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The late-acquired French subjunctive–indicative contrast conveys important information about event realization and is characterized by bound morphology, form ambiguity, contextual restrictedness, and the infrequency of the subjunctive. This study contributes underrepresented adverbial-clause interpretation data and incorporates lexical effects to extend what is known about why French mood is late-acquired. We assess interpretation of four adverbial conjunctions which primarily co-occur with subjunctive or indicative mood in corpus searches. Analysis of 77 participants revealed a statistically significant interaction between mood and proficiency, with more proficient learners affected by mood, whereas clause order influenced less proficient learners. Moreover, lower-proficiency learners treated adverbs within a particular class of co-occurrence more similarly across the 32 items than our advanced learners or native speakers, who were sensitive to lexical effects, attributable to the roles of frequency and semantics. The study contributes to the growing body of research on late-acquired structures, for which learners attend to evolving cues across acquisitional trajectories.
Debate surrounds the early peopling of the Arabian Peninsula. The first evidence of the Levallois lithic technology in the Huqf area of south-eastern Arabia now extends the Middle Palaeolithic record of hominin activity into central Oman and helps to diversify the picture of Arabian prehistory.
Paediatric cardiac electrophysiologists are essential in CHD inpatient care, but their involvement is typically limited to consultation with individual patients. In our integrated heart centre, an electrophysiologist reviews all cardiac inpatient telemetry over the preceding 24 hours and participates in daily multidisciplinary morning report. This study investigates the impact of the strategy of consistent, formalised electrophysiologist presence at multidisciplinary morning report.
Methods:
This is a single-centre, prospective, observational study of electrophysiologist participation in patient encounters during heart centre multidisciplinary morning report from 10/20/2021 to 10/31/2022. Multidisciplinary morning report includes discussion of all intensive care and non-intensive care cardiac patients. An encounter was defined as reporting on one patient for one day. Electrophysiologists were initially blinded to observations.
Results:
Two electrophysiologists were observed over 215 days encompassing 6413 patient encounters. Electrophysiologists made comments on 581(9.1%) encounters in 234 unique patients with diverse diagnoses, equating to a median of 3[interquartile range:1–4] encounters per day. These included identifications of arrhythmias and describing electrocardiographic findings. Recommendation to change management occurred in 282(48.5%) encounters, most commonly regarding medications (n = 142, 24.4%) or pacemaker management (n = 48, 8.3%). Of the 581 encounters, there were 61(10.5%) in which they corrected another physician’s interpretation of rhythm or electrocardiogram.
Conclusion:
Routine electrophysiologist involvement in multidisciplinary morning report provides significant, frequent, and timely input in patient management by identifying precise rhythm-related diagnoses and allowing nuanced, patient-specific medication and pacemaker management of all cardiac patients, not just those consulted. Electrophysiologist presence at multidisciplinary morning report is a vital resource and this practice should be considered at integrated paediatric cardiac centres.
Engaging patients, caregivers, and other stakeholders to help guide the research process is a cornerstone of patient-centered research. Lived expertise may help ensure the relevance of research questions, promote practices that are satisfactory to research participants, improve transparency, and assist with disseminating findings.
Methods:
Traditionally engagement has been conducted face-to-face in the local communities in which research operates. Decentralized platform trials pose new challenges for the practice of engagement. We used a remote model for stakeholder engagement, relying on Zoom meetings and blog communications.
Results:
Here we describe the approach used for research partnership with patients, caregivers, and clinicians in the planning and oversight of the ACTIV-6 trial and the impact of this work. We also present suggestions for future remote engagement.
Conclusions:
The ACTIV-6 experience may inform proposed strategies for future engagement in decentralized trials.
