Objectives/Goals: Aspiration causes or aggravates lung diseases. While bedside swallow evaluations are not sensitive/specific, gold standard tests for aspiration are invasive, uncomfortable, expose patients to radiation, and are resource intensive. We propose the development and validation of an AI model that analyzes voice to noninvasively predict aspiration. Methods/Study Population: Retrospectively recorded [i] phonations from 163 unique ENT patients were analyzed for acoustic features including jitter, shimmer, harmonic to noise ratio (HNR), etc. Patients were classified into three groups: aspirators (Penetration-Aspiration Scale, PAS 6–8), probable (PAS 3–5), and non-aspirators (PAS 1–2) based on video fluoroscopic swallow (VFSS) findings. Multivariate analysis evaluated patient demographics, history of head and neck surgery, radiation, neurological illness, obstructive sleep apnea, esophageal disease, body mass index, and vocal cord dysfunction. Supervised machine learning using five folds cross-validated neural additive network modelling (NAM) was performed on the phonations of aspirator versus non-aspirators. The model was then validated using an independent, external database. Results/Anticipated Results: Aspirators were found to have quantifiably worse quality of sound with higher jitter and shimmer but lower harmonics noise ratio. NAM modeling classified aspirators and non-aspirators as distinct groups (aspirator NAM risk score 0.528+0.2478 (mean + std) vs. non-aspirator (control) risk score of 0.252+0.241 (mean + std); p Discussion/Significance of Impact: We report the use of voice as a novel, noninvasive biomarker to detect aspiration risk using machine learning techniques. This tool has the potential to be used for the safe and early detection of aspiration in a variety of clinical settings including intensive care units, wards, outpatient clinics, and remote monitoring.

The goal of this paper is to derive a series expansion for standard normal probabilities F(b), where b ≥ 0 and the upper half of the cumulative distribution function (or CDF) of the standard normal is given by(1) See [1, Chapter 4] for information and results about the normal distribution. It is known that this integral is not elementary, and the usual approach is to use the Taylor series expansion for ez in order to evaluate the integral. We know that and therefore that (2).

Task-sharing approaches that train non-specialist providers (NSPs), people without specialized clinical training, are increasingly utilized to address the global mental health treatment gap. This review consolidates findings from peer reviewed articles on the impact of task-sharing mental health interventions on NSPs at the individual, family and community level. Studies that highlighted facilitators, barriers and recommendations for improving the experiences of NSPs were also included in the review. Fifteen studies, conducted across eight countries, met the inclusion criteria. Seven studies were conducted in Sub-Saharan Africa, six in South and Southeast Asia and two studies were conducted in high-income countries in Europe. Benefits for NSPs included personal application of mental health skills, elevated community status and increased social networks. Challenges include burnout, lack of career progression and difficult workplace environments. Findings indicate that while there were many positive impacts associated with NSPs’ work, challenges need to be addressed. Safety and harassment issues reported by female NSPs are especially urgent. Supervision, certifications, increased salaries and job stability were also recognized as significant opportunities. We recommend future intervention studies to collect data on the impact of intervention delivery on NSPs. Research is also needed on the impact of various supervision and health systems strategies on NSPs.

Globally, Siamese fighting fish (Betta splendens) continue to be sold and kept in small, barren jars or tanks, with little concern for their welfare. This study aimed to examine the impact of housing size and furnishings (i.e. live plants, refuges) on the behaviour of Siamese fighting fish, to understand optimal tank conditions. Thirteen male Siamese fighting fish were rotated between five different housing conditions: ‘jar’ (1.5 L); ‘small’ (3.3 L); ‘medium’ (5.6 L); ‘large’ (19.3 L); and ‘large-barren’ (19.3 L). All tanks had gravel and furnishings, except the large-barren tank which was devoid of these. Overall, tank size influenced behaviour. Fish were significantly more active and spent significantly less time resting and performing ‘abnormal’ behaviours (hovering and stereotypic swimming), in the large tank compared to the smaller tanks. Tank furnishings also influenced behaviour. Fishes in the large-barren tank performed more ‘abnormal’ behaviours (hovering, stereotypic swimming, interaction with the walls), compared to the large tank which had furnishings. These results suggest that the small, barren jars and tanks that Siamese fighting fish are often housed in are detrimental to their welfare, and larger, furnished tanks are more optimal. Behavioural variations were observed between the fish in this study, highlighting individual fish personality. We recommend a minimum tank size of 5.6 L for the display and sale of Siamese fighting fish, and tanks larger than this for keeping Siamese fighting fish at home. All tanks should contain gravel, live plants and refuges.

