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This study aimed to assess the impact of hypertensive disorders of pregnancy on infant neurodevelopment by comparing 6-month and 2-year psychomotor development outcomes of infants exposed to gestational hypertension (GH) or preeclampsia (PE) versus normotensive pregnancy (NTP). Participating infants were children of women enrolled in the Postpartum Physiology, Psychology and Paediatric (P4) cohort study who had NTPs, GH or PE. 6-month and 2-year Ages and Stages Questionnaires (ASQ-3) scores were categorised as passes or fails according to domain-specific values. For the 2-year Bayley Scales of Infant and Toddler Development (BSID-III) assessment, scores > 2 standard deviations below the mean in a domain were defined as developmental delay. Infants (n = 369, male = 190) exposed to PE (n = 75) versus GH (n = 20) and NTP (n = 274) were more likely to be born small for gestational age and premature. After adjustment, at 2 years, prematurity status was significantly associated with failing any domain of the ASQ-3 (p = 0.015), and maternal tertiary education with increased cognitive scores on the BSID-III (p = 0.013). However, PE and GH exposure were not associated with clinically significant risks of delayed infant neurodevelopment in this study. Larger, multicentre studies are required to further clarify early childhood neurodevelopmental outcomes following hypertensive pregnancies.
This study is a scoping review to identify literature pertinent to the question: “What are the criteria for deployment of the United States National Guard (USNG) to domestic sudden-onset natural disasters (SODs)?” As this question relies on factors across many disciplines—legal, medical, technical, cultural—and as there is no foundational body of academic literature or unified governmental or USNG policy addressing this question, a scoping review was designed to identify the body of literature on which further research and policy decisions surrounding this question may be based.
Objectives:
To perform a scoping review identifying the criteria for the deployment of the United States National Guard (USNG) to domestic sudden-onset natural disasters to identify the body of literature on which further research and policy decisions may be based.
Method/Description:
On January 23, 2023 a modified PRISMA-ScR search was performed using an online search engine of the following databases: Academic Search Premier, Google Scholar, JSTOR, PubMed, Web of Science, and WorldCat. The inclusion criteria included the involvement of the USNG response to U.S. domestic SOD. Non-SOD results were excluded. Results from all years and of any type of literature were considered and were limited to the English language. First, titles and abstracts were screened by 2 independent reviewers. Then, a full-text review was performed by 2 independent reviewers. Finally, data were extracted from included texts by 2 independent reviewers. A third reviewer resolved any discrepancies at each stage. This study did not require approval of an institutional review board.
Results/Outcomes:
Out of the 886 results identified by the original search, after the complete review process, 34 sources were relevant to the research question. Fifteen criteria for the deployment of the USNG to SODs were identified. Overwhelmed local responders, utility failure, the need for the provision of security, and the need for logistical coordination were the most commonly identified criteria. Hurricanes were the most common SOD addressed in the included literature, and most results were event reports.
Conclusion:
This modified PRISMA-ScR identified a foundation on which elected officials, USNG leadership, and the larger disaster response community may develop policies and disaster response plans to optimize available resources through the activation of the USNG when responding to SODs.
Disasters strain coordination efforts between groups. Interoperability is best assessed while in process, but retrospective analysis can also illuminate problems and identify solutions. COVID-19 created an international public health crisis that required civilian-military response in many locations, creating an opportunity to evaluate interoperability of multiple international systems at a single moment in time confronting a single crisis.
Objectives:
This project uses three published interoperability models to identify interoperability activities during the COVID-19 pandemic. That data was then utilized to assess the interoperability effectiveness. The data was also utilized to develop a framework for assessing a group’s current interoperability and assist with improvement goals.
Method/Description:
Papers on civilian-military interoperability during COVID-19 were identified utilizing a search of medical literature. They were then assessed using three interoperability models: Joint Emergency Services Interoperability Program (JESIP), Organizational Interoperability Maturity Model (OIMM), and the Homeland Security Interoperability Continuum (HSIC).
Results/Outcomes:
Of the 48 articles discussing interoperability criteria, the most common coordination criteria were shared situational awareness, joint understanding of risk, and standard operating procedures. The least likely interoperability criteria seen during international civilian-military COVID-19 disaster responses were co-location, preparedness, shared technology, prior training exercises, and previous experience. Utilizing this data, a combined interoperability assessment model was created for organizations to utilize to evaluate and improve their current level of interoperability.
