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During the COVID-19 pandemic, the small developing island of Barbados instituted measures to minimize the entry of COVID-19 into its lone public hospital. As part of this plan the emergency department formed a virtual observation unit to sort and manage potential cases pending the return of diagnostic investigations. This process was successful in keeping the hospital from being overrun in the pandemic.
The goal of this study was to unpack processes that may lead to child emotional insecurity. Guided by the emotional security theory (EST/EST-R), we examined the mediational role of parental depressive symptomology between interparental conflict (IPC), both constructive and destructive, and child emotional insecurity at age 36-months. We partitioned unique variance of IPC from shared using an extension of the common fate model. We used two-wave data from the Building Strong Families project, which consisted of racially diverse couples/parents (N = 4,424) who were low income and unmarried at the conception of their child. We found gendered differences for how mothers and fathers experience IPC, with mothers more influenced by their relational circumstances. We also found that fathers were vulnerable to experiencing depressive symptoms following aspects of destructive IPC. Consistent with EST-R, constructive IPC did not promote emotional security in children. Rather, both destructive and constructive IPC related to greater levels of emotional insecurity, with destructive IPC showing stronger effects. Proposed mediation was found for fathers only. Our findings may appeal to scholars who focus on untangling the complexity of IPC and intervention specialists and clinicians interested in a process-oriented approaches to the development of child psychopathology.
To illustrate how a partnership between an academic medical center and a public health department successfully responded to a large tuberculosis (TB) exposure at a community daycare center.
Setting:
A multidisciplinary team rapidly established a dedicated TB Exposure Clinic to evaluate and screen exposed children requiring window prophylaxis.
Patients:
The exposure affected 592 individuals, including 359 children under five—those at highest risk for severe disease.
Interventions:
Given the vulnerability of young children to TB infection, timely evaluation and initiation of window prophylaxis were prioritized.
Results:
Over two days, 162 children were assessed for TB window prophylaxis, and 110 additional children underwent TB screening.
Conclusions:
By leveraging clinical expertise, interdisciplinary collaboration, and informatics infrastructure, the TB Exposure Clinic delivered rapid, comprehensive care while minimizing disruption to local healthcare systems. This model underscores the essential role of academic medical centers in supporting public health responses.
Advances in medicine have led to an improvement in life expectancy, thus increasing the population of older individuals within the criminal justice system. This study investigates the determinants of risk formulation, care plan, and disposition among older adult forensic patients (OAFP) in Ontario, Canada.
Methods
This retrospective analysis utilized the Ontario Review Board database, focusing on 161 OAFP, aged 55 years and older. Hierarchical regression was used to analyze the relationship between changes in risk and six blocks of variables: sociodemographic characteristics (Block 1), circumstances during the index offense (Block 2), current clinical profile (Block 3), past psychiatric history and behavioral patterns (Block 4), criminal history and legal status (Block 5), and recent violent events (Block 6).
Results
The median age of patients was 61 years (IQR 58–67), with 83.4% being male. Schizophrenia was the most common diagnosis (68.3%), and 9.3% had neurocognitive disorders. The model with six blocks of factors explained 92% of the variability in risk change. Models 2 (blocks 1 and 2) and 4 (blocks 1–4) were statistically significant, explaining 34% (p = 0.010) and 22% (p = 0.018) of the variance in the change in risk of threat to public safety, respectively. OAFP with a significant risk to public safety were more likely to be inpatients and less likely intoxicated during their index offense.
Conclusion
Resources, policies, and a supervised model of care to curtail behavioral risks are relevant to the care of OAFP. Innovative risk management models for OAFP are indicated.
