosed, and monitored with combined anthropometric and performance metrics to better clarify risks. The use of combined anthropometric and performance metrics involves integrating measurements of body composition with assessments of physical function and fitness to provide a more comprehensive evaluation of an individual’s health and fitness status. Eligibility for bariatric surgery or semaglutide satiety/appetite-reduction medications should not be determined by BMI alone. Awareness of the advantages and limitations of using BMI as a tool to assess adult obesity can maximize its appropriate use in the context of population health and in rapid clinical screening and evaluation.

Background: As a result of the COVID-19 pandemic, educational systems worldwide were disrupted. Students, educators, and parents faced challenges from the rapid switch to distance learning with attendant social isolation and limited teacher or peer interaction, along with excessive demand and worries from the lasting pandemic. It exacerbated preexisting mental health crises within school communities. Amidst such challenges, psychiatrists prescribed tailored medication regimens to manage individual mental health in the time of crisis, ensuring continuity of care and support for those affected. Methods: A scoping review was conducted to identify studies of Kindergarten to 12th grade school members' mental health and mental health support programs offered by schools and institutions during the COVID-19 pandemic. We also conducted a survey to examine mental health concerns faced by grade 6 to 12 teachers, school staff, children, and parents in Connecticut, United States. Results: While publication bias may be extant, we found well-documented studies of exacerbation and the emergence of mental health problems among parents, teaching staff, and students during the COVID-19 pandemic. Based on our comprehensive review of relevant literature and analysis of survey results, we have identified four key themes pertaining to the mental health challenges encountered by parents, teaching and non-teaching staff, and students in Kindergarten through 12th grade (K-12). Moreover, upon examining pertinent mental health interventions and models, we have identified the multi-tiered systems of support as an effective approach to address these difficulties, with explanations on how to utilize the framework during a crisis. This system is designed with tiers that provide various levels of interventions aimed at helping schools effectively manage the psychological well-being of their members during a crisis. Conclusions: Drawing on findings from literature reviews and surveys, this study sheds light on the difficulties surrounding mental health in schools during times of crisis such as the COVID-19 pandemic. Moreover, it puts forward a recommendation for employing multi-tiered support strategies to address these challenges and promote psychological well-being within educational settings amidst crisis. By adopting a multi-tiered systems of support framework that integrates various interventions tailored to individual needs, schools can effectively manage mental health concerns among their members. The study underscores the critical role of psychiatry in providing specialized care and medication management to support mental health in educational environments, particularly during times of crisis, with important implications to address the urgent mental health demands in Kindergarten to 12th grade schools.

Background: Effective communication between schools and parents is crucial for fostering understanding, trust, and collaboration to enhance educational outcomes and student well-being, especially during crises such as the COVID-19 pandemic. Moreover, the current level of communication between schools and families is frequently insufficient, exacerbating the difficulties in parental engagement, comprehension, and certain policy implementation. This deficiency becomes even more pronounced during crises due to the added stressors. This study aims to highlight the challenges of parental engagement and communication during the pandemic and propose a viable solution for school districts and schools to enhance trust, understanding, and collaboration in schools to prepare for future crises. Method: The study employs a mixed-methods approach, including a scoping review of literature and policies on school communication during the pandemic, a survey study conducted among the Connecticut Independent Schools, and the integration of results from both sources. The scoping review provides key themes and frameworks, while the survey collects quantitative and qualitative data to identify challenges and concerns. The proposed solution utilizes Epstein's Six Types of Involvement Framework for school districts and schools to guide effective communication and collaboration between schools and parents. Results: The scoping review and survey findings reveal several key issues, including hesitant parental perception of disease control strategies, the burden on parents in supporting online learning, the lack of resources and guidance for online learning, and the absence of central communication guidelines. The proposed solution, Epstein's Six Types of Involvement Framework, addresses these challenges by emphasizing parenting, communication, volunteering, learning at home, decision-making, and community collaboration. Conclusion: The study highlights the importance of effective communication between schools and parents during crises and proposes Epstein's Six Types of Involvement Framework as a comprehensive solution. By implementing this framework, schools can foster understanding, trust, and collaboration, leading to better educational outcomes for students. The findings have implications for school administrators, policymakers, and educators seeking to improve communication during crises and can facilitate more effective communication and parental engagement beyond health crises. Further research is needed to evaluate the effectiveness and impact of implementing the framework in real-world crises. Moreover, healthcare professionals like pediatricians, psychologists, and school nurses are crucial in disease control in schools. The study proposes using Epstein’s framework to involve them directly, enhancing collaboration and trust, and empowering them to lead efforts in safeguarding students and staff health.

