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The flow over a cambered NACA 65(1)–412 airfoil at $Re\,=\,2\times 10^4$ is described based on a high-order direct numerical simulation. Simulations are run over a range of angles of attack, $\alpha$, where a number of instabilities in the unsteady, three-dimensional flow field are identified. The balance and competing effects of these instabilities are responsible for significant and abrupt (with respect to $\alpha$) changes in flow regime, with measurable consequences in time-averaged, integrated force coefficients, and in the far-wake footprint. At low $\alpha$, the flow is strongly influenced by vortex roll-up from the pressure side at the trailing edge. The interaction of this large-scale structure with shear and three-dimensional modal instabilities in the separated shear layer and associated wake region on the suction side, explains the transitions and bifurcations of the the flow states as $\alpha$ increases. The transition from a separation at low $\alpha$ to reattachment and establishment of a laminar separation bubble at the trailing edge at critical $\alpha$ is driven by instabilities within the separated shear layer that are absent at lower angles. Instabilities of different wavelengths are then shown to pave the path to turbulence in the near wake.
Objectives/Goals: We investigated the risk of trauma in the form of fractures and traumatic brain injuries (TBIs) among Medicare beneficiaries with incident Parkinson’s disease (PD) age ≥67 compared to population-based controls. Secondarily, we examined the risk of death following a fracture in PD cases compared to controls. Methods/Study Population: We identified incident PD cases (N = 94,317) within a population-based sample of 2017 Medicare beneficiaries. Controls (N = 471,585) were matched 5:1 on month and year. We obtained claims data from 2017 to 2019 to follow cases and controls to identify new fractures treated in a hospital. Our primary outcome was any fracture. We also considered fracture type and TBI. We compared frailty level between cases and controls. We used logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between trauma and PD after adjusting for the following covariates: selected medical comorbidities, age, sex, race/ethnicity, smoking, and use of care. We used Cox regression to estimate hazard ratios (HRs) and 95% CI for trauma in cases compared to controls using the same covariates. Results/Anticipated Results: Compared to controls, PD patients who developed a fracture were more likely to have a history of falls (OR = 2.20, 95% CI 2.08–2.34) and difficulties in walking (OR = 2.66, 95% CI 2.50–2.82). Compared to controls with a fracture, PD patients with a fracture were more likely to be moderately frail (OR = 1.43, 95% CI 1.25–1.64). PD cases had a higher risk of all fracture types, including hip (OR = 1.93, 95% CI 1.85, 2.01), spine (OR = 1.90, 95% CI 1.79, 2.02), upper extremity (OR = 1.69, 95% CI 1.58–1.80), and other traumas such as a TBI (OR = 2.14, 95% CI 1.88–2.43). PD patients had greater mortality following a fracture (HR = 1.18, 95% CI 1.13–1.24) than controls. Discussion/Significance of Impact: The burden of trauma in the first two years immediately after PD diagnosis is high and warrants the initiation of early fall and fracture prevention strategies, in addition to aggressive treatment of PD symptoms by all providers caring for patients with PD.
Objectives/Goals: Micro-credentials (MCs) or digital badges are short programs designed to allow learners to gain knowledge and skills at their own pace to tailor their professional development. This study aims to examine the characteristics of learners completing MCs and explore their motivation for pursuing MCs through the University at Buffalo Clinical and Translational Science Institute (CTSI) program. Methods/Study Population: Currently, the CTSI offers five MCs in Effective Teaching, Good Clinical Practice, Responsible Research, Scientific Communication, and Translational Teamwork. Individuals who completed an MC (2019–2024) were identified by the UB Office of Micro-credentials. An invitation email and two reminders were sent to all individuals who received MCs asking them to complete a short online survey in July-August 2024. The survey included three questions about the type(s) of MCs completed, learners’ motivation for pursuing MCs, and perceived or actual benefits of completing an MC. The questions included multiple choice, select all that apply, and open-ended format, respectively. The survey was sent using Google Forms; data were analyzed using descriptive statistics. We received 25 completed surveys (29% response rate). Results/Anticipated Results: Since 2019, 85 individuals completed MCs at Buffalo CTSI including 21 faculty, 18 trainees, 26 students, and 20 staff. The most popular MC, Responsible Research (65% of completers), is based on the Responsible Conduct of Research series, which consists of modules on authorship ethics, ethical use of animals (IACUC) and human subjects (IRB), conflicts of interest/commitment, and responsible data acquisition and management. We found that 33% of responders were motivated to obtain the MC to advance their career and for professional development, 30% for lifelong learning, and 23% intended to use the badges to showcase their proficiency to potential employers. The greatest benefits reported were to obtain knowledge/skills for their professional career (46%) and improve their ability to receive research funding (14%). Discussion/Significance of Impact: Micro-credentials are valuable learning tools to stay current on changing research requirements, with ability to engage asynchronously. Badges also provide unique professional development opportunities for students and research workforce (staff and community stakeholders) who have limited resources (time and money).
