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Racial disparities in healthcare have been well documented in the United States. We hypothesise that there will be a racial variance in different clinical variables in single-ventricle patients through stages of palliation.
Materials and Methods:
Retrospective single-centre study stratified all single-ventricle patients who reached stage 2 palliation by race: Black and White. Other races were excluded. Demographic and clinical characteristics were compared, alongside follow-up survival data. Primary outcomes were progression to Fontan and overall survival.
Results:
Among 526 patients, 325 (61.8%) were White, and 201 (38.2%) were Black. Median age at stage 2 palliation was 150 days for White and 165 for Black patients (p = 0.005), with similar weights. Black patients exhibited higher median cardiopulmonary bypass times (87 vs. 74 minutes, p = 0.001) and a greater frequency of genetic syndromes (30.1% vs. 22.1%, p = 0.044). No significant differences were observed in outcomes between groups from stage 2 to stage 3, pre-stage 3 cardiac catheterisation variables, or perioperative outcomes. Multivariable regression analysis identified hypoplastic pulmonary arteries as the risk factor for mortality after stage 2. Survival analysis showed no difference in survival by race; however, occurrence of combined cardiovascular event was significantly higher in Black race.
Conclusions:
Significant racial disparities exist among single-ventricle patients regarding the timing of stage 2 palliation, cardiopulmonary bypass duration, and frequency of genetic syndromes. Black race was a risk factor for sub-optimal long-term outcome, although perioperative mortality was similar. These race-related factors warrant further studies to improve our understanding of the impact of race on outcomes.
Detailed, precise information on a pharmaceutical’s projected therapeutic use is required for horizon scanning. Inferring an estimated indication from trial protocols is a key skill of horizon scanners. The International Horizon Scanning Initiative (IHSI) database utilizes semi-automated data collection. This pilot aimed to verify that the extraction of relevant word sets to generate an estimated indication could be semi-automated.
Methods
Ten drugs approved in Europe in 2021 were selected as the pilot test set. The test set included drugs approved for the treatment of rare diseases (n=4), haemato-oncology (n=3), and non-oncology conditions (n=3). Eight of the drugs were approved based on phase III trials. The assessment comprised a review of the pivotal trial that supported product registration for these drugs. We undertook a comparison between a human curator and a natural language processing (NLP) algorithm in generating granular tags relating to key aspects of the drugs’ estimated indication (stage of disease, patient-specific subgroup, and place in treatment).
Results
In 50 percent of cases, the NLP accurately tagged a word or word set related to stage of disease, patient-specific subgroup, or place in treatment, which was also tagged by human curators. In 50 percent of cases, the NLP did not identify words or word sets tagged by human curators. Where relevant, the NLP successfully tagged the same word sets relating to stage of disease for all drugs in the test set. The same word sets relating to patient-specific subgroup were successfully tagged for three drugs in the set. NLP successfully tagged word sets relating to place in treatment for two drugs.
Conclusions
The NLP algorithm is successful in extracting relevant word sets, which can be used to generate an estimated indication in an automated or semi-automated process. The pilot highlighted that further testing is required to advance the sensitivity of the algorithm. Further piloting exploring both unsupervised and supervised modeling approaches (named entity recognition and deep neural networks, respectively) is planned.
Detail on a technology’s projected therapeutic use is required for horizon scanning. The International Horizon Scanning Initiative (IHSI) database will utilize natural language processing (NLP) augmented by human curation to generate an estimated indication for technologies in development. We compared the estimated indication, generated as a test-set for NLP, with health technology developers’ (HTDs) proposed indications identified from Ireland’s horizon scanning system (HSS).
Methods
Eight oncology technologies common to both Ireland’s HSS and the IHSI database were analyzed. The analysis included unlicensed technologies in late-stage development that have not submitted a European marketing authorization application. Ireland’s HSS receives data on proposed indications for technologies from HTDs. IHSI database curators extract and convert terms from clinical trials into structured inputs (condition, combination therapy, stage of disease, place in treatment, patient/disease-specific subgroups) to produce an estimated indication for a technology. We sought to identify, by structured input, the degree of alignment between HTDs’ proposed indications with the IHSI database’s estimated indication.
Results
There was 100 percent alignment between the HTD’s proposed indication and the estimated indication generated in the IHSI database for five of the eight included technology records. There was 83 percent alignment for two records and 67 percent alignment for one record. Across all records there was full alignment on condition, combination therapy details, patient-specific subgroup, disease-specific subgroup, and place in treatment. Stage of disease was the only element where data was either not generated for the IHSI database’s estimated indication, not aligned with the HTD’s proposed indication, or reported in an incorrect field.