Purpose of Review. Our review aims to compare and contrast Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome and SARS-CoV-2/COVID-19's impact on maternal and neonatal outcomes. We have made significant progress in Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome prevention and treatment over the last few decades. Drawing on empirical evidence with past public health crises can offer valuable insights into dealing with current and future pandemics. Therefore, it is imperative to conduct a comparative analysis of the resemblances and disparities existing between Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome and SARS-CoV-2/COVID-19.This research endeavor represents a pioneering and all-encompassing examination, aiming to discern and comprehend the parallels and contrasts in the respective impacts of SARS-CoV-2 and Human Immunodeficiency Virus on pregnancy. Recent Findings. Based on the current evidence, there is no indication that pregnancy increases women's susceptibility to acquiring Human Immunodeficiency Virus or SARS-CoV-2. Nevertheless, the state of being pregnant was correlated with the worsening of diseases and their progression. Both Human Immunodeficiency Virus and SARS-CoV-2 pose increased risks of maternal mortality and several obstetric complications, including premature birth and pre-eclampsia. While the vertical transmission of Human Immunodeficiency Virus is well-established, a comprehensive understanding of the vertical transmission of SARS-CoV-2 remains elusive, emphasizing the need for further investigations. Initial data suggest low SARS-CoV-2 vertical transmission rates in the setting of proper preventative interventions and universal screening. A cesarean delivery could reduce the risk of mother-to-child transmission in Human Immunodeficiency Virus-infected women with high viral loads or poor adherence to antiretroviral therapy (ART). However, it did not offer additional protection for Human Immunodeficiency Virus-infected women who adhered to Adherence to Antiretroviral Therapy or those with COVID-19. Human Immunodeficiency Virus and SARS-CoV-2 were linked to neonatal complications such as stillbirth, low birth weight, and neonatal intensive care unit (ICU) admissions. The universal testing of both pregnant patients and neonates is an effective strategy to prevent the spread and complications of both Human Immunodeficiency Virus and SARS-CoV-2. Human Immunodeficiency Virus control largely relies on preventing vertical transmission and medications during pregnancy and postpartum, whereas safety behaviors and vaccines have proven effective in preventing SARS-CoV-2 vertical transmissions. Summary. This review aims to compare and contrast the impact of Human Immunodeficiency Virus and SARS-CoV-2 on pregnancy outcomes, vertical transmissions, delivery modalities, neonatal outcomes, and clinical management. SARS-CoV-2 and Human Immunodeficiency Virus were associated with significant obstetric-related complications, making close clinical monitoring and preparation essential. Integration of SARS-CoV-2/COVID-19 management with reproductive health services is crucial to ensuring maternal and neonatal outcomes. Our review is not only the first to establish a groundwork for the current state of knowledge and its clinical implications on this topic, but it also sheds new insights for future research directions. Comparing Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome and SARS-CoV-2 in terms of their impact on maternal and neonatal outcomes provides valuable insights despite their differences. Leveraging Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome research can help understand SARS-CoV-2 effects on pregnancy. Both infections pose risks to pregnant individuals and their fetuses, leading to increased maternal mortality and complications. Identifying common patterns and risk factors can improve clinical management for pregnant individuals with SARS-CoV-2. While a direct observational study for this comparison may not be feasible, comparing with Human Immunodeficiency Virus offers an ethical and practical approach. However, specific studies on SARS-CoV-2 are still necessary to gather detailed data on maternal and fetal outcomes.

Background: Contact tracing is a vital public health tool used to prevent the spread of infectious diseases. However, traditional interview-format contact tracing (TCT) is labor-intensive and time-consuming and may be unsustainable for large-scale pandemics such as COVID-19. Objective: In this study, we aimed to address the limitations of TCT. The Yale School of Engineering developed a Hardware-Assisted Bluetooth-based Infection Tracking (HABIT) device. Following the successful implementation of HABIT in a university setting, this study sought to evaluate the performance and implementation of HABIT in a high school setting using an embedded mixed methods design. Methods: In this pilot implementation study, we first assessed the performance of HABIT using mock case simulations in which we compared contact tracing data collected from mock case interviews (TCT) versus Bluetooth devices (HABIT). For each method, we compared the number of close contacts identified and identification of unique contacts. We then conducted an embedded mixed methods evaluation of the implementation outcomes of HABIT devices using pre- and postimplementation quantitative surveys and qualitative focus group discussions with users and implementers according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Results: In total, 17 students and staff completed mock case simulations in which 161 close contact interactions were detected by interview or Bluetooth devices. We detected significant differences in the number of close contacts detected by interview versus Bluetooth devices (P<.001), with most (127/161, 78.9%) contacts being reported by interview only. However, a significant number (26/161, 16.1%; P<.001) of contacts were uniquely identified by Bluetooth devices. The interface, ease of use, coherence, and appropriateness were highly rated by both faculty and students. HABIT provided emotional security to users. However, the prototype design and technical difficulties presented barriers to the uptake and sustained use of HABIT. Conclusions: Implementation of HABIT in a high school was impeded by technical difficulties leading to decreased engagement and adherence. Nonetheless, HABIT identified a significant number of unique contacts not reported by interview, indicating that electronic technologies may augment traditional contact tracing once user preferences are accommodated and technical glitches are overcome. Participants indicated a high degree of acceptance, citing emotional reassurance and a sense of security with the device.