We prove an asymptotic formula for the second moment of central values of Dirichlet L-functions restricted to a coset. More specifically, consider a coset of the subgroup of characters modulo d inside the full group of characters modulo q. Suppose that $\nu _p(d) \geq \nu _p(q)/2$ for all primes p dividing q. In this range, we obtain an asymptotic formula with a power-saving error term; curiously, there is a secondary main term of rough size $q^{1/2}$ here which is not predicted by the integral moments conjecture of Conrey, Farmer, Keating, Rubinstein, and Snaith. The lower-order main term does not appear in the second moment of the Riemann zeta function, so this feature is not anticipated from the analogous archimedean moment problem.
We also obtain an asymptotic result for smaller d, with $\nu _p(q)/3 \leq \nu _p(d) \leq \nu _p(q)/2$, with a power-saving error term for d larger than $q^{2/5}$. In this more difficult range, the secondary main term somewhat changes its form and may have size roughly d, which is only slightly smaller than the diagonal main term.
Historically, medical response efforts to large-scale disaster events have highlighted significant variability in the capabilities of responding medical providers and emergency medical teams (EMTs). Analysis of the 2010 Haiti earthquake response found that a number of medical teams were poorly prepared, inexperienced, or lacked the competencies to provide the level of medical care required, highlighting the need for medical team standards.
The World Health Organization (WHO) EMT initiative that followed created minimum team standards for responding international EMTs to improve the quality and timeliness of medical services. At the present time however, there remains a lack of globally recognized minimum competency standards at the level of the individual disaster medical responder, allowing for continued variability in patient care.
Objectives:
This study examines existing competencies for physicians, nurses, and paramedics who are members of deployable disaster response teams.
Method/Description:
A scoping review of published English-language articles on existing competencies for physicians, nurses, and paramedics who are members of deployable disaster response teams was performed in Ovid MEDLINE, Ovid Embase, CINAHL, Scopus, and Web of Science Core Collection. A total of 3,474 articles will be reviewed.
Results/Outcomes:
Data to be analyzed by October 1, 2024.
Conclusion:
There is a need to develop minimum standards for healthcare providers on disaster response teams. Identification of key existing competencies for disaster responders will provide the foundation for the creation of globally recognized minimum competency standards for individuals seeking to join an EMT in the future and will guide training and curricula development.
We present a novel scheme for rapid quantitative analysis of debris generated during experiments with solid targets following relativistic laser–plasma interaction at high-power laser facilities. Results are supported by standard analysis techniques. Experimental data indicate that predictions by available modelling for non-mass-limited targets are reasonable, with debris of the order of hundreds of μg per shot. We detect for the first time two clearly distinct types of debris emitted from the same interaction. A fraction of the debris is ejected directionally, following the target normal (rear and interaction side). The directional debris ejection towards the interaction side is larger than on the side of the target rear. The second type of debris is characterized by a more spherically uniform ejection, albeit with a small asymmetry that favours ejection towards the target rear side.
Understanding the physics of electromagnetic pulse (EMP) emission and nozzle damage is critical for the long-term operation of laser experiments with gas targets, particularly at facilities looking to produce stable sources of radiation at high repetition rates. We present a theoretical model of plasma formation and electrostatic charging when high-power lasers are focused inside gases. The model can be used to estimate the amplitude of gigahertz EMPs produced by the laser and the extent of damage to the gas jet nozzle. Looking at a range of laser and target properties relevant to existing high-power laser systems, we find that EMP fields of tens to hundreds of kV/m can be generated several metres from the gas jet. Model predictions are compared with measurements of EMPs, plasma formation and nozzle damage from two experiments on the VEGA-3 laser and one experiment on the Vulcan Petawatt laser.
Written by key names in the field, this book explores the impact of digitization and COVID-19 on justice in housing and special needs education. It analyses access to justice, offers recommendations for improvement and provides valuable insights into administrative justice from user perspectives.