OBJECTIVES/GOALS: Accurate classification of disorders of consciousness (DoC) is key in developing rehabilitation plans following brain injury. The Coma Recovery Scale-Revised (CRS-R) is a sensitive measure of consciousness. We explore feasibility, safety and impact of CRS-R guided rehab in hemorrhagic stroke patients with DoC and evaluate predictors of recovery. METHODS/STUDY POPULATION: Consecutive patients with non-traumatic hemorrhagic stroke, defined as subarachnoid hemorrhage (SAH) or intracerebral hemorrhage (ICH), receiving serial CRS-R assessments during their ICU stay at University of Maryland Medical Center from 2017-2021 were retrospectively identified. Outcomes of interest included the association with CRS-R and discharge disposition, therapy-based function and mobility and occurrence of safety events during CRS assessment. We also examined the association between CRS-R and physiological and anatomical injury pattern on electroencephalography (EEG) and magnetic resonance imaging (MRI), respectively. CRS-R RESULTS/ANTICIPATED RESULTS: 76 patients with≥2 CRS-R assessments were identified (22 SAH, 54 ICH, median age = 59, 50% female). Median CRS-R completed was 3 with no SAEs identified during sessions. We identified 4 patterns: persistent VS/UWS (49%), persistent MCS or better (13%), emergence from VS/UWS to MCS or better (27%) and regression from MCS or better to VS/UWS (11%). Persistent low CRS-R correlated with older age in SAH (p=0.01), female gender in ICH (p=0.04), and history of diabetes (p=0.01). 2% of patients with final CRS-R DISCUSSION/SIGNIFICANCE: Early neurorehabilitation guided by CRS-R appears to be feasible and safe acutely following hemorrhagic stroke complicated by prolonged DoC and may enhance access to inpatient rehabilitation with a lasting benefit on recovery. Further characterization of DoC patterns and their correlation to clinical markers, including EEG and MRI is needed.
Until recently, the influence of basal liquid water on the evolution of buried glaciers in Mars' mid latitudes was assumed to be negligible because the latter stages of Mars' Amazonian period (3 Ga to present) have long been thought to have been similarly cold and dry to today. Recent identifications of several landforms interpreted as eskers associated with these young (100s Ma) glaciers calls this assumption into doubt. They indicate basal melting (at least locally and transiently) of their parent glaciers. Although rare, they demonstrate a more complex mid-to-late Amazonian environment than was previously understood. Here, we discuss several open questions posed by the existence of glacier-linked eskers on Mars, including on their global-scale abundance and distribution, the drivers and dynamics of melting and drainage, and the fate of meltwater upon reaching the ice margin. Such questions provide rich opportunities for collaboration between the Mars and Earth cryosphere research communities.
On January 29, 2020, a total of 195 US citizens were evacuated from the coronavirus disease 2019 (COVID-19) epidemic in Wuhan, China, to March Air Reserve Base in Riverside, California, and entered the first federally mandated quarantine in over 50 years. With less than 1-d notice, a multi-disciplinary team from Riverside County and Riverside University Health System in conjunction with local and federal agencies established on-site 24-h medical care and behavioral health support. This report details the coordinated efforts by multiple teams that took place to provide care for the passengers and to support the surrounding community.
To detect modest associations of dietary intake with disease risk, observational studies need to be large and control for moderate measurement errors. The reproducibility of dietary intakes of macronutrients, food groups and dietary patterns (vegetarian and Mediterranean) was assessed in adults in the UK Biobank study on up to five occasions using a web-based 24-h dietary assessment (n 211 050), and using short FFQ recorded at baseline (n 502 655) and after 4 years (n 20 346). When the means of two 24-h assessments were used, the intra-class correlation coefficients (ICC) for macronutrients varied from 0·63 for alcohol to 0·36 for polyunsaturated fat. The ICC for food groups also varied from 0·68 for fruit to 0·18 for fish. The ICC for the FFQ varied from 0·66 for meat and fruit to 0·48 for bread and cereals. The reproducibility was higher for vegetarian status (κ > 0·80) than for the Mediterranean dietary pattern (ICC = 0·45). Overall, the reproducibility of pairs of 24-h dietary assessments and single FFQ used in the UK Biobank were comparable with results of previous prospective studies using conventional methods. Analyses of diet–disease relationships need to correct for both measurement error and within-person variability in dietary intake in order to reliably assess any such associations with disease in the UK Biobank.
Many fossil assemblages are time-averaged, with multiple generations of organisms mixed into a single stratigraphic horizon. A time-averaged sample of a taxon should be more variable than a single-generation sample if enough morphologic change occurred during the interval of time-averaging. Time-averaging may also alter correlations between morphologic variables and obscure allometric relationships in an evolving population. To investigate these issues, we estimated the variability of six modern, single-generation samples of the bivalve Mercenaria campechiensis using Procrustes analysis and compared them with several time-averaged Pleistocene samples of M. campechiensis and M. permagna. Both the modern and the fossil samples ranged in variability, but these ranges were virtually identical. Morphology was quite stable over the hundreds to many thousands of years that passed as the assemblages accumulated, and the variabilities of the fossil samples could be used to estimate single-generation variability. At one fossil locality, the environment and paleocommunity changed partway through the collection interval; the morphology of Mercenaria appears stable above and below the transition but changes across it. This change is similar in magnitude to the differences between geographically separated modern populations, whereas temporal variation within single environmental settings is distinctly less than geographic variation. Analytical time-averaging (the mixing of fossils from different horizons) between paleocommunities increased variability slightly (but not significantly) above that found in living populations. While its constituent populations appear stable on millennial timescales, M. campechiensis has been evolutionarily static since at least the early to middle Pleistocene.
