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Over a span of three and a half centuries (1200–1550) Japan experienced profound transformations in the institutions, ideals, and methods of war. Originally a limited, clearly defined and extraordinary event, warfare became an endemic and encompassing element of life in the mid sixteenth century. Earlier, small bands of mounted warriors, skilled in archery, arrived in camp and departed as they saw fit, for no institutional mechanisms existed for them to supply themselves or their followers with food and materials of war. By the sixteenth century, however, powerful magnates (daimyō) were capable of supplying and maintaining large armies, numbering in the thousands, largely composed of pike-wielding foot soldiers.
The pharmacotherapy of epilepsy is a complex process guided by evidence-based research and clinical experience. Some patients achieve seizure freedom upon treatment with the first anti-seizure medication (ASM) prescribed, whereas others may be treated with two or three medications before one (or a combination) is found that reduces seizure frequency and/or severity with minimal side effects. Many patients demonstrate a partial response to treatment, leading to reduced seizure frequency and/or severity, but do not become completely seizure free. It is often stated that ~30% of epilepsy patients have seizures that cannot be controlled pharmacologically, and these patients are defined as having medication-resistant epilepsy (MRE). The International League Against Epilepsy (ILAE) published the following definition of MRE: ‘drug resistant epilepsy may be defined as failure of adequate trials of two tolerated and appropriately chosen and used ASM schedules (whether as monotherapies or in combination) to achieve sustained seizure freedom’. Treatment success or sustained seizure freedom is defined as one year without seizures or three times the inter-seizure interval (whichever is longer). The ILAE definition provides a useful standard from which to work, and MRE can be clinically identified in patients that fail to achieve seizure freedom after multiple ASM trials. However, the ILAE definition of successful treatment does not account for partial response to pharmacotherapy. Indeed, many partial responders have improved quality of life, even if they are not seizure-free for one year or more.
To characterize associations between exposures within and outside the medical workplace with healthcare personnel (HCP) SARS-CoV-2 infection, including the effect of various forms of respiratory protection.
We collected data from international participants via an online survey.
In total, 1,130 HCP (244 cases with laboratory-confirmed COVID-19, and 886 controls healthy throughout the pandemic) from 67 countries not meeting prespecified exclusion (ie, healthy but not working, missing workplace exposure data, COVID symptoms without lab confirmation) were included in this study.
Respondents were queried regarding workplace exposures, respiratory protection, and extra-occupational activities. Odds ratios for HCP infection were calculated using multivariable logistic regression and sensitivity analyses controlling for confounders and known biases.
HCP infection was associated with non–aerosol-generating contact with COVID-19 patients (adjusted OR, 1.4; 95% CI, 1.04–1.9; P = .03) and extra-occupational exposures including gatherings of ≥10 people, patronizing restaurants or bars, and public transportation (adjusted OR range, 3.1–16.2). Respirator use during aerosol-generating procedures (AGPs) was associated with lower odds of HCP infection (adjusted OR, 0.4; 95% CI, 0.2–0.8, P = .005), as was exposure to intensive care and dedicated COVID units, negative pressure rooms, and personal protective equipment (PPE) observers (adjusted OR range, 0.4–0.7).
COVID-19 transmission to HCP was associated with medical exposures currently considered lower-risk and multiple extra-occupational exposures, and exposures associated with proper use of appropriate PPE were protective. Closer scrutiny of infection control measures surrounding healthcare activities and medical settings considered lower risk, and continued awareness of the risks of public congregation, may reduce the incidence of HCP infection.
Reward Deficiency Syndrome (RDS) is an umbrella term for all drug and nondrug addictive behaviors, due to a dopamine deficiency, “hypodopaminergia.” There is an opioid-overdose epidemic in the USA, which may result in or worsen RDS. A paradigm shift is needed to combat a system that is not working. This shift involves the recognition of dopamine homeostasis as the ultimate treatment of RDS via precision, genetically guided KB220 variants, called Precision Behavioral Management (PBM). Recognition of RDS as an endophenotype and an umbrella term in the future DSM 6, following the Research Domain Criteria (RDoC), would assist in shifting this paradigm.
The emphasis on team science in clinical and translational research increases the importance of collaborative biostatisticians (CBs) in healthcare. Adequate training and development of CBs ensure appropriate conduct of robust and meaningful research and, therefore, should be considered as a high-priority focus for biostatistics groups. Comprehensive training enhances clinical and translational research by facilitating more productive and efficient collaborations. While many graduate programs in Biostatistics and Epidemiology include training in research collaboration, it is often limited in scope and duration. Therefore, additional training is often required once a CB is hired into a full-time position. This article presents a comprehensive CB training strategy that can be adapted to any collaborative biostatistics group. This strategy follows a roadmap of the biostatistics collaboration process, which is also presented. A TIE approach (Teach the necessary skills, monitor the Implementation of these skills, and Evaluate the proficiency of these skills) was developed to support the adoption of key principles. The training strategy also incorporates a “train the trainer” approach to enable CBs who have successfully completed training to train new staff or faculty.
Although the association between stress and poor reproductive health is well established, this association has not been examined from a life course perspective. Using data from the National Longitudinal Survey of Youth 1997 cohort (N = 1652), we fit logistic regression models to test the association between stressful life events (SLEs) (e.g., death of a close relative, victim of a violent crime) during childhood, adolescence, and early adulthood and later experiences of infertility (inability to achieve pregnancy after 12 months of intercourse without contraception) reported by female respondents. Because reactions to SLEs may be moderated by different family life experiences, we stratified responses by maternal responsiveness (based on the Conger and Elder Parent-Youth Relationship scale) in adolescence. After adjusting for demographic and environmental factors, in comparison to respondents with one or zero SLEs, those with 3 SLEs and ≥ 4 SLEs had 1.68 (1.16, 2.42) and 1.88 (1.38, 2.57) times higher odds of infertility, respectively. Respondents with low maternal responsiveness had higher odds of infertility that increased in a dose–response manner. Among respondents with high maternal responsiveness, only those experiencing four or more SLEs had an elevated risk of infertility (aOR = 1.53; 1.05, 2.25). In this novel investigation, we demonstrate a temporal association between the experience of SLEs and self-reported infertility. This association varies by maternal responsiveness in adolescence, highlighting the importance of maternal behavior toward children in mitigating harms associated with stress over the life course.
The Khao Wong Prachan Valley of central Thailand is one of four known prehistoric loci of copper mining, smelting and casting in Southeast Asia. Many radiocarbon determinations from bronze-consumption sites in north-east Thailand date the earliest copper-base metallurgy there in the late second millennium BC. By applying kernel density estimation analysis to approximately 100 new AMS radiocarbon dates, the authors conclude that the valley's first Neolithic millet farmers had settled there by c. 2000 BC, and initial copper mining and rudimentary smelting began in the late second millennium BC. This overlaps with the established dates for Southeast Asian metal-consumption sites, and provides an important new insight into the development of metallurgy in central Thailand and beyond.
In prehistoric coastal and western-central Thailand, rice was the dominant cultivar. In eastern-central Thailand, however, the first known farmers cultivated millet. Using one of the largest collections of archaeobotanical material in Southeast Asia, this article examines how cropping systems were adapted as domesticates were introduced into eastern-central Thailand. The authors argue that millet reached the region first, to be progressively replaced by rice, possibly due to climatic pressures. But despite the increasing importance of rice, dryland, rain-fed cultivation persisted throughout ancient central Thailand, a result that contributes to refining understanding of the development of farming in Southeast Asia.