Dualism holds that experiences and physical states are distinct in that neither sort of state is identical with or grounded in the other. Cognitive phenomenal realism holds that cognitive experiences are irreducible to sensory experiences. While dualism and cognitive phenomenal realism are logically orthogonal and usually discussed separately, I argue that dualism’s plausibility is sensitive to whether cognitive phenomenal realism is true. In particular, I argue that if cognitive phenomenal realism is true, then it bolsters the case for dualism via a cognitive knowledge argument that has several advantages over the standard sensory knowledge argument.
The relationship between psychosis and violence is often construed focusing on a narrow panel of factors; however, recent evidence suggests violence might be linked to a complex interplay of biopsychosocial factors among forensic psychiatric patients with psychosis (FPPP). This review describes violence incidents in FPPP, the factors associated with violence, and relevant implications.
Methods
This review was conducted following the preferred reporting items for systematic reviews and meta-analyses guideline. Databases, including CINAHL, EMBASE, Medline/PubMed, PsycINFO, and Web of Science, were searched for eligible studies that examined violence among adult FPPP. Screening of reports and data extraction were completed by at least two independent reviewers.
Results
Across the 29 included studies, violence was consistently related to prior contact with psychiatric services, active psychotic symptoms, impulsivity, adverse experiences, and low social support. However, FPPP who reported violence varied in most other biopsychosocial domains, suggesting the underlying combinatorial effects of multiple risk factors for violence rather than individual factors. Variability in violence was addressed by stratifying FPPP into subgroups using composite/aggregate of identifiable factors (including gender, onset/course of illness, system-related, and other biopsychosocial factors) to identify FPPP with similar risk profiles.
Conclusions
There are multiple explanatory pathways to violence in FPPP. Recent studies identify subgroups with underlying similarities or risk profiles for violence. There is a need for future prospective studies to replicate the clinical utility of stratifying FPPP into subgroups and integrate emerging evidence using recent advancements in technology and data mining to improve risk assessment, prediction, and management.
On the report model of appreciating fiction, one imagines learning about a fictional world through a report: reading or viewing someone’s account or listening to them tell their story. On the transparency model, one simply imagines the things that are fictional in the story, without imagining anything about how that information is acquired. It is argued that the transparency model is the default, in literature and cinema, but in comics, it is the report model that is the default.
OBJECTIVES/GOALS: The Clinical Research Professionals (CRP) at Cincinnati Children’s Hospital Medical Center (CCHMC) identified and addressed gaps in a static on boarding material by transforming it into an interactive, centralized, and customizable REDCap checklist to better meet researcher needs across the institution. METHODS/STUDY POPULATION: The CRP On boarding Checklist is a tool designed to assist clinical researchers in their onboarding process at CCHMC. This tool helps CRPs determine the required/recommended trainings available to assist with skill-building and establishing job role competency. CRP supervisorsand subject matter experts were included incontent revisions, format, and transition to a RED Capsurvey. The new checklist is interactive, targets training requirements by job function, and clearly labels mandatory training. A companion document allows new CRPs to create and track their own individualized training plan. RESULTS/ANTICIPATED RESULTS: The revised CRP On boarding Checklist was launched in April 2022 and announced via email communication. Alive demonstration was presented to all CRPs during the May 2022 CRP Monthly Meeting. The checklist and companion document are linked to the internal CRP website, which is accessible institutionally. Sincelaunch, almost 100 new and internally transferring CRPs have utilized the online tool to guide their training needs. The checklist is intended to reflect real-time changes in educational offerings. In addition to feedback and change requests from the CRP community, the checklist is updated as necessary and routinely reviewed on a biannual basisby the CRP Education Committee. DISCUSSION/SIGNIFICANCE: The creation and maintenance of the CRP Onboarding Checklist is a modern and accessible way for CRPs and supervisors to explore role-applicable training and take active roles in the on boarding process. The RED Capformat allows easy sharing and adoptability to other institutions via data dictionary.