Conclusion:
Disaster focused organizations with different cultures yet potential future interactions should perform an initial interoperability self-assessment to determine their current level of coordination. They should then follow the next steps for improving interoperability before the next disaster strikes.
The motion and deformation of a neutrally buoyant drop in a rectangular channel experiencing a pressure-driven flow at a low Reynolds number has been investigated both experimentally and numerically. A moving-frame boundary-integral algorithm was used to simulate the drop dynamics, with a focus on steady-state drop velocity and deformation. Results are presented for drops of varying undeformed diameters relative to channel height ($D/H$), drop-to-bulk viscosity ratio ($\lambda$), capillary number ($Ca$, ratio of deforming viscous forces to shape-preserving interfacial tension) and initial position in the channel in a parameter space larger than considered previously. The general trend shows that the drop steady-state velocity decreases with increasing drop diameter and viscosity ratio but increases with increasing $Ca$. An opposite trend is seen for drops with small viscosity ratio, however, where the steady-state velocity increases with increasing $D/H$ and can exceed the maximum background flow velocity. Experimental results verify theoretical predictions. A deformable drop with a size comparable to the channel height when placed off centre migrates towards the centreline and attains a steady state there. In general, a drop with a low viscosity ratio and high capillary number experiences faster cross-stream migration. With increasing aspect ratio, there is a competition between the effect of reduced wall interactions and lower maximum channel centreline velocity at fixed average velocity, with the former helping drops attain higher steady-state velocities at low aspect ratios, but the latter takes over at aspect ratios above approximately 1.5.
This paper reports an experiment designed to assess the effects of a rotation in the marginal cost curve on convergence in a repeated Cournot triopoly. Increasing the cost curve's slope both reduces the serially-undominated set to the Nash prediction, and increases the peakedness of earnings. We observe higher rates of Nash equilibrium play in the design with the steeper marginal cost schedule, but only when participants are also rematched after each decision. Examination of response patterns suggests that the treatment with a steeper marginal cost curve and with a re-matching of participants across periods induces the selection of Nash Consistent responses.
This article replicates and “stress tests” a recent finding by Eckel and Grossman (2003) that matching subsidies generate substantially higher Charity Receipts than theoretically comparable rebate subsidies. In a first replication treatment, we show that most choices are consist with a “constant (gross) contribution” rule, suggesting that inattention to the subsidies’ differing net consequences may explain the higher revenues elicited with matching subsidies. Results of additional treatments suggest that (a) the charity dimension of the decision problems has little to do with the result, and (b) extra information regarding the net consequences of decisions reduces but does not eliminate the result.
This paper evaluates the effects of some standard procedural variations on outcomes in posted offer oligopoly experiments. Variations studied include the presence or absence of market information, the use of re-matched or fixed seller pairs and alterations in the order of sequencing. Experimental results indicate that such variations can have first order effects on outcomes. For this reason, we recommend that results in oligopoly experiments be carefully interpreted in light of the procedures selected.
We study the effects of price signaling activity and underlying propensities to cooperate on tacit collusion in posted offer markets. The primary experiment consists of an extensively repeated baseline sequence and a ‘forecast’ sequence that adds to the baseline a forecasting game that allows identification of signaling intentions. Forecast sequence results indicate that signaling intentions differ considerably from those that are counted under a standard signal measure based on previous period prices. Nevertheless, we find essentially no correlation between either measure of signal volumes and collusive efficiency. A second experiment demonstrates that underlying seller propensities to cooperate more clearly affect collusiveness.
The adipofascial anterolateral thigh (AF-ALT) free flap represents a versatile technique in head and neck reconstructions, with its applications increasingly broadening. The objective was to detail the novel utilization of the AF-ALT flap in orbital and skull base reconstruction, along with salvage laryngectomy onlay in our case series.
Method
We conducted a retrospective analysis at Roswell Park Comprehensive Cancer Center, spanning from July 2019 to June 2023, focusing on patient demographics and reconstructive parameters data.
Results
The AF-ALT flap was successfully employed in eight patients (average age 59, body mass index [BMI] 32.0) to repair various defects. Noteworthy outcomes were observed in skull base reconstructions, with no flap failures or major complications over an average 12-month follow-up. Donor sites typically healed well with minimal interventions.
Conclusion
Our series is the first to report the AF-ALT flap's efficacy in anterior skull base and orbital reconstructions, demonstrating an additional innovation in complex head and neck surgeries.
