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We examine a cyclic order on the directed edges of a tree whose vertices have cyclically ordered links. We use it to show that a graph of groups with left-cyclically ordered vertex groups and convex left-ordered edge groups is left-cyclically orderable.
Physician assisted dying is not new, neither historically, nor globally. What has changed in the UK however, is the perspective of society. In the UK, the British Medical Association is both a union and a professional organisation representing doctors and liaising with governments departments in matters of healthcare. As with various specialties within medicine, there are those in favour of change and those against. There are matters on which there is common ground, and a consensus of experts has identified principles, which, if legislation is to change, would be sensible to follow. A profession has united around the idea that if change is coming, it is better to inform the debate proactively and ensure that the interest of patients and doctors are promoted. This session will look at how potential change in the UK has been approached and hopefully well managed.’
OBJECTIVES/GOALS: To evaluate the incidence of brachial plexus birth injury (BPBI) and its associations with maternal demographic factors. Additionally, we sought to determine whether longitudinal changes in BPBI incidence differed by maternal demographics. METHODS/STUDY POPULATION: We conducted a retrospective cohort study of over 8 million maternal-infant pairs using California’s Office of Statewide Health Planning and Development Linked Birth Files from 1991-2012. Descriptive statistics were used to determine BPBI incidence and the prevalence of maternal demographic factors (race, ethnicity, age). Multivariable logistic regression was used to determine associations of year, maternal race, ethnicity, and age with BPBI. Excess population level risk associated with these characteristics was determined by calculating population attributable fractions. RESULTS/ANTICIPATED RESULTS: The incidence of BPBI between 1991-2012 was 1.28 per 1000 live births, with peak incidence of 1.84 per 1000 in 1998 and low of 0.9 per 1000 in 2008. Incidence varied by demographic group, with infants of Black (1.78 per 1000) and Hispanic (1.34 per 1000) mothers having the highest incidences. Controlling for relevant covariates, infants of Black (AOR=1.88, 95% CI 1.70, 2.08), Hispanic (AOR=1.25, 95% CI 1.18, 1.32) and advanced-age mothers (AOR=1.16, 95% CI 1.09, 1.25) were at increased risk. Disparities in risk experienced by Black, Hispanic, and advanced-age mothers contributed to a 5%, 10%, and 2% excess risk at the population level, respectively. Longitudinal trends in incidence did not vary among demographic groups. Population-level changes in maternal demographics did not explain changes in incidence over time. DISCUSSION/SIGNIFICANCE: Although BPBI incidence has decreased in California, demographic disparities exist. Infants of Black, Hispanic, and advanced-age mothers are at increased BPBI risk compared to White, Non-Hispanic, and younger mothers.
OBJECTIVES/GOALS: To evaluate the association of maternal delivery history with a brachial plexus birth injury (BPBI) risk in subsequent deliveries, and to estimate the effect of subsequent delivery method on BPBI risk. METHODS/STUDY POPULATION: We conducted a retrospective cohort study of all livebirth deliveries occurring in California-licensed hospitals from 1996-2012. The primary outcome was recurrent BPBI in a subsequent pregnancy. The exposure was prior delivery history (parity, shoulder dystocia in a previous delivery, or previously delivering an infant with BPBI). Multiple logistic regression was used to model adjusted associations of prior delivery history with BPBI in a subsequent pregnancy. The adjusted risk (AR) and adjusted risk difference (ARD) for BPBI between vaginal and cesarean delivery in subsequent pregnancies were determined, stratified by prior delivery history, and the number of cesarean deliveries needed to prevent one BPBI was determined. RESULTS/ANTICIPATED RESULTS: Of 6,286,324 infants delivered by 4,104,825 individuals, 7,762 (0.12%) were diagnosed with a BPBI. Higher parity was associated with a 5.7% decrease in BPBI risk with each subsequent delivery (aOR 0.94, 95%CI 0.92, 0.97). Previous shoulder dystocia or BPBI were associated with 5-fold (aOR=5.39, 95%CI 4.10, 7.08) and 17-fold increases (aOR=17.22, 95%CI 13.31, 22.27) in BPBI risk, respectively. Among individuals with a history of delivering an infant with a BPBI , cesarean delivery was associated with a 73.0% decrease in BPBI risk (aOR=0.27, 95%CI 0.13, 0.55), compared with an 87.9% decrease in BPBI risk (aOR=0.12, 95%CI 0.10, 0.15) in individuals without this history. Among individuals with a previous history of BPBI, 48.1 cesarean deliveries are needed to prevent one BPBI. DISCUSSION/SIGNIFICANCE: Parity, previous shoulder dystocia, and previously delivering a BPBI infant are associated with future BPBI risk. These factors are identifiable prenatally and can inform discussions with pregnant individuals regarding BPBI risk and planned mode of delivery.