vascular dementia (VaD) and mixed Alzheimer's disease (AD/VaD) are common. How best to monitor treatment is not clear. Our objective was to compare responsiveness and construct validity of change scores, following donepezil treatment, of the standardized Mini-Mental State Examination (sMMSE) and other measures potentially usable in primary care.
Methods:
A six-month, outcome measurement study. The Disability Assessment for Dementia (DAD), CLOX-1 and 2, Phonetic Fluency, a short Neuropsychiatric Inventory, (the NPI-Q), Clinical Global Impression (CGI) and the SymptomGuide™ (SG) were measured. Construct validity was tested by correlating change scores, and responsiveness by calculating standardized response means (SRMs).
Results:
Of 148 treated patients, 116 completed. The mean sMMSE increased by 0.7 (95% Confidence Interval (CI) = -0.005, 1.41; p=0.06; SRM= 0.15). There was no statistically significant difference in the DAD. The NPI-Q (-1.4; 95% CI = -2.08, -0.72; p<0.01; SRM=0.24), ClOX-1 (0.9; 95% CI = 0.19, 1.61; p<0.01; SRM=0.21), ClOX-2 (0.9; 95% CI = 0.17, 1.63; p=0.03; SRM=0.26), Phonetic Fluency (0.9; 95% CI = 0.19, 1.61; p=0.02; SRM=0.21) and SG (0.35; 95% CI = 0.20,0.51; p<0.01; SRM=0.28) each detected significant improvement. The CGI suggested improvement in 74 completers (64%) - mostly “minimal” (44/116, 38%) - while 21/116 (18%) were worse. Change scores at 24 weeks were at best modestly correlated with each other (range -0.22 to 0.30).
Discussion:
Different measures showed different responsiveness, in a setting in which the mean treatment effect seems to have been small, but clinically detectable. Patient-centered and executive function measures might be useful in vascular and mixed dementia.
By the middle of the nineteenth century, culture was often considered to be nothing but a meaningless 'smattering of Latin and Greek'. In this work, first published in 1869, Matthew Arnold (1822–88) redefines culture as a striving for 'the best that has been thought or said', and as a contrast to 'philistinism' and the over-valuation of the practical. Critical of the uninspiring lifestyles of many of his religious and non-religious contemporaries, he raises the controversial issue of how to lead a good life, aesthetically, intellectually and morally. He introduces a middle road between classical and Judaeo-Christian ideals ('Hellenism' and 'Hebraism') which promotes the state over the individual, a position that has often prompted his critics to consider him an authoritarian thinker. A fascinating piece of social and political criticism, and an adjunct to Arnold's poetry, this work was both controversial when it was first published, and enormously influential thereafter.
Blister-actuated laser-induced forward transfer (BA-LIFT) is a versatile printing technique in which fine jets of ink are ejected from a thin donor film onto an acceptor substrate, enabling high-resolution patterns to be formed. Fluid ejections are initiated by the rapid expansion of micrometre-sized blisters that form on a polymer film underneath the ink layer. Recent work has demonstrated that these ejections exhibit novel flow phenomena due to the unique dimensions and geometry of the BA-LIFT configuration. In this work, we study the dynamics of BA-LIFT printing using a computational model in which fluid is forced by a boundary that deforms according to experimental time-resolved measurements of an expanding blister profile. This allows the model’s predictions to be unambiguously correlated with experimental blister-actuated ejections without any fitting parameters. First, we validate the model’s predictive capabilities against experimental results, including the ability to accurately reproduce the size, shape and temporal evolution of the jet as well as the total volume of ink released. The validated model is then used to interrogate the flow dynamics in order to better understand the mechanisms for fluid ejection. Finally, parametric studies are conducted to investigate the influence of ink density, surface tension, viscosity and film thickness as well as the size of the blister used. These results provide key insights into avenues for optimization and better control of the BA-LIFT process for improved resolution and repeatability of the printed features.