Abnormally high lymphocyte counts are seen in persons with nonalcoholic fatty liver disease (NAFLD). Gut microbiota dysbiosis is a risk factor for NAFLD. We assessed the gut microbiota of 63 healthy children and 63 children with NAFLD using 16S rRNA gene and metagenomic sequencing to explore the relationships. Compared with healthy children (HC group), the Bacteroidetes, Verrucomicrobia, and Akkermansia were less abundant, while the Actinobacteria were more abundant in children with NAFLD (FLD group). To understand the effect of lymphocytes on the gut microbiota of children with NAFLD, we compared the microbiota of 41 children with NAFLD and high numbers of lymphocytes (FLD_HL group) and 22 children with NAFLD and low numbers of lymphocytes (FLD_LL group). The abundances of Bacteroidetes, Verrucobacterium, and Akkermansia increased and Actinobacteria decreased in the FLD_LL group compared to the FLD_HL group. Akkermansia was negatively correlated with lymphocyte count. NAFLD may disturb the gut microbiota in children through reducing the abundance of Akkermansia and increasing the abundance of proinflammatory bacteria, such as Escherichia-Shigella. Conclusions: High lymphocyte counts are associated with disturbances of gut microbiota and emergence of opportunistic pathogens in children with NAFLD.

The COVID-19 vaccination rate among children ages 5–11 is low in the U.S., with parental vaccine hesitancy being the primary cause. Current work suggests that safety and side effect concerns are the primary reasons for such vaccine hesitancy. This study explores whether this hesitancy can be mitigated with information interventions. Based on theories of health decision making and persuasion, we designed four information interventions with varying contents and lengths. We wrote two messages on vaccine safety (a detailed safety-long message and a succinct safety-short message), explaining the vaccine’s lower dosage, low rate of side effects, and the rigorous approval process. We also had two messages on protection effects (protect-family, protect-child). We combined these four messages with a vaccine-irrelevant control message and compared their effects on parental vaccine intention. We measured the parental vaccination intention using a 0–6 Likert scale question. Among the four intervention groups, we found that the short version of the safety message increased the average vaccination intention by over 1 point compared to the control arm, while the other three interventions failed to show significance. Specifically, these effects are particularly pronounced (around 2 points) for Republican parents who had a much lower initial intention to vaccinate their children. Our study highlights the importance of concise and to-the-point information rendering in promoting public health activities and therefore has important policy implications for raising vaccination intentions among parents, especially those leaning towards more conservative political affiliation.

BACKGROUND Contact tracing is a vital public health tool used to prevent the spread of infectious diseases. However, traditional interview-format contact tracing (TCT) is labor-intensive and time-consuming and may be unsustainable for large-scale pandemics such as COVID-19. OBJECTIVE In this study, we aimed to address the limitations of TCT. The Yale School of Engineering developed a Hardware-Assisted Bluetooth-based Infection Tracking (HABIT) device. Following the successful implementation of HABIT in a university setting, this study sought to evaluate the performance and implementation of HABIT in a high school setting using an embedded mixed methods design. METHODS In this pilot implementation study, we first assessed the performance of HABIT using mock case simulations in which we compared contact tracing data collected from mock case interviews (TCT) versus Bluetooth devices (HABIT). For each method, we compared the number of close contacts identified and identification of unique contacts. We then conducted an embedded mixed methods evaluation of the implementation outcomes of HABIT devices using pre- and postimplementation quantitative surveys and qualitative focus group discussions with users and implementers according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. RESULTS In total, 17 students and staff completed mock case simulations in which 161 close contact interactions were detected by interview or Bluetooth devices. We detected significant differences in the number of close contacts detected by interview versus Bluetooth devices (P<.001), with most (127/161, 78.9%) contacts being reported by interview only. However, a significant number (26/161, 16.1%; P<.001) of contacts were uniquely identified by Bluetooth devices. The interface, ease of use, coherence, and appropriateness were highly rated by both faculty and students. HABIT provided emotional security to users. However, the prototype design and technical difficulties presented barriers to the uptake and sustained use of HABIT. CONCLUSIONS Implementation of HABIT in a high school was impeded by technical difficulties leading to decreased engagement and adherence. Nonetheless, HABIT identified a significant number of unique contacts not reported by interview, indicating that electronic technologies may augment traditional contact tracing once user preferences are accommodated and technical glitches are overcome. Participants indicated a high degree of acceptance, citing emotional reassurance and a sense of security with the device.