This research focuses on the dissidence of Michif French, an endangered variety of Laurentian French spoken by a number of Métis in Western Canada. We examine the vernacular use of [tʊt] (tout/tous ‘all, every’) in a corpus of around 50 interviews collected in the Métis community of St. Laurent, Manitoba, in the 1980s. On the one hand, the internal analysis supports the hypothesis that it is related to the other varieties of Laurentian French. On the other hand, the external data reveal that [tʊt] is widely used, confirming the highly vernacular character of Michif French compared to the other varieties. Finally, the analysis of several interview extracts illustrates that the intensive use of vernacular variants acts as an identity marker, enabling speakers to lay claim not only to their culture, but also to a language they consider distinct from that of other French speakers.
Lithofacies and biostratigraphical analysis has enabled the establishment of a stratigraphic event framework for Ludfordian and Pridoli strata in south Wales and the Welsh Borderland. In SW Wales, the Golden Grove Axis acted as a structural hinge separating the shallow marine storm-influenced Cae’r mynach Seaway from a pediment surface above which Ludfordian colluvium (Abercyfor Formation) was deposited. The Axis seeded four NW-derived river-influenced delta progrades of Leintwardinian to early Pridoli age (Tilestones Formation). A NE-sourced early Pridoli wave-influenced delta deposited the Downton Castle Sandstone Formation (DCSF), coeval to the youngest Tilestones prograde, with a lateral interface existing between Mynydd Epynt and the Clun Forest area. Except for the Malverns area, the DCSF is no longer recognized south of the Neath Disturbance. Early Pridoli forced regression promoted widespread subaerial exposure north of the Neath Disturbance, with incision into tracts close to the Welsh Borderland Fault System. The basinward-shift in facies belts resulted in marine erosion and deposition of a phosphatic ravinement pebble lag. The wave-influenced Clifford’s Mesne Sandstone Formation delta subsequently seeded on the Gorsley Axis with tidally influenced Rushall Formation accumulating in a back-barrier setting. The Pwll-Mawr Formation records the easterly advance of coeval coastal deposits on the western side of the remnant Cae’r mynach Seaway. Behind migrating delta coastlines, green muds accumulated on coastal plains (Temeside Mudstone Formation) with better drained red dryland alluvium (Moor Cliffs Formation) charting expansion of Old Red Sandstone lithofacies. Mid-Pridoli incision preserves the Pont ar Llechau Formation estuarine valley fill.
Particle trapping and manipulation have a wide range of applications in biotechnology and engineering. Recently, a flow-based, particle-trapping device called the Stokes trap was developed for trapping and control of small particles in the intersection of multiple branches in a microfluidic channel. This device can also be used to perform rheological experiments to determine the viscoelastic response of an emulsion or suspension. We show that besides these applications, the various flow modes produced by the Stokes trap are able to manipulate drop shapes and induce active mixing inside droplets. To this end, we analyse the dynamics of a droplet in a Stokes trap through boundary-integral simulations. We also explore the dynamic response of drop shape with respect to distinct external flow modes, which allows us to perform numerical experiments such as step strain and oscillatory extension. A linear controller is used to manipulate drop position, and the drop deformation is characterized by a spherical-harmonic decomposition. For small drop deformations, we observe a linear superposition of harmonics, which, surprisingly, seems to hold even for moderate deformations. This result indicates that such a device can be used for shape control of droplets. We also investigate how the different flow modes may be combined to induce mixing inside the droplets. The transient combination of modes produces an effective chaotic mixing, which is characterized by a mixing number. The mixing inside the droplet can be further enhanced for lower viscosity ratios and low, but non-zero capillary number and flow frequencies.
Edited by
Roland Dix, Gloucestershire Health and Care NHS Foundation Trust, Gloucester,Stephen Dye, Norfolk and Suffolk Foundation Trust, Ipswich,Stephen M. Pereira, Keats House, London
Being able to do activities is an inherent human need and essential to health and well-being. This chapter relates this need to the altered experience of activity participation for people who are patients within a psychiatric intensive care unit (PICU). It explains the negative impact of impaired functioning, occupational deprivation and boredom and the converse positive effect of adequate meaningful activity provision for patients, staff and the service as a whole. It discusses how engaging patients in activity can prevent, reduce and help to manage violence and aggression. This is balanced by a discussion of how enabling positive engagement through use of activity requires careful assessment, which includes considering the environment, different aspects of functioning such as sensory processing and the risks associated with the activities described herein. The chapter provides information on a wide range of activities for individual and group-based programmes, including enabling activity participation in seclusion and using sensory interventions.