Among inpatients, peer-comparison of prescribing metrics is challenging due to variation in patient-mix and prescribing by multiple providers daily. We established risk-adjusted provider-specific antibiotic prescribing metrics to allow peer-comparisons among hospitalists.
Methods:
Using clinical and billing data from inpatient encounters discharged from the Hospital Medicine Service between January 2020 through June 2021 at four acute care hospitals, we calculated bimonthly (every two months) days of therapy (DOT) for antibiotics attributed to specific providers based on patient billing dates. Ten patient-mix characteristics, including demographics, infectious disease diagnoses, and noninfectious comorbidities were considered as potential predictors of antibiotic prescribing. Using linear mixed models, we identified risk-adjusted models predicting the prescribing of three antibiotic groups: broad spectrum hospital-onset (BSHO), broad-spectrum community-acquired (BSCA), and anti-methicillin-resistant Staphylococcus aureus (Anti-MRSA) antibiotics. Provider-specific observed-to-expected ratios (OERs) were calculated to describe provider-level antibiotic prescribing trends over time.
Results:
Predictors of antibiotic prescribing varied for the three antibiotic groups across the four hospitals, commonly selected predictors included sepsis, COVID-19, pneumonia, urinary tract infection, malignancy, and age >65 years. OERs varied within each hospital, with medians of approximately 1 and a 75th percentile of approximately 1.25. The median OER demonstrated a downward trend for the Anti-MRSA group at two hospitals but remained relatively stable elsewhere. Instances of heightened antibiotic prescribing (OER >1.25) were identified in approximately 25% of the observed time-points across all four hospitals.
Conclusion:
Our findings indicate provider-specific benchmarking among inpatient providers is achievable and has potential utility as a valuable tool for inpatient stewardship efforts.
Viral hemorrhagic fevers (VHFs), such as Ebola virus disease, Marburg virus disease, and Lassa fever, are associated with significant morbidity and mortality and the potential for person-to-person transmission. While most individuals in whom VHF is suspected will ultimately be diagnosed with a non-VHF illness, such patients may present to any United States healthcare facility (HCF) for initial evaluation; therefore, all HCFs must be prepared to evaluate and initiate care for suspect VHF patients, especially if they are acutely ill. Included within this evaluation is the ability to perform basic routine laboratory testing before VHF-specific diagnostic test results are available, as well as rapid malaria testing to assess for a common, dangerous “VHF mimic.”
Objective:
To improve laboratory preparedness and readiness in the initial care of suspect VHF patients who may present to acute care hospitals.
Design:
Plan-Do-Study-Act quality improvement model.
Setting:
Frontline healthcare facilities and their clinical laboratories.
Methods:
We describe the development of a laboratory testing toolkit for a suspect VHF patient that can assist frontline HCFs in providing basic laboratory testing required for the care of these patients.
Results:
The toolkit provides guidance on infection prevention and control, waste management, occupational health, laboratory test collection, processing, and resulting, in the context of suspect VHF patient evaluation.
Conclusions:
The toolkit is designed to be readily adapted by any frontline HCF in the US. With the guidance provided, facilities will be able to support safer initial evaluation of VHF suspects and ensure high-quality patient care.
Seismic imaging in 3-D holds great potential for improving our understanding of ice sheet structure and dynamics. Conducting 3-D imaging in remote areas is simplified by using lightweight and logistically straightforward sources. We report results from controlled seismic source tests carried out near the West Antarctic Ice Sheet Divide investigating the characteristics of two types of surface seismic sources, Poulter shots and detonating cord, for use in both 2-D and 3-D seismic surveys on glaciers. Both source types produced strong basal P-wave and S-wave reflections and multiples recorded in three components. The Poulter shots had a higher amplitude for low frequencies (<10 Hz) and comparable amplitude at high frequencies (>50 Hz) relative to the detonating cord. Amplitudes, frequencies, speed of source set-up, and cost all suggested Poulter shots to be the preferred surface source compared to detonating cord for future 2-D and 3-D seismic surveys on glaciers.