Therapeutics targeting frontotemporal dementia (FTD) are entering clinical trials. There are challenges to conducting these studies, including the relative rarity of the disease. Remote assessment tools could increase access to clinical research and pave the way for decentralized clinical trials. We developed the ALLFTD Mobile App, a smartphone application that includes assessments of cognition, speech/language, and motor functioning. The objectives were to determine the feasibility and acceptability of collecting remote smartphone data in a multicenter FTD research study and evaluate the reliability and validity of the smartphone cognitive and motor measures.
Participants and Methods:
A diagnostically mixed sample of 207 participants with FTD or from familial FTD kindreds (CDR®+NACC-FTLD=0 [n=91]; CDR®+NACC-FTLD=0.5 [n=39]; CDR®+NACC-FTLD>1 [n=39]; unknown [n=38]) were asked to remotely complete a battery of tests on their smartphones three times over two weeks. Measures included five executive functioning (EF) tests, an adaptive memory test, and participant experience surveys. A subset completed smartphone tests of balance at home (n=31) and a finger tapping test (FTT) in the clinic (n=11). We analyzed adherence (percentage of available measures that were completed) and user experience. We evaluated Spearman-Brown split-half reliability (100 iterations) using the first available assessment for each participant. We assessed test-retest reliability across all available assessments by estimating intraclass correlation coefficients (ICC). To investigate construct validity, we fit regression models testing the association of the smartphone measures with gold-standard neuropsychological outcomes (UDS3-EF composite [Staffaroni et al., 2021], CVLT3-Brief Form [CVLT3-BF] Immediate Recall, mechanical FTT), measures of disease severity (CDR®+NACC-FTLD Box Score & Progressive Supranuclear Palsy Rating Scale [PSPRS]), and regional gray matter volumes (cognitive tests only).
Results:
Participants completed 70% of tasks. Most reported that the instructions were understandable (93%), considered the time commitment acceptable (97%), and were willing to complete additional assessments (98%). Split-half reliability was excellent for the executive functioning (r’s=0.93-0.99) and good for the memory test (r=0.78). Test-retest reliabilities ranged from acceptable to excellent for cognitive tasks (ICC: 0.70-0.96) and were excellent for the balance (ICC=0.97) and good for FTT (ICC=0.89). Smartphone EF measures were strongly associated with the UDS3-EF composite (ß's=0.6-0.8, all p<.001), and the memory test was strongly correlated with total immediate recall on the CVLT3-BF (ß=0.7, p<.001). Smartphone FTT was associated with mechanical FTT (ß=0.9, p=.02), and greater acceleration on the balance test was associated with more motor features (ß=0.6, p=0.02). Worse performance on all cognitive tests was associated with greater disease severity (ß's=0.5-0.7, all p<.001). Poorer performance on the smartphone EF tasks was associated with smaller frontoparietal/subcortical volume (ß's=0.4-0.6, all p<.015) and worse memory scores with smaller hippocampal volume (ß=0.5, p<.001).
Conclusions:
These results suggest remote digital data collection of cognitive and motor functioning in FTD research is feasible and acceptable. These findings also support the reliability and validity of unsupervised ALLFTD Mobile App cognitive tests and provide preliminary support for the motor measures, although further study in larger samples is required.
Dr Wise will help the audience familiarise themselves with the attitudes, atributes and skills neccessary to establish and maintain a practice outside of a state-supported environment, to develop and grow a career, and reduce the risk of burn out.
Excessive negative self-referential processing plays an important role in the development and maintenance of major depressive disorder (MDD). Current measures of self-reflection are limited to self-report questionnaires and invoking imagined states, which may not be suitable for all populations.