Matthew Arnold's Culture and Anarchy (1869) is one of the most celebrated works of social criticism ever written. It has become an inescapable reference-point for all subsequent discussion of the relations between politics and culture, and it has exercised a profound influence both on conceptions of the distinctive nature of British society, and on ideas about education and the teaching of literature more generally. This edition establishes the authoritative text of this much-revised work, and places it alongside Arnold's three most important essays on political subjects - Democracy, Equality, and The Function of Criticism at the Present Time. The editor's substantial introduction situates these works in the context both of Arnold's life and other writings, and of nineteenth-century intellectual and political history. This edition also contains a chronology of Arnold's life, a bibliographical guide and full notes on the names, books, and historical events mentioned in the texts.
The Expanded Disability Status Scale (EDSS) represents the most widely accepted measure of disease progression in multiple sclerosis (MS), and is used in many natural history studies. This chapter discusses natural history of relapsing onset MS, primary progressive MS, changes in natural history and impact on clinical trial design, traditional prognostic factors, and other factors which may influence prognosis such as race, comorbid diseases, and health behaviors. Pharmacoepidemiological studies using real world data derived from clinical practice represent a cost-effective means of evaluating the long-term effectiveness of immunomodulatory drug treatments for MS. Along with evidence from the basic sciences, epidemiological studies can provide insights into potentially novel treatments, as well as the rationale and hypotheses for testing these treatments in clinical trials. For example, vitamin D and estrogen are being evaluated in clinical trials based partly on epidemiological observations. Heterogeneity remains the hallmark of MS.
Blister-actuated laser-induced forward transfer (BA-LIFT) is a direct-write technique, which enables high-resolution printing of sensitive inks for electronic or biological applications. During BA-LIFT, a polymer laser-absorbing layer deforms into an enclosed blister and ejects ink from an adjacent donor film. In this work, we develop a finite element model to replicate and predict blister expansion dynamics during BA-LIFT. Model inputs consist of standard mechanical properties, strain-rate-dependent material parameters, and a parameter encapsulating the thermal and optical properties of the film. We present methods to determine these material parameters from experimental measurements. The simulated expansion dynamics are shown to be in good agreement with experimental measurements using two different polymer layer thicknesses. Finally, the ability to model high-fluence blister rupture is demonstrated through a strain-based failure approach.
Spatial-frequency transfer functions are regularly used to model the imaging performance of near-field �superlens� systems. However, these do not account for interactions between the object that is being imaged and the superlens itself. As the imaging in these systems is in the near field, such interactions are important to consider if accurate performance estimates are to be obtained. We present here a simple analytical modification that can be made to the transfer function to account for near-field interactions for objects consisting of small apertures in otherwise-continuous metal screens. The modified transfer functions are evaluated by comparison with full-field finite-element simulations for representative single-layer and multi-layer silver superlenses, and good agreement is found.
Despite stipulations in the Sudan's 2005 Comprehensive Peace Agreement (CPA) that all ‘other armed groups’ be demobilised by January 2006, the South Sudan Defence Force (SSDF) continued to maintain a significant armed presence in South Sudan. This paper analyses the dynamics of the organisation, the impact of its ongoing presence on the security situation and reconstruction efforts, and attempts by the government of South Sudan to counteract the SSDF from January to August 2006. It argues that the strategies implemented by the government to counter the SSDF were fairly successful in that there was no major return to conflict. However, it concludes that the SSDF's continued presence, while hindered, has the potential to spark a return to civil war.
The Welsh schools that I have seen are generally on the British system … The children in them are generally docile and quick in apprehension, to a greater degree than English children; their drawback, of course, is that they have to acquire the medium of information, as well as the information itself, while the English children possess the medium at the outset. There can, I think, be no question but that the acquirement of the English language should be more and more insisted upon by your Lordships in your relations with these schools as the one main object for which your aid is granted. Whatever encouragement individuals may think it desirable to give the preservation of the Welsh language on grounds of philological or antiquarian interest, it must always be the desire of a Government to render its dominions, as far as possible, homogeneous, and to break down barriers to the freest intercourse between the different parts of them. Sooner or later, the difference of language between Wales and England will probably be effaced, as has happened with the difference of language between Cornwall and the rest of England; as is now happening with the difference of language between Brittany and the rest of France; and they are not the true friends of the Welsh people who, from a romantic interest in their manners and traditions, would impede an event which is socially and politically so desirable for them.