Conclusions
There is a high degree of alignment between an HTD-proposed indication and the IHSI-estimated indication. The processes for generating an estimated indication will involve both NLP-generation and human co-curation. The current (curator-selected) elements are being used to train the NLP engine. Thereafter, the engine will process clinical trial data to surface tags for human selection to generate the structured inputs.
Motor neuron disease (MND) is a progressive, fatal, neurodegenerative condition that affects motor neurons in the brain and spinal cord, resulting in loss of the ability to move, speak, swallow and breathe. Acceptance and commitment therapy (ACT) is an acceptance-based behavioural therapy that may be particularly beneficial for people living with MND (plwMND). This qualitative study aimed to explore plwMND’s experiences of receiving adapted ACT, tailored to their specific needs, and therapists’ experiences of delivering it.
Method:
Semi-structured qualitative interviews were conducted with plwMND who had received up to eight 1:1 sessions of adapted ACT and therapists who had delivered it within an uncontrolled feasibility study. Interviews explored experiences of ACT and how it could be optimised for plwMND. Interviews were audio recorded, transcribed and analysed using framework analysis.
Results:
Participants were 14 plwMND and 11 therapists. Data were coded into four over-arching themes: (i) an appropriate tool to navigate the disease course; (ii) the value of therapy outweighing the challenges; (iii) relevance to the individual; and (iv) involving others. These themes highlighted that ACT was perceived to be acceptable by plwMND and therapists, and many participants reported or anticipated beneficial outcomes in the future, despite some therapeutic challenges. They also highlighted how individual factors can influence experiences of ACT, and the potential benefit of involving others in therapy.
Conclusions:
Qualitative data supported the acceptability of ACT for plwMND. Future research and clinical practice should address expectations and personal relevance of ACT to optimise its delivery to plwMND.
Key learning aims
(1) To understand the views of people living with motor neuron disease (plwMND) and therapists on acceptance and commitment therapy (ACT) for people living with this condition.
(2) To understand the facilitators of and barriers to ACT for plwMND.
(3) To learn whether ACT that has been tailored to meet the specific needs of plwMND needs to be further adapted to potentially increase its acceptability to this population.
The Classic Maya polities of Baking Pot and Lower Dover developed along two dramatically different trajectories. At Baking Pot, the capital and associated apical elite regime grew concomitantly with surrounding populations over a thousand-year period. The smaller polity of Lower Dover, in contrast, formed when a Late Classic political center was established by an emergent apical elite regime amidst several long-established intermediate elite-headed districts. The different trajectories through which these polities formed should have clear implications for residential size variability. We employ the Gini coefficient to measure variability in household volume to compare patterns of residential size differentiation between the two polities. The Gini coefficients, while similar, suggest greater differentiation in residential size at Baking Pot than at Lower Dover, likely related to the centralized control of labor by the ruling elite at Baking Pot. While the Gini coefficient is synonymous with measuring wealth inequalities, we suggest that in the Classic period Belize River Valley, residential size was more reflective of labor control.
Being a form of labor investment, house size is frequently analyzed as an index of socioeconomic inequality. However, datasets that lack wide-ranging residential stratigraphic information are not reliable sources of labor investment estimates. This is the case for Late Classic domestic architecture data from three polities in the Rosario Valley (modern-day Chiapas) on the southwest Maya frontier: Rosario, Ojo de Agua, and Los Encuentros. Although the sample's house size inequality generally cannot index period-specific labor investment, it may signify prestige differentiation. For each polity we generated Lorenz curves and calculated Gini coefficients for five variables representing house size (area and volume). Results resemble inequality data from lowland Classic Maya centers. We also demonstrate that the smallest, shortest-lived polity had more equal house size values, likely due to the modesty of its apical elite architecture. In contrast, the two larger, older polities were more unequal because they had substantial palaces.