Aims
The current study aimed to pilot a new measure of self-reflection, the Fake IQ Test (FIQT).
Method
Participants with MDD and unaffected controls completed a behavioural (experiment 1, n = 50) and functional magnetic resonance imaging version (experiment 2, n = 35) of the FIQT.
Results
Behaviourally, those with MDD showed elevated negative self-comparison with others, higher self-dissatisfaction and lower perceived success on the task, compared with controls; however, FIQT scores were not related to existing self-report measures of self-reflection. In the functional magnetic resonance imaging version, greater activation in self-reflection versus control conditions was found bilaterally in the inferior frontal cortex, insula, dorsolateral prefrontal cortex, motor cortex and dorsal anterior cingulate cortex. No differences in neural activation were found between participants with MDD and controls, nor were there any associations between neural activity, FIQT scores or self-report measures of self-reflection.
Conclusions
Our results suggest the FIQT is sensitive to affective psychopathology, but a lack of association with other measures of self-reflection may indicate that the task is measuring a different construct. Alternatively, the FIQT may measure aspects of self-reflection inaccessible to current questionnaires. Future work should explore relationships with alternative measures of self-reflection likely to be involved in perception of task performance, such as perfectionism.
From 2016–2019, dry bulb onions were the suspected cause of three multistate outbreaks in the United States. We investigated a large multistate outbreak of Salmonella Newport infections that caused illnesses in both the United States and Canada in 2020. Epidemiologic, laboratory and traceback investigations were conducted to determine the source of the infections, and data were shared among U.S. and Canadian public health officials. We identified 1127 U.S. illnesses from 48 states with illness onset dates ranging from 19 June to 11 September 2020. Sixty-six per cent of ill people reported consuming red onions in the week before illness onset. Thirty-five illness sub-clusters were identified during the investigation and seventy-four per cent of sub-clusters served red onions to customers during the exposure period. Traceback for the source of onions in illness sub-clusters identified a common onion grower in Bakersfield, CA as the source of red onions, and onions were recalled at this time. Although other strains of Salmonella Newport were identified in environmental samples collected at the Bakersfield, CA grower, extensive environmental and product testing did not yield the outbreak strain. This was the third largest U.S. foodborne Salmonella outbreak in the last 30 years. It is the first U.S. multistate outbreak with a confirmed link to dry bulb onions, and it was nearly 10-fold larger than prior outbreaks with a suspected link to onions. This outbreak is notable for its size and scope, as well as the international data sharing that led to implication of red onions as the primary cause of the outbreak. Although an environmental assessment at the grower identified several factors that likely contributed to the outbreak, no main reason was identified. The expedient identification of the outbreak vehicle and response of multiple public health agencies allowed for recall and removal of product from the marketplace, and rapid messaging to both the public and industry on actions to protect consumers; these features contributed to a decrease in cases and expeditious conclusion of the outbreak.
This chapter is devoted to the study of finite element methods in one and two dimensions. We begin by presenting the general theory of Galerkin methods and their analysis; in particular Galerkin orthogonality and Cea’s lemma are introduced in an abstract setting. Then the construction of finite element spaces, and their bases, in one dimension is detailed. The notions of mesh and hat basis functions are introduced here. The general theory of Galerkin approximations is then used to reduced the error analysis of finite element schemes to a question in approximation theory. The properties of the Lagrange interpolant in Sobolev spaces (in one dimension) then close the argument. Duality techniques, i.e. Nitsche’s trick are then used to obtain optimal error estimates in L2. The same ideas are presented, mostly without proof, for the finite element scheme in two dimensions.
Periodic differential equations and their approximation are the topic of this chapter. We discuss the application of classical finite difference schemes and their analysis in this setting. The spectral Galerkin method, that is, using trigonometric polynomials as basis is then discussed and we show its spectral accuracy. Finally the pseudo-spectral method is presented, its implementation via the DFT is discussed.