Under what conditions are people more likely to support judicial invalidation of legislative acts? We theorize that constitutional recency confers greater democratic legitimacy on constitutional provisions, reducing concerns that judges may use dated language to impose their own will on a living majority. Exploiting differences among US state constitutions, we show in a pre-registered vignette experiment and conjoint analysis that Americans are more supportive of judicial review and original intent interpretation when presented with a younger constitutional provision or constitution. These results imply that Americans might alter their approach to the US Constitution if it were changed as easily and as often as a typical state constitution.

We evaluate three measures of state legislative professionalism: Squire’s (1992) index that measures professionalism relative to the US House, Bowen and Greene’s (2014b) two-dimensional scaling, and legislative operating expenditures per member, an older measure that remains in occasional use. Replications of 18 recent articles show that these three measures regularly produce significantly different estimates of the effect of professionalism, particularly in longitudinal analysis; when they do, the choice of measure often affects whether other central variables retain a significant relationship with the dependent variable. These divergent results appear to reflect differences among these measures in terms of missingness, vulnerability to outliers, measurement of session length, and whether to benchmark to the US House. Researchers seeking a general indicator of professionalism should consider these differences when choosing an appropriate measure.

Migrants and refugees face elevated risks for mental health problems but have limited access to services. This study compared two strategies for training and supervising nonspecialists to deliver a scalable psychological intervention, Group Problem Management Plus (gPM+), in northern Colombia. Adult women who reported elevated psychological distress and functional impairment were randomized to receive gPM+ delivered by nonspecialists who received training and supervision by: 1) a psychologist (specialized technical support); or 2) a nonspecialist who had been trained as a trainer/supervisor (nonspecialized technical support). We examined effectiveness and implementation outcomes using a mixed-methods approach. Thirteen nonspecialists were trained as gPM+ facilitators and three were trained-as-trainers. We enrolled 128 women to participate in gPM+ across the two conditions. Intervention attendance was higher in the specialized technical support condition. The nonspecialized technical support condition demonstrated higher fidelity to gPM+ and lower cost of implementation. Other indicators of effectiveness, adoption and implementation were comparable between the two implementation strategies. These results suggest it is feasible to implement mental health interventions, like gPM+, using lower-resource, community-embedded task sharing models, while maintaining safety and fidelity. Further evidence from fully powered trials is needed to make definitive conclusions about the relative cost of these implementation strategies.

Accelerating COVID-19 Treatment Interventions and Vaccines (ACTIV) was initiated by the US government to rapidly develop and test vaccines and therapeutics against COVID-19 in 2020. The ACTIV Therapeutics-Clinical Working Group selected ACTIV trial teams and clinical networks to expeditiously develop and launch master protocols based on therapeutic targets and patient populations. The suite of clinical trials was designed to collectively inform therapeutic care for COVID-19 outpatient, inpatient, and intensive care populations globally. In this report, we highlight challenges, strategies, and solutions around clinical protocol development and regulatory approval to document our experience and propose plans for future similar healthcare emergencies.

A significant number of young people throughout the world are experiencing mental health concerns. Many young people will develop their first mental health concerns or will be managing their symptoms while enrolled in institutions of higher education. Although many colleges and universities are aware of the significant mental health needs among their students, the mental health and psychosocial needs of students often exceed the availability of resources and cultural and contextual barriers, such as stigma, may further impede access to care. Such gaps and barriers in mental health may lead to poor prognosis as well as negative educational and social outcomes. We propose that non-specialist delivered mental health and psychosocial interventions may play a critical role in reducing the gaps in care for students in higher education. In particular, non-specialist delivered care can complement existing specialized services to provide stepped models of care. Importantly, the adaptation and implementation of non-specialist delivered mental health and psychosocial support interventions in higher education may lead to innovative strategies for increasing access to care in this context, but may lead to adaptations that could apply to contexts outside of higher education as well.