From the safety inside vehicles, Knowsley Safari offers visitors a close-up encounter with captive olive baboons. As exiting vehicles may be contaminated with baboon stool, a comprehensive coprological inspection was conducted to address public health concerns. Baboon stools were obtained from vehicles, and sleeping areas, inclusive of video analysis of baboon–vehicle interactions. A purposely selected 4-day sampling period enabled comparative inspections of 2662 vehicles, with a total of 669 baboon stools examined (371 from vehicles and 298 from sleeping areas). As informed by our pilot study, front-line diagnostic methods were: QUIK-CHEK rapid diagnostic test (RDT) (Giardia and Cryptosporidium), Kato–Katz coproscopy (Trichuris) and charcoal culture (Strongyloides). Some 13.9% of vehicles were contaminated with baboon stool. Prevalence of giardiasis was 37.4% while cryptosporidiosis was <0.01%, however, an absence of faecal cysts by quality control coproscopy, alongside lower than the expected levels of Giardia-specific DNA, judged RDT results as misleading, grossly overestimating prevalence. Prevalence of trichuriasis was 48.0% and strongyloidiasis was 13.7%, a first report of Strongyloides fuelleborni in UK. We advise regular blanket administration(s) of anthelminthics to the colony, exploring pour-on formulations, thereafter, smaller-scale indicator surveys would be adequate.
Recent excavations at the ancient Maya minor center of Tutu Uitz Na in the Belize River Valley revealed an especially large—about 20 million shells—Middle Preclassic (900–300 BC) shell deposit underlying the plaza. Although marine shell species make up a small percentage of the assemblage, most shells are Pachychilus spp., a common freshwater snail known in the southern Maya Lowlands as jute. This report describes the architectural context and assemblage of the deposit and compares it to similar examples in the region. We propose that the Tutu Uitz Na deposit provides one of the earliest examples of depictions of the Maya primordial sea in an architectural context.
The objective of this research was to evaluate managed access policy in England, drawing upon the expertise of a range of stakeholders involved in its implementation.
Methods
Seven focus groups were conducted with payer and health technology assessment representatives, clinicians, and representatives from industry and patient/carer organizations within England. Transcripts were analyzed using framework analysis to identify stakeholders’ views on the successes and challenges of managed access policy.
Results
Stakeholders discussed the many aims of managed access within the National Health Service in England, and how competing aims had affected decision making. While stakeholders highlighted a number of priorities within eligibility criteria for managed access agreements (MAAs), stakeholders agreed that strict eligibility criteria would be challenging to implement due to the highly variable nature of innovative technologies and their indications. Participants highlighted challenges faced with implementing MAAs, including evidence generation, supporting patients during and after the end of MAAs, and agreeing and reinforcing contractual agreements with industry.
Conclusions
Managed access is one strategy that can be used by payers to resolve uncertainty for innovative technologies that present challenges for reimbursement and can also deliver earlier access to promising technologies for patients. However, participants cautioned that managed access is not a “silver bullet,” and there is a need for greater clarity about the aims of managed access and how these should be prioritized in decision making. Discussions between key stakeholders involved in managed access identified challenges with implementing MAAs and these experiences should be used to inform future managed access policy.
Bustards comprise a highly threatened family of birds and, being relatively fast, heavy fliers with very limited frontal visual fields, are particularly susceptible to mortality at powerlines. These infrastructures can also displace them from immediately adjacent habitat and act as barriers, fragmenting their ranges. With geographically ever wider energy transmission and distribution grids, the powerline threat to bustards is constantly growing. Reviewing the published and unpublished literature up to January 2021, we found 2,774 records of bustard collision with powerlines, involving 14 species. Some studies associate powerline collisions with population declines. To avoid mortalities, the most effective solution is to bury the lines; otherwise they should be either routed away from bustard-frequented areas, or made redundant by local energy generation. When possible, new lines should run parallel to existing structures and wires should preferably be as low and thick as possible, with minimal conductor obstruction of vertical airspace, although it should be noted that these measures require additional testing. A review of studies finds limited evidence that ‘bird flight diverters’ (BFDs; devices fitted to wires to induce evasive action) achieve significant reductions in mortality for some bustard species. Nevertheless, dynamic BFDs are preferable to static ones as they are thought to perform more effectively. Rigorous evaluation of powerline mortalities, and effectiveness of mitigation measures, need systematic carcass surveys and bias corrections. Whenever feasible, assessments of displacement and barrier effects should be undertaken. Following best practice guidelines proposed with this review paper to monitor impacts and mitigation could help build a reliable body of evidence on best ways to prevent bustard mortality at powerlines. Research should focus on validating mitigation measures and quantifying, particularly for threatened bustards, the population effects of powerline grids at the national scale, to account for cumulative impacts on bustards and establish an equitable basis for compensation measures.
