The reactivity of transverse waves in detonations of methane, oxygen and nitrogen are experimentally assessed using MHz rate schlieren and chemiluminescence imaging. In these highly unstable mixtures, the mode of wave propagation is more complex than what is described by the cellular instability model that is conventionally used for weakly unstable mixtures. Behind the low-speed leading shock in unstable waves, the processed gas remains essentially unreacted until transverse waves reach this region. In highly unstable waves, the transverse waves have a range of reactivity, that is rates of reaction in the flow immediately behind the wave. In this study, we present examples of transverse waves for near-limit detonations and analyse four cases in detail. In some cases, these waves appear to be essentially non-reactive or cause very slow reaction. In other cases, the transverse waves can be highly reactive. In the most extreme example, the transverse wave is propagating at the Chapman–Jouguet speed with a small reaction zone, i.e. a transverse detonation. A reactive oblique shock model is used to approximate the triple-point configuration of this case as a double-Mach reflection, which shows good agreement with the images. The reaction evolution along path lines is analysed using detailed reaction mechanisms and considerations about flow-field unsteadiness. Length scales of the energy release and expansion processes within the reaction zone region are used to explain the observed modes of wave propagation and interaction.

Isotopes of strontium, oxygen, and carbon were analyzed in human tooth enamel from two Postclassic sites in the central Peten lakes region, Guatemala, to examine patterns of mobility and diet during a time of social unrest. Excavations at both sites, Ixlu and Zacpeten, have revealed evidence for purposeful dismemberment and interment of individuals. This study examines a possible shrine surrounded by rows of skulls at Ixlu, and a mass grave of comingled individuals interred at Zacpeten. The interments coincide with a period of conflict and warfare between two dominant polities, Itza and Kowoj. The 14 sampled individuals at Ixlu were young males, six of whom isotopically match the Maya Mountains of central Belize/southeastern Peten. At Zacpeten, isotopic signatures of adults and children (n = 68) suggested that many were either local or came from other parts of the Maya lowlands, but not the Maya Mountains. In the Late Postclassic, the Zacpeten individuals were exhumed, defiled, and deposited in a mass grave, probably by Kowojs. Although temporally and geographically related, the Ixlu and Zacpeten burials represent two distinct cases of ritual violence that reflect the tumultuous political landscape of the Postclassic period.

Antenatal corticosteroids are given to pregnant people at risk of preterm birth to reduce newborn morbidity, including respiratory distress syndrome. However, there has been concern surrounding potential adverse effects on subsequent generations. Animal studies have demonstrated endocrine and metabolic changes in those exposed to corticosteroids in utero (F1) and in the second generation (F2). We aimed to assess the effects of parental antenatal corticosteroid exposure on health of the second generation (F2) of Auckland Steroid Trial (AST) participants. In the AST, women (F0) expected to birth between 24 and 36 weeks’ gestation were randomised to betamethasone or placebo. When their children (F1) were 50 years old, they and their children (F2) were followed up with a self-report questionnaire and data linkage. The primary outcome for this analysis was body mass index (BMI) z-score in the F2 generation. Secondary outcomes included respiratory, cardiovascular, neurodevelopmental, mental and general health, and social outcomes. Of the 213 F2 participants, 144 had BMI data available. There was no difference in BMI z-score between participants whose parent was exposed to betamethasone versus placebo (mean (SD) 0.63 (1.45), N = 77 vs 0.41 (1.28), N = 67, adjusted mean difference (95% confidence interval) = 0.16 (-0.37, 0.69)). There was no evidence of a difference in rates of overweight, diabetes, respiratory disease, cardiometabolic risk factors, neurodevelopmental difficulties, mental health difficulties and social outcomes between parental betamethasone versus placebo exposure groups, but confidence intervals were wide. These findings are reassuring regarding the intergenerational safety of antenatal corticosteroids.