In this chapter we begin the study of best approximations. In this case we study the best (min) polynomial approximation in the uniform (max) norm. The existence a best approximating polynomial is first presented. The more subtle issue of uniqueness is then discussed. To show uniqueness the celebrated de la Vallee Poussin, and Chebyshev equi-oscillation theorems are presented. A first error estimate is then presented. The problems of interpolation, discussed in the previous chapter, and best approximation are then related via the Lebesgue constant. Chebyshev polynomials are then introduced, and their most relevant properties presented. Interpolation at Chebyshev nodes, and the mitigation of the Runge phenomenon are then discussed. Finally; Bernstein polynomials; moduli of continuity and smoothness; are detailed in order to study Weierstrass approximation theorem.
We prove the equivalence of the solution to a linear system of equations with an HPD matrix to the problem of quadratic minimization. With the help of this equivalence, we study the minimization of a quadratic energy and introduce gradient descent methods with exact and approximate line search, we study the preconditioned steepest descent method. We introduce the conjugate gradient method, with preconditioning, as a Galerkin approximation over Krylov subspaces and show its convergence. For systems with non HPD matrices we discuss the GMRES method.
We present the classical theory of linear iterative schemes for linear systems of equations: the Richardson, Jacobi, Gauss–Seidel, and relaxation methods are presented and analyzed. We introduce the Householder-John criterion for convergence of iterative schemes. The symmetrization and symmetric iterations are presented for the relaxation scheme. Some nonstationary methods, like minimal residuals, Chebyshev iterations, and minimal corrections are presented.
This chapter studies finite difference methods for elliptic problems. It begins with a rather lengthy and general discussion of grid domains, grid functions, finite difference operators, and their consistency. We then introduce the notion of stability of a finite difference scheme and Lax’s principle: a consistent and stable scheme is convergent. Then we apply all these notions to elliptic operators in one and two dimensions, with the main focus being the Laplacian. We show the discrete maximum principle, energy arguments and how these can be used to attain stability and convergence in various norms. For more general operators we introduce the notions of homogeneous schemes and upwinding. For operators in divergence form we provide an analysis via energy arguments. For non divergence form operators we analyze the monotonicity and comparison principles of the arising schemes.
We introduce Runge-Kutta methods and their Butcher tableau. We discuss necessary order conditions, and thoroughly analyze some two and three stage schemes. We then discuss the class of Runge-Kutta collocation methods and their consistency. In particular we present the class of Gauss-Legendre-Runge-Kutta methods and their order. Finally, we study how to approximate dissipative equations via so-called dissipative schemes: the M-matrix of a scheme and schemes of B(q) and C(q) types.
In this chapter we study finite difference schemes for parabolic partial differential equations. The notions of conditional and unconditional stability, and CFL condition are introduced to analyze the classical schemes for the heat equation. Different techniques, like maximum principles and energy arguments are presented to obtain stability in different norms. Then, we turn to the study of the pure initial value problem, the grand goal being to discuss the von Neumann stability analysis. To accomplish this we introduce the notions of Fourier-Z transform of grid functions and the symbol of a finite difference scheme. This allows us to state the von Neumann stability condition and prove that it is necessary and sufficient for stability. These notions are also used to present a covergence analysis that is somewhat different than the one presented in previous sections.
We study the solution of overdetermined systems of equations. Introduce weak, and in particular least squares solutions. For full rank systems, we show existence and uniqueness via the normal equations. We introduce projection matrices and the QR factorization. We discuss the computation of the QR factorization with the help of Householder reflectors. For rank defficient systems we prove the existence and uniqueness of a minimal norm least squares solution. We introduce the Moore-Penrose pseudoinverse, show how it relates to the SVD, and how it can be used to solve rank defficient systems.
This appendix collects a review of the calculus and analysis in one and several variables that the reader should be familiar with. Notions of convergence, continuity, differentiability and integrability are recalled here.
We present several facts about the natural transformations between vector spaces, and their representations via matrices. We introduce induced matrix norms, and the spectral decomposition of nondefective matrices
This chapter presents all the needed theoretical background regarding the initial value problem for a first order ordinary differential equation in finite dimensions. Local and global existence, uniqueness, and continuous dependence on data are presented. The discussion then turns to stability of solutions. We discuss the flow map and the Alekseev-Grobner Lemma. Dissipative equations. and a discussion of Lyapunov stability of fixed points conclude the chapter.