In decision making regarding the management of vestibular schwannomas, alongside clinical outcomes, an understanding of patient reported health-related quality of life measures is key. Therefore, the aim of this research is to compare health-related quality of life in vestibular schwannoma patients treated with active observation, stereotactic radiotherapy and microsurgical excision.
Methods
A cross-sectional study of patients diagnosed with unilateral sporadic vestibular schwannomas between 1995 and 2015 at a specialist tertiary centre was conducted. Patients completed the Penn Acoustic Neuroma Quality of Life questionnaire and handicap inventories for dizziness, hearing and tinnitus.
Results
Of 234 patients, 136 responded (58.1 per cent). Management modality was: 86 observation, 23 stereotactic radiotherapy and 25 microsurgery. Females reported significantly worse dizziness; males reported significantly worse physical disability. Patients less than 65 years old reported significantly worse tinnitus and pain scores. Overall, quality of life was higher in the observation group.
Conclusion
Conservative management, where appropriate, is favourable with higher quality-of-life outcomes in this cohort. This must be weighed against the risks of a growing tumour.
Sensed data from high-value engineering systems is being increasingly exploited to optimise their operation and maintenance. In aerospace, returning all measured data to a central repository is prohibitively expensive, often causing useful, high-value data to be discarded. The ability to detect, prioritise and return useful data on asset and in real-time is vital to move toward more sustainable maintenance activities.
We present a data-driven solution for on-line detection and prioritisation of anomalous data that is centrally processed and used to update individualised digital twins (DT) distributed onto remote machines. The DT is embodied as a convolutional neural network (CNN) optimised for real-time execution on a resource constrained gas turbine monitoring computer. The CNN generates a state prediction with uncertainty, which is used as a metric to select informative data for transfer to a remote fleet monitoring system. The received data is screened for faults before updating the weights on the CNN, which are synchronised between real and virtual asset.
Results show the successful detection of a known in-flight engine fault and the collection of data related to high novelty pre-cursor events that were previously unrecognised. We demonstrate that data related to novel operation are also identified for transfer to the fleet monitoring system, allowing model improvement by retraining. In addition to these industrial dataset results, reproducible examples are provided for a public domain NASA dataset.
The data prioritisation solution is capable of running in real-time on production-standard low-power embedded hardware and is deployed on the Rolls-Royce Pearl 15 engines.
The Brunauer-Emmett-Teller (BET) theory models the effective specific surface area and water content of solids as a function of the relative vapor pressure of water. A modified form of the BET equation has been used successfully to model water activity in concentrated electrolyte solutions as a function of electrolyte concentration. This modified form, referred to here as the Stokes-Robinson BET model, is based on the electrolyte molality rather than on the mass of solute sorbed. The present study evaluates the Stokes-Robinson form of the BET equation to model water-sorption data on two smectites with different layer charges. One smectite was saturated with Na+ and another with Na+, Ca2+, or Mg2+. These results are compared to the Stokes-Robinson BET results of aqueous electrolyte solutions. Given published data on cation exchange capacities and water-vapor sorption isotherms for various clays, the molality of the aqueous phase in contact with the clay surface is calculated and related to water activity. The Stokes-Robinson BET model was found to describe accurately the water activity as a function of cation molality below water activities of 0.5 for the smectites. Good relative agreement was obtained between the number of water binding sites predicted by the model and the experimental data reported in the literature for other smectites. Water molecules were found to have a significantly greater affinity for montmorillonite than electrolyte solutions with the same cation molality as the montmorillonite interlayer. This modified BET approach simplifies water-activity modeling in highly saline environments because the same equation can be used for both the liquid- and mineral-surface phases.
This article provides an analysis of the potential danger to a president’s policy agenda that comes from appointing a sitting elected official to the cabinet. We present historical data on cabinet secretaries since the founding and demonstrate that concerns about seats falling to the other party following the appointment of an elected official to the cabinet date back at least to Martin Van Buren’s establishment of the first American mass political party in 1828. We then focus on the post-Seventeenth Amendment cabinet and show that almost 30 percent of cabinet secretaries in this era who were elected officials at the time of their appointment left seats that flipped to the other party by the next regular general election. We conclude by discussing how our results compare with Alexander Hamilton, Martin Van Buren, and Woodrow Wilson’s differing views on the cabinet and the implications for the president’s policy agenda.