This article builds on Richards’s work to formulate an understanding of the emerging practice of performance-installation, which embraces sound art, DIY electronic music and maker culture. A number of key points are addressed in this formulation: making/unmaking and ‘public making’; the assembling/disassembling of sonic devices and artefacts in the performance space; sound ‘through’ materials and materials at hand; and site and architectural features as material. In addition, readymade actions, illustrated by George Brecht’s The Cabinet, and the relationship between audience and performer are also presented. The article continues by outlining practice undertaken by the authors comprising two UK tours: ‘Sacrificial Floors’, 2018 with Tetsuya Umeda; and ‘Points of Failure’, 2020. Derek Bailey’s idea of ‘instrumental impulse’ is extended to include the concepts of expanded and reduced instruments that encompass ‘instrument as object’ and ‘raw material as instrument’. ‘Instrument’ is also viewed as a distributed mesh-like structure in which collective improvisation may occur. Borrowing from Ingold, ‘wayfaring’ is used to describe improvising with materials found ‘along the way’. Silent actions, uncontrollable instruments, unstable systems, performative failures, reimagined affordance of objects, ‘playing with resource’ and ‘improvising inside electronics’ are all addressed in relation to performance-installation. Finally, the authors explore the idea of ‘virtuosity in listening’, and question sonic autonomy and self-expression in improvisation and how ‘attending to sound’ can be an active part of improvised performance.
We analyse the stability of the interface between two immiscible fluids both flowing in the horizontal direction in a thin cell with vertically varying gap width. The dispersion relation for the growth rate of each mode is derived. The stability is approximately determined by the sign of a simple expression, which incorporates the density difference between the fluids and the effect of surface tension in the along- and cross-cell directions. The latter arises from the varying channel width: if the non-wetting fluid is in the thinner part of the channel, the interface is unstable as it will preferentially migrate into the thicker part. The density difference may suppress or complement this effect. The system is always stable to sufficiently large wavenumbers owing to the along-flow component of surface tension.
A chloroacetamide herbicide by application timing factorial experiment was conducted in 2017 and 2018 in Mississippi to investigate chloroacetamide use in a dicamba-based Palmer amaranth management program in cotton production. Herbicides used were S-metolachlor or acetochlor, and application timings were preemergence, preemergence followed by (fb) early postemergence, preemergence fb late postemergence, early postemergence alone, late postemergence alone, and early postemergence fb late postemergence. Dicamba was included in all preemergence applications, and dicamba plus glyphosate was included with all postemergence applications. Differences in cotton and weed response due to chloroacetamide type were minimal, and cotton injury at 14 d after late postemergence application was less than 10% for all application timings. Late-season weed control was reduced up to 30% and 53% if chloroacetamide application occurred preemergence or late postemergence only, respectively. Late-season weed densities were minimized if multiple applications were used instead of a single application. Cotton height was reduced by up to 23% if a single application was made late postemergence relative to other application timings. Chloroacetamide application at any timing except preemergence alone minimized late-season weed biomass. Yield was maximized by any treatment involving multiple applications or early postemergence alone, whereas applications preemergence or late postemergence alone resulted in up to 56% and 27% yield losses, respectively. While no yield loss was reported by delaying the first of sequential applications until early postemergence, forgoing a preemergence application is not advisable given the multiple factors that may delay timely postemergence applications such as inclement weather.
Poor physical health in severe mental illness (SMI) remains a major issue for clinical practice.
Aims
To use electronic health records of routinely collected clinical data to determine levels of screening for cardiometabolic disease and adverse health outcomes in a large sample (n = 7718) of patients with SMI, predominantly schizophrenia and bipolar disorder.
Method
We linked data from the Glasgow Psychosis Clinical Information System (PsyCIS) to morbidity records, routine blood results and prescribing data.
Results
There was no record of routine blood monitoring during the preceding 2 years for 16.9% of the cohort. However, monitoring was poorer for male patients, younger patients aged 16–44, those with schizophrenia, and for tests of cholesterol, triglyceride and glycosylated haemoglobin. We estimated that 8.0% of participants had diabetes and that lipids levels, and use of lipid-lowering medication, was generally high.
Conclusions
Electronic record linkage identified poor health screening and adverse health outcomes in this vulnerable patient group. This approach can inform the design of future interventions and health policy.