The quenching of cluster satellite galaxies is inextricably linked to the suppression of their cold interstellar medium (ISM) by environmental mechanisms. While the removal of neutral atomic hydrogen (H i) at large radii is well studied, how the environment impacts the remaining gas in the centres of galaxies, which are dominated by molecular gas, is less clear. Using new observations from the Virgo Environment traced in CO survey (VERTICO) and archival H i data, we study the H i and molecular gas within the optical discs of Virgo cluster galaxies on 1.2-kpc scales with spatially resolved scaling relations between stellar ($\Sigma_{\star}$), H i ($\Sigma_{\text{H}\,{\small\text{I}}}$), and molecular gas ($\Sigma_{\text{mol}}$) surface densities. Adopting H i deficiency as a measure of environmental impact, we find evidence that, in addition to removing the H i at large radii, the cluster processes also lower the average $\Sigma_{\text{H}\,{\small\text{I}}}$ of the remaining gas even in the central $1.2\,$kpc. The impact on molecular gas is comparatively weaker than on the H i, and we show that the lower $\Sigma_{\text{mol}}$ gas is removed first. In the most H i-deficient galaxies, however, we find evidence that environmental processes reduce the typical $\Sigma_{\text{mol}}$ of the remaining gas by nearly a factor of 3. We find no evidence for environment-driven elevation of $\Sigma_{\text{H}\,{\small\text{I}}}$ or $\Sigma_{\text{mol}}$ in H i-deficient galaxies. Using the ratio of $\Sigma_{\text{mol}}$-to-$\Sigma_{\text{H}\,{\small\text{I}}}$ in individual regions, we show that changes in the ISM physical conditions, estimated using the total gas surface density and midplane hydrostatic pressure, cannot explain the observed reduction in molecular gas content. Instead, we suggest that direct stripping of the molecular gas is required to explain our results.

This study examined relationships between foodborne outbreak investigation characteristics, such as the epidemiological methods used, and the success of the investigation, as determined by whether the investigation identified an outbreak agent (i.e. pathogen), food item and contributing factor. This study used data from the Centers for Disease Control and Prevention's (CDC) National Outbreak Reporting System and National Environmental Assessment Reporting System to identify outbreak investigation characteristics associated with outbreak investigation success. We identified investigation characteristics that increase the probability of successful outbreak investigations: a rigorous epidemiology investigation method; a thorough environmental assessment, as measured by number of visits to complete the assessment; and the collection of clinical samples. This research highlights the importance of a comprehensive outbreak investigation, which includes epidemiology, environmental health and laboratory personnel working together to solve the outbreak.

Translational research should examine racism and bias and improve health equity. We designed and implemented a course for the Master of Science in Clinical Investigation program of the Northwestern University Clinical and Translational Sciences Institute. We describe curriculum development, content, outcomes, and revisions involving 36 students in 2 years of “Anti-Racist Strategies for Clinical and Translational Science.” Ninety-six percent of students reported they would recommend the course. Many reported changes in research approaches based on course content. A course designed to teach anti-racist research design is feasible and has a positive short-term impact on learners.

Let $r=[a_1(r), a_2(r),\ldots ]$ be the continued fraction expansion of a real number $r\in \mathbb R$ . The growth properties of the products of consecutive partial quotients are tied up with the set admitting improvements to Dirichlet’s theorem. Let $(t_1, \ldots , t_m)\in \mathbb R_+^m$ , and let $\Psi :\mathbb {N}\rightarrow (1,\infty )$ be a function such that $\Psi (n)\to \infty $ as $n\to \infty $ . We calculate the Hausdorff dimension of the set of all $ (x, y)\in [0,1)^2$ such that

$$ \begin{align*} \max\left\{\prod_{i=1}^ma_{n+i}^{t_i}(x), \prod_{i=1}^ma_{n+i}^{t_i}(y)\right\} \geq \Psi(n) \end{align*} $$