Knowledge of the status of ecosystems is vital to help develop and implement conservation strategies. This is particularly relevant to the Arctic where the need for biodiversity conservation and monitoring has long been recognised, but where issues of local capacity and logistic barriers make surveys challenging. This paper demonstrates how long-term monitoring programmes outside the Arctic can contribute to developing composite trend indicators, using monitoring of annual abundance and population-level reproduction of species of migratory Arctic-breeding waterbirds on their temperate non-breeding areas. Using data from the UK and the Netherlands, countries with year-round waterbird monitoring schemes and supporting relevant shares of Arctic-breeding populations of waterbirds, we present example multi-species abundance and productivity indicators related to the migratory pathways used by different biogeographical populations of Arctic-breeding wildfowl and wader species in the East Atlantic Flyway. These composite trend indicators show that long-term increases in population size have slowed markedly in recent years and in several cases show declines over, at least, the last decade. These results constitute proof of concept. Some other non-Arctic countries located on the flyways of Arctic-breeding waterbirds also annually monitor abundance and breeding success, and we advocate that future development of “Arctic waterbird indicators” should be as inclusive of data as possible to derive the most robust outputs and help account for effects of current changes in non-breeding waterbird distributions. The incorporation of non-Arctic datasets into assessments of the status of Arctic biodiversity is recognised as highly desirable, because logistic constraints in monitoring within the Arctic region limit effective population-scale monitoring there, in effect enabling “monitoring at a distance”.

To combat the decline in North American grasslands and prairies, innovative strategies to establish new native grass and forb plantings must be considered. Integrated vegetation management entails the use of many practices to cultivate desirable vegetation along roadsides, including mowing, applying herbicides, burning, and replanting. Currently, only a limited selection of postemergence herbicides are available to improve native plant establishment along roadsides. A greenhouse herbicide screen that included four postemergence herbicides registered for use on Conservation Reserve Program (CRP) acres and rights-of-way was conducted to test their safety for use on four native grasses (big bluestem, buffalograss, sideoats grama, and switchgrass) and seven forb species (ashy sunflower, black-eyed Susan, butterfly milkweed, desert false indigo, Illinois bundleflower, Mexican hat plant, and purple coneflower). Clopyralid (689 g ae ha−1), metsulfuron (4.18 g ai ha−1), and quinclorac (418 g ai ha−1) applied at labeled rates caused no injury to the native grass species or butterfly milkweed. However, florpyrauxifen-benzyl (38.4 g ai ha−1) caused significant injury to buffalograss and switchgrass. None of the herbicides tested were universally safe to use on all forb species evaluated in this trial, with each herbicide causing unacceptable injury (≥25%) to one or more forb species. None of the herbicides studied here would be completely safe for use on mixed stands of native grasses and native forbs at the seedling growth stage, indicating that prairie establishment must use alternative chemistries, plant mixes with fewer species, or avoid postemergence applications shortly after emergence of native forbs.

Background: Minimally invasive endoscopic techniques via the transorbital approach (ETOA) is emerging as an alternative approach for addressing skull base tumours. This study aims to showcase our institution’s 8 year experience in using ETOA, detailing the surgical technique employed and presenting comprehensive patient outcomes. Methods: A retrospective analysis was conducted on data from 32 patients who underwent ETOA within the past eight years. Demographic data was obtained as well as information on surgical approaches, intra-operative findings, recurrence and complications. Results: 33 ETOA procedures were performed on 29 patients, with an average age of 45, 14 of whom were women. The superior orbital corridor was utilized in 100% of cases, and in 79.17%, ETOA was complemented by a transnasal approach. Spheno-orbital meningioma accounted for the most common surgical indication (36.36%, n=12, followed by lateral frontal sinus mucocele (18.75%, n=6). The median length of stay was one day.Transient V1 numbness was the primary complication (33%, n=8), and 18.75% (n=6) necessitated another surgery. Notably, no mortality was associated with this procedure. Conclusions: Our institution’s experience underscores the notable safety and effectiveness of ETOA, The main complications being transient V1 numbness, proptosis, transient diplopia. Revision surgery was only required in 6 out of 33 cases.

Background: Over 28% of people with epilepsy (PwE) experience anxiety related to their seizures, yet research on interventions for epilepsy-specific (ES) interictal anxiety remains limited. The community-based pilot, ’AnxEpi-VR,’ tested virtual reality exposure therapy (VR-ET), showing potential effectiveness and laying the groundwork for evaluating its impact on ES-anxiety in the present randomized controlled trial. Methods: Fourteen PwE admitted to the Epilepsy Monitoring Unit at Toronto Western Hospital used a 360-degree VR-intervention twice daily for five minutes up to ten days. The control group (n=7) viewed neutral VR environments (e.g., beach, forest scenes), while the experimental group (n=7) experienced VR-ET targeting ES anxiety (e.g., subway seizure scenarios). Data was collected at baseline, pre and post-VR exposure, post-intervention, and one-month follow-up using self-report questionnaires, semi-structured interviews, and VR-usage metrics. Clinicaltrials.gov NCT06028945. Results: At baseline, 71% of the control group and 83% of the exposure group had a brEASI score ≥7, indicative of an anxiety disorder. Post-intervention, this decreased to 57% and 50%, respectively. The average Fast Motion Sickness rating was 1.29, indicating minimal motion sickness. Of the exposure participants, 71% felt the scenarios simulated their real-world anxiety triggers. Conclusions: VR-ET was well-tolerated in PwE. Future recommendations include diversifying scenarios, adding interactive features, and improving software connectivity.