Building on prior work using Tom Dishion's Family Check-Up, the current article examined intervention effects on dysregulated irritability in early childhood. Dysregulated irritability, defined as reactive and intense response to frustration, and prolonged angry mood, is an ideal marker of neurodevelopmental vulnerability to later psychopathology because it is a transdiagnostic indicator of decrements in self-regulation that are measurable in the first years of life that have lifelong implications for health and disease. This study is perhaps the first randomized trial to examine the direct effects of an evidence- and family-based intervention, the Family Check-Up (FCU), on irritability in early childhood and the effects of reductions in irritability on later risk of child internalizing and externalizing symptomatology. Data from the geographically and sociodemographically diverse multisite Early Steps randomized prevention trial were used. Path modeling revealed intervention effects on irritability at age 4, which predicted lower externalizing and internalizing symptoms at age 10.5. Results indicate that family-based programs initiated in early childhood can reduce early childhood irritability and later risk for psychopathology. This holds promise for earlier identification and prevention approaches that target transdiagnostic pathways. Implications for future basic and prevention research are discussed.
To assess if there is a difference in salt intake (24 h urine collection and dietary recall) and dietary sources of salt (Na) on weekdays and weekend days.
Design
A cross-sectional study of adults who provided one 24 h urine collection and one telephone-administered 24 h dietary recall.
Setting
Community-dwelling adults living in the State of Victoria, Australia.
Subjects
Adults (n 598) who participated in a health survey (53·5 % women; mean age 57·1 (95 % CI 56·2, 58·1) years).
Results
Mean (95 % CI) salt intake (dietary recall) was 6·8 (6·6, 7·1) g/d and 24 h urinary salt excretion was 8·1 (7·8, 8·3) g/d. Mean dietary and 24 h urinary salt (age-adjusted) were 0·9 (0·1, 1·6) g/d (P=0·024) and 0·8 (0·3, 1·6) g/d (P=0·0017), respectively, higher at weekends compared with weekdays. There was an indication of a greater energy intake at weekends (+0·6 (0·02, 1·2) MJ/d, P=0·06), but no difference in Na density (weekday: 291 (279, 304) mg/MJ; weekend: 304 (281, 327) mg/MJ; P=0·360). Cereals/cereal products and dishes, meat, poultry, milk products and gravy/sauces accounted for 71 % of dietary Na.
Conclusions
Mean salt intake (24 h urine collection) was more than 60 % above the recommended level of 5 g salt/d and 8–14 % more salt was consumed at weekends than on weekdays. Substantial reductions in the Na content of staple foods, processed meat, sauces, mixed dishes (e.g. pasta), convenience and takeaway foods are required to achieve a significant consistent reduction in population salt intake throughout the week.
Fatigue cracking in polycrystalline NiTi was investigated using a multiscale experimental framework for average grain sizes (GS) from 10 to 1500 nm for the first time. Macroscopic fatigue crack growth rates, measured by optical digital image correlation, were connected to microscopic crack opening and closing displacements, measured by scanning electron microscope DIC (SEM-DIC) using a high-precision external SEM scan controller. Among all grain sizes, the 1500 nm GS sample exhibited the slowest crack growth rate at the macroscale, and the largest crack opening level (stress intensity at first crack opening) and minimum crack opening displacements at the microscale. Smaller GS samples (10, 18, 42, and 80 nm) exhibited nonmonotonic trends in their fatigue performance, yet the correlation was strong between macroscale and microscale behaviors for each GS. The samples that exhibited the fastest crack growth rates (42 and 80 nm GS) showed a small crack opening level and the largest crack opening displacements. The irregular trends in fatigue performance across the nanocrystalline GS samples were consistent with nonmonotonic values in the elastic modulus reported previously, both of which may be related to the presence of residual martensite only evident in the small GS samples (10 and 18 nm).
We analyse the displacement of one fluid by a second immiscible fluid through a narrow channel of finite length which connects two reservoirs. We assume that the channel width slowly decreases in the direction of flow, and that the fluids have different viscosity and density. We examine the stability of the interface and find that there are Saffman–Taylor and Rayleigh–Taylor type modes, which may dominate in the narrow and wide regions of the channel, respectively. The gradient of the pressure jump across the interface associated with the surface tension acts to stabilise the interface, and for intermediate channel widths, this effect may dominate the destabilisation associated with both the Rayleigh–Taylor and Saffman–Taylor instabilities, provided the rate of change of the channel width with distance along the channel is sufficient. We also note that the effect of the converging channel leads to instability of long-wavelength modes owing to the quasi-static acceleration of the flow through the cell: we consider cases in which this effect only occurs at much lower wavenumbers than the most unstable Saffman–Taylor and Rayleigh–Taylor modes. We show that there is a maximum wavenumber for instability, which varies with position in the channel. By integrating the growth rate of each wavenumber in time as the interface moves across the channel, we predict the mode which grows to the greatest amplitude as the interface traverses the channel.