This collectively authored article argues for a regional turn in the historical study of transnational activism. By considering not only pan-regional movements but also examples of borderland contexts, transregional connections and diasporic understandings of ‘region’, our discussion identifies fresh possibilities for investigating the evolution and functioning of transnational activism. Based on a Royal Historical Society-funded workshop held at and supported by Northumbria University, the article brings together insights from diverse locations and arenas of contestation. The first part considers literatures on three macro-regional settings – South Asia, Western Europe and Latin America – to illustrate the importance of distinctive regional contexts and constructs in shaping transnational activism and its goals. The second part turns to case studies of transnational activism in and beyond Eastern Europe, West Africa, the Caribbean and East Asia. In doing so, it explores very different notions of the regional to identify how transnational activism has both shaped and been shaped by these ideas. Taken together, the two parts highlight the role of regional identities and projects in challenging inequalities and external domination. Our analysis and examples indicate the possibilities of a regionally rooted approach for writing histories of transnational activism.
Glycerol is a byproduct of biodiesel synthesis by transesterification of triglycerides with short-chain alcohols in the presence of solid base catalysts. Because hydrotalcite is a potentially useful basic catalyst for the transesterification reaction, the interaction of glycerol with hydrotalcite is the focus of this work. Glycerol was intercalated into Mg-Al hydrotalcite with a Mg/Al molar ratio of 4 under elevated temperatures of 4432/503 K in the absence and presence of NaOH. The resulting materials were characterized by X-ray diffraction, Fourier transform infrared spectroscopy, thermogravimetric analysis, and N2 adsorption. The amount of glycerol incorporated into hydrotalcite increased with increasing temperature of intercalation. However, the brucite-like sheets of hydrotalcite partially decomposed during the intercalation process at the highest temperature. The presence of NaOH stabilized the hydrotalcite layers against decomposition under high temperature (503 K). The intercalated materials exposed large surface areas ranging from 142 to 663 m2 g−1, depending on the preparation conditions. The glycerol-intercalated hydrotalcites were less catalytically active than hydrotalcite with OH− counterions for the transesterification of tributyrin with methanol. The lower reactivity of glycerol-intercalated hydrotalcite was probably the result of a strong interaction between the intercalated glycerolate (HOCH2-CHOH-CH2O−) and the partially decomposed brucite-like sheets.
Area-based conservation is a widely used approach for maintaining biodiversity, and there are ongoing discussions over what is an appropriate global conservation area coverage target. To inform such debates, it is necessary to know the extent and ecological representativeness of the current conservation area network, but this is hampered by gaps in existing global datasets. In particular, although data on privately and community-governed protected areas and other effective area-based conservation measures are often available at the national level, it can take many years to incorporate these into official datasets. This suggests a complementary approach is needed based on selecting a sample of countries and using their national-scale datasets to produce more accurate metrics. However, every country added to the sample increases the costs of data collection, collation and analysis. To address this, here we present a data collection framework underpinned by a spatial prioritization algorithm, which identifies a minimum set of countries that are also representative of 10 factors that influence conservation area establishment and biodiversity patterns. We then illustrate this approach by identifying a representative set of sampling units that cover 10% of the terrestrial realm, which included areas in only 25 countries. In contrast, selecting 10% of the terrestrial realm at random included areas across a mean of 162 countries. These sampling units could be the focus of future data collation on different types of conservation area. Analysing these data could produce more rapid and accurate estimates of global conservation area coverage and ecological representativeness, complementing existing international reporting systems.
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.
Lumateperone (LUMA) is an FDA-approved antipsychotic to treat schizophrenia and depressive episodes associated with bipolar I or bipolar II disorder. An open-label study (Study 303) evaluated the safety and tolerability of LUMA in outpatients with stable schizophrenia who switched from previous antipsychotic (AP) treatment. This post hoc analysis of Study 303 investigated the safety and tolerability of LUMA stratified by previous AP in patients who switched to LUMA treatment for 6 weeks.
Methods
Adult outpatients (≥18 years) with stable schizophrenia were switched from previous AP to LUMA 42 mg once daily for 6 weeks followed by switching to another approved AP for 2 weeks follow-up. Post hoc analyses were stratified by most common previous AP: risperidone or paliperidone (RIS/PAL); quetiapine (QET); aripiprazole or brexpiprazole (ARI/BRE); olanzapine (OLA). Safety analyses included adverse events (AE), vital signs, and laboratory tests. Efficacy was assessed using the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impressions-Severity (CGI-S) scale.