Background: The efficacy and safety of lecanemab have previously been evaluated in the Phase 3 randomized clinical trial, Clarity AD (NCT03887455). Methods: A Markov cohort model was developed to estimate the cost-effectiveness of lecanemab versus standard of care (SoC) in patients with mild cognitive impairment (MCI) or mild dementia due to Alzheimer’s disease (AD), with confirmed beta-amyloid (Aβ) pathology, from a Canadian societal perspective. Health states were determined by Clinical Dementia Rating-Sum of Boxes (CDR-SB) scores. Transitions between health states during month 0-18 were estimated from Clarity AD. Beyond month 18, relative efficacy for lecanemab in the form of the hazard ratio for time-to-worsening of CDR-SB was applied to literature-based transition probabilities. The model included the effects of lost productivity and impact on carer health-related quality of life. Results: The incremental cost-effectiveness ratio (ICER) for lecanemab vs SoC was estimated to be CAD 62,751 per QALY gained. The probability that lecanemab was cost-effective at a threshold of CAD 100,000 was estimated to be 88.5%. Conclusions: Lecanemab represents a cost-effective option for the treatment for early AD from the Canadian societal perspective. The results of this analysis can be used to inform clinical and economic decision making.

Background: TeleStroke can improve access to stroke care in rural areas. We aim to evaluate the safety and effectiveness of intravenous thrombolysis in our TeleStroke system. Methods: The Manitoba TeleStroke program was rolled out across 7 sites between November 2014 and January 2019. We retrospectively analyzed prospectively collected consecutive acute stroke patients’ data in this duration. The primary outcome was safety and effectiveness measured in terms of 90-day modified Rankin score (mRs). The number of acute ischemic stroke (AIS) patients receiving thrombolysis and endovascular thrombectomy [EVT] and process metrics were also analyzed. R/RStudio version-4.3.2 was used (p<0.05). Results: Of the 1,748 TeleStroke patients (age 71 years [IQR 58-81], female 810[46.3%]), 696 were identified as AIS. Of these, 265(38.1%) received thrombolysis and 48(6.9%) EVT. Ninety-day mortality was 53(20.0%) among those receiving thrombolysis and 117(44.2%) had a favorable outcome (mRs ≤2). Of those who received intravenous thrombolysis, 9 patients (4.2%) were found to have symptomatic intracranial hemorrhage. The median last-seen-normal (LSN)-to-door was121 minutes and the median door-to-needle, 55 minutes. Conclusions: Intravenous thrombolysis was found to be effective with acceptable safety. TeleStroke improved overall access to stroke care and played an important role in identifying AIS patients eligible for thrombolysis and EVT.

We present the first radio–continuum detection of the circumstellar shell around the well-known WN8 type Wolf-Rayet star WR16 at 943.5 MHz using the Australian Square Kilometre Array Pathfinder (ASKAP) Evolutionary Map of the Universe (EMU) survey. At this frequency, the shell has a measured flux density of 72.2$\pm$7.2 mJy. Using previous Australia Telescope Compact Array (ATCA) measurements at 2.4, 4.8, and 8.64 GHz, as well as the Evolutionary Map of the Universe (EMU) observations of the star itself, we determine a spectral index of $\alpha\,=\,+0.74\pm0.02$, indicating thermal emission. We propose that the shell and star both exhibit thermal emission, supported by the its appearance in near-infrared and H$\alpha$ observations. The latest Gaia parallax is used to determine a distance of 2.28$\pm$0.09 kpc. This star is well known for its surrounding circular nebulosity, and using the distance and an angular diameter of $8.^{\prime}42$, we determine the shell size to be 5.57$\pm$0.22 pc. We use the Gaia proper motion (PM) of WR16 to determine peculiar velocities of the star as $V_{\alpha}(pec) =$ –45.3$\pm$5.4 km s$^{-1}$ and $V_{\delta}(pec) =$ 22.8$\pm$4.7 km s$^{-1}$, which indicates that the star is moving in a north-west direction, and translates to a peculiar tangential velocity to be 50.7$\pm$6.9 km s$^{-1}$. We also use these proper motion (PM) to determine the shell’s origin, estimate an age of $\sim 9500\pm 1300$ yr, and determine its average expansion velocity to be $280\pm40$ km s$^{-1}$. This average expansion velocity suggests that the previous transitional phase is a Luminous Blue Variable (LBV) phase, rather than a Red Super Giant (RSG) phase. We also use the measured flux at 943.5 MHz to determine a mass-loss rate of $1.753\times 10^{-5}\,{\rm M}_\odot\,$yr$^{-1}$, and use this to determine a lower-limit on ionising photons of $N_{UV} \gt 1.406\times 10^{47}\,\textit{s}^{-1}$.