People with mental disorders have worse physical health compared with the general population, which could be attributable to receiving poorer quality healthcare.
Aims
To examine the relationship between severe and common mental disorders and risk of emergency hospital admissions for ambulatory care sensitive conditions (ACSCs), and factors associated with increased risk.
Method
Baseline data for England (N = 445 814) were taken from UK Biobank, which recruited participants aged 37–73 years during 2006–2010, and linked to hospital admission records up to 31 December 2019. Participants were grouped into those with a history of either schizophrenia, bipolar disorder, depression or anxiety, or no mental disorder. Survival analysis was used to assess the risk of hospital admission for ACSCs among those with mental disorders compared with those without, adjusting for factors in different domains (sociodemographic, socioeconomic, health and biomarkers, health-related behaviours, social isolation and psychological).
Results
People with schizophrenia had the highest (unadjusted) risk of hospital admission for ACSCs compared with those with no mental disorder (hazard ratio 4.40, 95% CI 4.04–4.80). People with bipolar disorder (hazard ratio 2.48, 95% CI 2.28–2.69) and depression or anxiety (hazard ratio 1.76, 95% CI 1.73–1.80) also had higher risk. Associations were more conservative when including all admissions, as opposed to first admissions only. The observed associations persisted after adjusting for a range of factors.
Conclusions
People with severe mental disorders have the highest risk of preventable hospital admissions. Ensuring people with mental disorders receive adequate ambulatory care is essential to reduce the large health inequalities they experience.
The needs of young people attending mental healthcare can be complex and often span multiple domains (e.g., social, emotional and physical health factors). These factors often complicate treatment approaches and contribute to poorer outcomes in youth mental health. We aimed to identify how these factors interact over time by modelling the temporal dependencies between these transdiagnostic social, emotional and physical health factors among young people presenting for youth mental healthcare.
Methods
Dynamic Bayesian networks were used to examine the relationship between mental health factors across multiple domains (social and occupational function, self-harm and suicidality, alcohol and substance use, physical health and psychiatric syndromes) in a longitudinal cohort of 2663 young people accessing youth mental health services. Two networks were developed: (1) ‘initial network’, that shows the conditional dependencies between factors at first presentation, and a (2) ‘transition network’, how factors are dependent longitudinally.
Results
The ‘initial network’ identified that childhood disorders tend to precede adolescent depression which itself was associated with three distinct pathways or illness trajectories; (1) anxiety disorder; (2) bipolar disorder, manic-like experiences, circadian disturbances and psychosis-like experiences; (3) self-harm and suicidality to alcohol and substance use or functioning. The ‘transition network’ identified that over time social and occupational function had the largest effect on self-harm and suicidality, with direct effects on ideation (relative risk [RR], 1.79; CI, 1.59–1.99) and self-harm (RR, 1.32; CI, 1.22–1.41), and an indirect effect on attempts (RR, 2.10; CI, 1.69–2.50). Suicide ideation had a direct effect on future suicide attempts (RR, 4.37; CI, 3.28–5.43) and self-harm (RR, 2.78; CI, 2.55–3.01). Alcohol and substance use, physical health and psychiatric syndromes (e.g., depression and anxiety, at-risk mental states) were independent domains whereby all direct effects remained within each domain over time.
Conclusions
This study identified probable temporal dependencies between domains, which has causal interpretations, and therefore can provide insight into their differential role over the course of illness. This work identified social, emotional and physical health factors that may be important early intervention and prevention targets. Improving social and occupational function may be a critical target due to its impacts longitudinally on self-harm and suicidality. The conditional independence of alcohol and substance use supports the need for specific interventions to target these comorbidities.
The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery (WCPCCS) will be held in Washington DC, USA, from Saturday, 26 August, 2023 to Friday, 1 September, 2023, inclusive. The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery will be the largest and most comprehensive scientific meeting dedicated to paediatric and congenital cardiac care ever held. At the time of the writing of this manuscript, The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery has 5,037 registered attendees (and rising) from 117 countries, a truly diverse and international faculty of over 925 individuals from 89 countries, over 2,000 individual abstracts and poster presenters from 101 countries, and a Best Abstract Competition featuring 153 oral abstracts from 34 countries. For information about the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery, please visit the following website: [www.WCPCCS2023.org]. The purpose of this manuscript is to review the activities related to global health and advocacy that will occur at the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery.