OBJECTIVES/GOALS: The Clinical Research Professionals (CRP) group was founded in 2000 by research managers at Cincinnati Children’s Hospital Medical Center (CCHMC) as an avenue to share research processes, ideas, successes, and community. The group has developed and evolved at CCHMC to meet the needs of CRP members. METHODS/STUDY POPULATION: CRP has evolved to meet the needs of the clinical research community at CCHMC. In 2008, monthly education meetings and a Research Educator supported a standardized onboarding process. CRP hosted the inaugural CRP Appreciation Day in 2010 to recognize researchers. The group established the CRP Leadership Committee (CRPLC) in 2011 and by 2016 expanded to include subcommittees. Career development opportunities include onsite clinical research certification exams and a centralized process for advancement. CRP updated processes and onboarding materials to electronic formats during the pandemic and now includes nursing, data management, and University of Cincinnati representation on the CRPLC. RESULTS/ANTICIPATED RESULTS: The culmination of 20+ years of CRP has led to the current state of CRP at CCHMC. CRP operates an internal website to collate all activities and resources, including educational opportunities and helpful links related to CCHMC research processes. CRP currently has leadership, membership, education, and regulatory committees providing opportunities for all clinical research professionals to join, collaborate, and grow within CCHMC and beyond. Established career pathways and centralized CRP advancement guidelines support career development. The centralized REDCap onboarding tool is accessible at any time for initial onboarding and then continuing education. DISCUSSION/SIGNIFICANCE: The formation and evolution of CRP, developed by work of past CRPs, has fostered an innovative community to meet clinical research needs through education, career development, and process standardization. We aim to continue to disseminate knowledge and lessons learned beyond our institutional walls.
The California Department of Public Health (CDPH) reviewed 109 cases of healthcare personnel (HCP) with laboratory-confirmed mpox to understand transmission risk in healthcare settings. Overall, 90% of HCP with mpox had nonoccupational exposure risk factors. One occupationally acquired case was associated with sharps injury while unroofing a patient’s lesion for diagnostic testing.
We report the first high-repetition-rate generation and simultaneous characterization of nanosecond-scale return currents of kA-magnitude issued by the polarization of a target irradiated with a PW-class high-repetition-rate titanium:sapphire laser system at relativistic intensities. We present experimental results obtained with the VEGA-3 laser at intensities from $5\times {10}^{18}$ to $1.3\times {10}^{20}$ W cm${}^{-2}$. A non-invasive inductive return-current monitor is adopted to measure the derivative of return currents of the order of kA ns${}^{-1}$ and analysis methodology is developed to derive return currents. We compare the current for copper, aluminium and Kapton targets at different laser energies. The data show the stable production of current peaks and clear prospects for the tailoring of the pulse shape, which is promising for future applications in high-energy-density science, for example, electromagnetic interference stress tests, high-voltage pulse response measurements and charged particle beam lensing. We compare the target discharge of the order of hundreds of nC with theoretical predictions and a good agreement is found.
We describe an analysis of the flaked stone tools recovered from households in the Postclassic central Mexican city of Calixtlahuaca (a.d. 1130–1530). Most artifacts are obsidian and represent the blade-core technology, but biface and bipolar artifacts are also represented. Even though household residents were involved in limited biface and bipolar reduction, it appears that the city did not have any resident blade producers. This finding is at odds with the views of many archaeologists, who tend to associate craft production with the emergence of complex Mesoamerican urban centers. We examine the technologies from temporally distinct Calixtlahuacan household assemblages. We discuss why the quantity and quality artifacts associated with blade production are not consistent with resident blade making in the city. Finally, we examine four models for blade provisioning: (1) whole-blade trade, (2) processed-blade trade, (3) long-distance itinerant craftsmen, and (4) local, hinterland-based craftsmen. Evaluating how the Calixtlahuacans got their flaked stone tools has important implications for the comparative understanding of the organization and scale of economic provisioning systems in Postclassic central Mexico. This analysis supports new inferences about the nature of commercial networks that supplied the Toluca Valley prior to the arrival of the Spanish in the sixteenth century.