Background: Experimental and clinical evidence suggest that Parkinson’s disease (PD) manifests differently between females and males, yet women have been underrepresented in PD clinical research, leading to a limited understanding of the sex- and gender-specific aspects of the disease. Understanding the needs of women with PD (WwPD) is critical Methods: Patient-centered outcomes-based mixed methods study. Phase 1: Qualitative focus groups, patient-centered discussions, led by female interviewers. Phase 2: Nationwide survey via the Qualtrics platform, informed by focus group findings. We report the Phase 1 preliminary results Results: We conducted 5 focus groups with 22 cisgender women. Mean age 60.5 (range: 44 -81) and disease duration of 6.82 years. Two main themes emerged: (1) Mental Health: participants reported significant emotional distress, altered self-image, and impacts on family, social, and professional life. (2) Physical Health and Health care: While some were satisfied with care, those with young-onset PD experienced misdiagnosis, dismissal, and inadequate information. Sexual health, and the overlap between menopause and PD symptoms, were highlighted. Most participants emphasized the benefits of physical activity, nutrition, and social support. Conclusions: Findings highlight significant health challenges in women, underscoring the need for gender-specific care and tailored support to improve healthcare outcomes

Background: Nipocalimab is a human IgG1 monoclonal antibody targeting FcRn that selectively reduces IgG levels without impacting antigen presentation, T- and B-cell functions. This study describes the effect of nipocalimab on vaccine response. Methods: Open-label, parallel, interventional study randomized participants 1:1 to receive intravenous 30mg/kg nipocalimab at Week0 and 15mg/kg at Week2 and Week4 (active) or no drug (control). On Day 3, participants received Tdap and PPSV®23 vaccinations and were followed through Wk16. Results: Twenty-nine participants completed the study and are included (active, n=15; control, n=14). Participants with a positive anti-tetanus IgG response was comparable between groups at Wk2 and Wk16, but lower at Wk4 (nipocalimab 3/15 [20%] vs control 7/14 [50%]; P=0.089). All maintained anti-tetanus IgG above the protective threshold (0.16IU/mL) through Wk16. While anti-pneumococcal-capsular-polysaccharide (PCP) IgG levels were lower during nipocalimab treatment, the percent increase from baseline at Wk2 and Wk16 was comparable between groups. Post-vaccination, anti-PCP IgG remained above 50mg/L and showed a 2-fold increase from baseline throughout the study in both groups. Nipocalimab co-administration with vaccines was safe and well-tolerated. Conclusions: These findings suggest that nipocalimab does not impact the development of an adequate IgG response to T-cell–dependent/independent vaccines and that nipocalimab-treated patients can follow recommended vaccination schedules.

Background: Electroencephalography (EEG) has emerged as a minimally invasive technique to quantify functional changes in neural activity associated with neurodegenerative disorders such as Alzheimer’s Disease (AD). Given its non-invasive approach, EEG has the potential to fill the pressing gap forearly, accurate, and accessible methods to detect and characterize disease progression in AD. Methods: To address these challenges, we conducted a pilot analysis of a custom machine learning-based automated preprocessing and feature extraction pipeline to identify indicators of AD and correlates of disease progression. Results: Our pipeline successfully detected several new and previously established EEG-based measures indicative of AD status and progression. Key findings included alterations in delta and theta band power, network connectivity disruptions, and increased slowing of brain rhythms. Additionally, we observed strong correlations between EEG-derived metrics and clinical measures such as Mini-Mental State Examination (MMSE) scores, supporting the external validity of our approach. These findings highlight the sensitivity of EEG biomarkers in differentiating between early and late stages of AD. Conclusions: Our findings suggest that this automated approach provides a promising initial framework for implementing EEG biomarkers in the AD patient population, paving the way for improved diagnostic and monitoring strategies.