Results
The safety population comprised 301 patients, of which 235 (78.1%) were previously treated with RIS/PAL (n=95), QET (n=60), ARI/BRE (n=43), or OLA (n=37). Rates of treatment-emergent AEs (TEAEs) while on LUMA were similar between previous AP groups (44.2%-55.8%). TEAEs with incidences of ≥5% in any AP group were dry mouth, somnolence, sedation, headache, diarrhea, cough, and insomnia. Most TEAEs were mild or moderate in severity for all groups. Rates of serious TEAEs were low and similar between groups (0%–7.0%).
Statistically significant (P<.05) decreases from baseline were observed in the OLA group that switched to LUMA in total cholesterol and low-density lipoprotein cholesterol with significant decreases thereafter on LUMA. Statistically significant decreases in prolactin levels were observed in both the RIS/PAL (P<.0001) and OLA (P<.05) groups. Patients switched from RIS/PAL to LUMA showed significant (P<.05) decreases for body mass index, waist circumference, and weight. At follow-up, 2 weeks after patients switched back from LUMA to another AP, none of the decreases in laboratory parameters or body morphology observed while on LUMA maintained significance.
Those switching from QET had significant improvements from baseline at Day 42 in PANSS Total score (mean change from baseline −3.47; 95% confidence interval [CI] −5.27, −1.68; P<.001) and CGI-S Total score (mean change from baseline −0.24; 95% CI, −0.38, −0.10; P<.01).
Conclusion
In outpatients with stable schizophrenia, LUMA 42 mg treatment was well tolerated in patients switching from a variety of previous APs. Patients switching from RIS/PAL or OLA to LUMA had significant improvements in cardiometabolic and prolactin parameters. These data further support the favorable safety, tolerability, and efficacy of LUMA in patients with schizophrenia.
Lumateperone is an FDA-approved antipsychotic to treat schizophrenia and depressive episodes associated with bipolar I or bipolar II disorder as monotherapy and as adjunctive therapy with lithium or valproate. This post hoc analysis investigated the efficacy and tolerability of lumateperone in patients with schizophrenia via number needed to treat (NNT), number needed to harm (NNH), and likelihood to be helped or harmed (LHH).
Methods
Data were pooled from three late-phase 4–6 week placebo-controlled studies of lumateperone 42 mg/day in adults with schizophrenia and an acute exacerbation of psychosis (Study 005 [NCT01499563], Study 301 [NCT02282761], Study 302 [NCT02469155]). NNT and NNH were calculated vs placebo for several different Positive and Negative Syndrome Scale [PANSS] Total score response cutoffs (percent reduction from baseline) and for adverse events (AEs), respectively.
Results
In the two informative studies (placebo, n=221; lumateperone, n=224), the NNT vs placebo for lumateperone was statistically significant for PANSS Total score reductions from baseline to 4 weeks/endpoint of ≥20% (NNT=9, 95% confidence interval [CI] 5–36) and ≥30% (NNT=8; 95%CI 5–21). In all studies pooled (placebo, n=412; lumateperone, n=406), study discontinuations due to AEs were uncommon and the NNH (389) was not statistically significant from placebo. The only AE with NNH vs placebo <10 was somnolence/sedation (NNH=8; 95%CI 6–12). With lumateperone treatment, weight gain ≥7% from baseline was similar to placebo (NNH=112) and fewer patients experienced akathisia than placebo. Lumateperone LHH ratios were >>1 for all AEs (range 13.6–48.6) except somnolence/sedation (LHH~1).
Conclusion
Lumateperone’s benefit-risk profile was favorable in late-phase schizophrenia trials.
The current coronavirus disease (COVID-19) pandemic has placed unprecedented strain on underfunded public health resources in the Southeastern United States. The Memphis, TN, metropolitan region has lacked infrastructure for health data exchange.
This manuscript describes a multidisciplinary initiative to create a community-focused COVID-19 data registry, the Memphis Pandemic Health Informatics System (MEMPHI-SYS). MEMPHI-SYS leverages test result data updated directly from community-based testing sites, as well as a full complement of public health data sets and knowledge-based informatics. It has been guided by relationships with community stakeholders and is managed alongside the largest publicly funded community-based COVID-19 testing response in the Mid-South. MEMPHI-SYS has supported interactive Web-based analytic resources and informs federally funded COVID-19 outreach directed toward neighborhoods most in need of pandemic support.
MEMPHI-SYS provides an instructive case study of how to collaboratively establish the technical scaffolding and human relationships necessary for data-driven, health equity-focused pandemic surveillance, and policy interventions.