Acknowledging the need for urgent change, we wanted to take the opportunity to bring a common voice to the global community and issue the Washington DC WCPCCS Call to Action on Addressing the Global Burden of Pediatric and Congenital Heart Diseases. A copy of this Washington DC WCPCCS Call to Action is provided in the Appendix of this manuscript. This Washington DC WCPCCS Call to Action is an initiative aimed at increasing awareness of the global burden, promoting the development of sustainable care systems, and improving access to high quality and equitable healthcare for children with heart disease as well as adults with congenital heart disease worldwide.
We develop a frame-invariant theory of material spike formation during flow separation over a no-slip boundary in three-dimensional flows with arbitrary time dependence. Based on the exact evolution of the largest principal curvature on near-wall material surfaces, our theory identifies fixed and moving separation. Our approach is effective over short time intervals and admits an instantaneous limit. As a byproduct, we derive explicit formulas for the evolution of the Weingarten map and the principal curvatures of any surface advected by general three-dimensional flows. The material backbone we identify acts first as a precursor and later as the centrepiece of Lagrangian flow separation. We discover previously undetected spiking points and curves where the separation backbones connect to the boundary and provide wall-based analytical formulas for their locations. We illustrate our results on several steady and unsteady flows.
The present study examines whether neuroticism is predicted by genetic vulnerability, summarized as polygenic risk score for neuroticism (PRSN), in interaction with bullying, parental bonding, and childhood adversity. Data were derived from a general population adolescent and young adult twin cohort. The final sample consisted of 202 monozygotic and 436 dizygotic twins and 319 twin pairs. The Short Eysenck Personality questionnaire was used to measure neuroticism. PRSN was trained on the results from the Genetics of Personality Consortium (GPC) and United Kingdom Biobank (UKB) cohorts, yielding two different PRSN. Multilevel mixed-effects models were used to analyze the main and interacting associations of PRSN, childhood adversity, bullying, and parental bonding style with neuroticism. We found no evidence of gene–environment correlation. PRSN thresholds of .005 and .2 were chosen, based on GPC and UKB datasets, respectively. After correction for confounders, all the individual variables were associated with the expression of neuroticism: both PRSN from GPC and UKB, childhood adversity, maternal bonding, paternal bonding, and bullying in primary school and secondary school. However, the results indicated no evidence for gene–environment interaction in this cohort. These results suggest that genetic vulnerability on the one hand and negative life events (childhood adversity and bullying) and positive life events (optimal parental bonding) on the other represent noninteracting pathways to neuroticism.
Neuroticism has societal, mental and physical health relevance, with an etiology involving genetic predisposition, psychological influence, and their interaction.
Objectives
To understand whether the association between polygenic risk score for neuroticism (PRS-N) and neuroticism is moderated by affective well-being.
Methods
Data were derived from TwinssCan, a general population twin cohort (age range=15-35 years, 478 monozygotic twins). Self-report questionnaires were used to measure well-being and neuroticism. PRS-N was trained from the Genetics of Personality Consortium (GPC) and United Kingdom Biobank (UKB). Multilevel mixed-effects models were used to test baseline and changes in well-being and neuroticism.
Results
Baseline wellbeing and neuroticism were associated (β=-1.35, p<0.001). PRSs-N were associated with baseline neuroticism (lowest p-value: 0.008 in GPC, 0.01 in UKB). In interaction models (PRS x wellbeing), GPC PRS-N (β=0.38, p=0.04) and UKB PRS-N (β=0.81, p<0.001) had significant interactions.
PRSs-N were associated with changes in neuroticism (lowest p-value: 0.03 in GPC, 0.3 in UKB). Furthermore, changes in wellbeing and neuroticism were associated (β =-0.66, p<0.001). In interaction models (PRS x change in wellbeing), only UKB PRS-N had a significant interaction (β=0.80, p<0.001).
Conclusions
Interaction between polygenic risk, wellbeing and neuroticism, were observed regarding baselines measures and change over time. Depending on the analysis step, the direction of the effect changed.