$n\geq 1$

Luskin and Bullock’s (2011) randomized experiment on live-interview respondents found no evidence that American National Election Studies and Time-Sharing Experiments for the Social Sciences respondents hide knowledge behind the “don’t know” (DK) option. We successfully replicated their finding using two online platforms, the Cooperative Congressional Election Study and Google Surveys. However, we obtained different results on Amazon’s Mechanical Turk (MTurk). We attribute this difference to MTurkers’ experience with attention checks and other quality-control mechanisms, which condition them to avoid errors. This conditioning leads MTurkers to hide knowledge behind DK in ways not observed on other platforms. Researchers conducting political knowledge experiments or piloting surveys on MTurk should be aware of these differences.

Adipocytokines, which are secreted during fetal development by both mothers and fetuses, may influence fetal lung development, but little human data are available. We used data from the HOME Study to investigate the associations of cord blood adipocytokine concentrations with children’s lung forced expiratory volume (FEV1; N = 160) and their risk of wheeze (N = 281). We measured umbilical cord serum adipocytokine concentrations using enzyme-linked immunosorbent assays and FEV1 using a portable spirometer at ages 4 and 5 to calculate the percent predicted FEV1 (%FEV1). Parents completed standardized questionnaires of their child’s wheeze symptoms every 6 months from birth to age 5, then again at ages 6 and 8. We used multivariable linear mixed models and modified Poisson regression with generalized estimating equations to estimate associations of adipocytokine concentrations (log2-transformed) with children’s %FEV1 and the risk of wheeze, respectively, adjusting for sociodemographic, perinatal, and child factors. Cord serum leptin was not associated with children’s %FEV1. Higher cord serum adiponectin concentrations were associated with higher %FEV1 in girls (β = 3.1, 95% confidence interval [CI]: 0.6, 5.6), but not in boys (β = −1.3, 95% CI: −5.9, 3.3) (sex × adiponectin p-value = 0.05). Higher leptin was associated with lower risk of wheeze in girls (RR = 0.74, 95% CI: 0.66, 0.84), but not boys (RR = 0.87, 95% CI: 0.69, 1.11) (sex × leptin p-value = 0.01). In contrast, higher adiponectin concentrations were associated with lower risk of wheeze (RR = 0.84, 95% CI: 0.73, 0.96) in both boys and girls. These data suggest that fetal adipocytokines may impact lung development and function in early childhood. Future studies are needed to confirm these findings and explore the mechanisms underlying these associations.

The Black-capped Petrel or Diablotin Pterodroma hasitata has a fragmented and declining population estimated at c.1,000 breeding pairs. On land, the species nests underground in steep ravines with dense understorey vegetation. The only confirmed breeding sites are located in the mountain ranges of Hispaniola in the Caribbean, where habitat loss and degradation are continuing threats. Other nesting populations may still remain undiscovered but, to locate them, laborious in situ nest searches must be conducted over expansive geographical areas. To focus nest-search efforts more efficiently, we analysed the environmental characteristics of Black-capped Petrel nesting habitat and modeled suitable habitat on Hispaniola using openly available environmental datasets. We used a univariate generalized linear model to compare the habitat characteristics of active Black-capped Petrel nests sites with those of potentially available sites (i.e. random pseudo-absences). Elevation, distance to coast, and the influence of tree cover and density emerged as important environmental variables. We then applied multivariate generalized linear models to these environmental variables that showed a significant relationship with petrel nesting activity. We used the top performing model of habitat suitability model to create maps of predicted suitability for Hispaniola. In addition to areas of known petrel activity, the model identified possible nesting areas for Black-capped Petrels in habitats not previously considered suitable. Based on model results, we estimated the total area of predicted suitable nesting habitat for Black-capped Petrels on Hispaniola and found that forest loss due to hurricanes, forest fires, and encroachment from agriculture had severely decreased availability of predicted suitable habitat between 2000 and 2018.