We present the third data release from the Parkes Pulsar Timing Array (PPTA) project. The release contains observations of 32 pulsars obtained using the 64-m Parkes ‘Murriyang’ radio telescope. The data span is up to 18 yr with a typical cadence of 3 weeks. This data release is formed by combining an updated version of our second data release with $\sim$3 yr of more recent data primarily obtained using an ultra-wide-bandwidth receiver system that operates between 704 and 4032 MHz. We provide calibrated pulse profiles, flux density dynamic spectra, pulse times of arrival, and initial pulsar timing models. We describe methods for processing such wide-bandwidth observations and compare this data release with our previous release.
Prior evidence suggests that men and women might be differentially susceptible to distinct types of childhood adversity (CA), but research on gender-specific associations between CA subtypes and psychiatric symptoms is limited.
Objectives
To test the gender-specific associations of CA subtypes and psychiatric symptoms in the general population.
Methods
Data from 791 twins and siblings from the TwinssCan project were used. Psychopathology and CA exposure were assessed using the Symptom Checklist-90 Revised (SCL-90) and the Childhood Trauma Questionnaire (CTQ), respectively. The associations between the total CTQ scores and SCL-90 scores (i.e. total SCL-90, psychoticism, paranoid ideation, anxiety, depression, somatization, obsessive-compulsive, interpersonal sensitivity, hostility, and phobic anxiety) were tested in men and women separately. The associations between the five CA subtypes (i.e. physical abuse, emotional abuse, sexual abuse, physical neglect, and emotional neglect) and total SCL-90 were tested in a mutually adjusted model. As exploratory analyses, the associations between all CA subtypes and the nine SCL-90 subdomain scores were similarly tested. The regression coefficients between men and women were compared using Chow’s test. All models were adjusted for age and family structure.
Results
Total CTQ was significantly associated with total SCL-90 in men (B = 0.013, SE = 0.003, P < .001) and women (B = 0.011, SE = 0.002, P < .001). The associations with the nine symptom domains were also significant in both genders (P < .001). No significant gender differences in the regression coefficients of total CTQ were detected. The analyses of CA subtypes showed a significant association between emotional abuse and total SCL-90 in women (B = 0.173, SE = 0.030, P < .001) and men (B = 0.080, SE = 0.035, P = .023), but the association was significantly stronger in women (ꭓ2(1) = 4.10, P = .043). The association of sexual abuse and total SCL-90 was only significant in women (B = 0.217, SE = 0.053, P < .001). The associations of emotional neglect (B = 0.061, SE = 0.027, P = .026) and physical neglect (B = 0.167, SE = 0.043, P < .001) with total SCL-90 were only significant in men. The explorative analyses of SCL-90 subdomains revealed significant associations of emotional abuse with all nine symptom domains and of sexual abuse with seven symptom domains in women. Significant associations of physical neglect with six symptom domains and of emotional neglect with depression were also detected in men. No other significant associations between CT subtypes and total SCL-90 or symptom domain scores were observed in men and women.
Conclusions
CA exposure was associated with diverse psychopathology similarly in both genders. However, women are more sensitive to abuse, but men are more sensitive to neglect. Gender-specific influences of CA subtypes on psychopathology should be considered in future studies.
This Position Statement provides guidelines to assist all health professionals who receive requests for carrier testing and laboratory staff conducting the tests.
In this Statement, the term ‘carrier testing’ refers to genetic testing in an individual to determine whether they have inherited a pathogenic variant associated with an autosomal or X-linked recessive condition previously identified in a blood relative. Carrier testing recommendations: (1) Carrier testing should only be performed with the individual’s knowledge and consent; (2) An individual considering (for themselves, or on behalf of another) whether to have a carrier test should be supported to make an informed decision; (3) The mode of inheritance, the individual’s personal experience with the condition, and the healthcare setting in which the test is being performed should be considered when determining whether carrier testing should be offered by a genetic health professional. Regarding children and young people: Unless there is direct medical benefit in the immediate future, the default position should be to postpone carrier testing until the child or young person can be supported to make an informed decision. There may be some specific situations where it is appropriate to facilitate carrier testing in children and young people (see section in this article). In such cases, testing should only be offered with pre- and post-test genetic counseling in which genetic health professionals and parents/guardians should explore the rationale for testing and the interests of the child and the family.
The fearful ape hypothesis proposes that heightened fearfulness in humans is adaptive. However, despite its attractive anthropocentric narrative, the evidence presented for greater fearfulness in humans versus other apes is not sufficient to support this claim. Conceptualization, context, and comparison are strongly lacking in Grossmann's proposal, but are key to understanding variation in the fear response among individuals and species.