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From the Trojan War to the sack of Rome, from the fall of Constantinople to the bombings of World War II and the recent devastation of Syrian towns, the destruction of cities and the slaughter of civilian populations are among the most dramatic events in world history. But how reliable are literary sources for these events? Did ancient authors exaggerate the scale of destruction to create sensational narratives? This volume reassesses the impact of physical destruction on ancient Greek cities and its demographic and economic implications. Addressing methodological issues of interpreting the archaeological evidence for destructions, the volume examines the evidence for the destruction, survival, and recovery of Greek cities. The studies, written by an international group of specialists in archaeology, ancient history, and numismatic, range from Sicily to Asia Minor and Aegean Thrace, and include Athens, Corinth, and Eretria. They highlight the resilience of ancient populations and the recovery of cities in the long term.
Chapter 2 explores the structure and evolution of federal, state, and international SORN policies. The chapter first outlines the history of federal legislation in the United States that has shaped the current SORN environment, beginning with the 1994 Jacob Wetterling Act and continuing through the 2006 Sex Offender Registration and Notification Act (SORNA) and its subsequent amendments. The chapter then explores the key points of variation in state SORN policies, underscoring the elusive nature of fulfilling SORNA’s vision of a uniform national system. This analysis examines two particularly prominent points of interstate variation: provisions for the registration of juveniles and mechanisms for registrant classification. The chapter concludes with a brief examination of SORN systems outside the United States, indicating that, although many countries have adopted provisions for requiring registration with law enforcement, the provision of public access to registrant information is far less common.
Early in the COVID-19 pandemic, CDC recommended collection of a lower respiratory tract (LRT) specimen for SARS-CoV-2 testing in addition to the routinely recommended upper respiratory tract (URT) testing in mechanically ventilated patients. Significant operational challenges were noted at our institution using this approach. In this report, we describe our experience with routine collection of paired URT and LRT sample testing. Our results revealed a high concordance between the two sources, and that all children tested for SARS-CoV-2 were appropriately diagnosed with URT testing alone. There was no added benefit to LRT testing. Based on these findings, our institutional approach was therefore adjusted to sample the URT alone for most patients, with LRT sampling reserved for patients with ongoing clinical suspicion for SARS-CoV-2 after a negative URT test.
Our objective was to describe, for the first time in an English-speaking Caribbean country, the contribution of ultra-processed foods (UPFs) to nutrients linked to non-communicable disease. Using a cross-sectional study design, dietary data were collected from two non-consecutive 24-h dietary recalls. Recorded food items were then classified according to their degree of processing by the NOVA system. The present study took place in Barbados (2012–13). A representative population-based sample of 364 adult Barbadians (161 males and 203 females) aged 25–64 years participated in the study. UPFs represented 40⋅5 % (838 kcal/d; 95 % CI 791, 885) of mean energy intake. Sugar-sweetened beverages made the largest contribution to energy within the UPF category. Younger persons (25–44 years) consumed a significantly higher proportion of calories from UPF (NOVA group 4) compared with older persons (45–64 years). The mean energy shares of UPF ranged from 22⋅0 to 58⋅9 % for those in the lowest tertile to highest tertile. Within each tertile, the energy contribution was significantly higher in the younger age group (25–44 years) compared with the older (45–64 years). One-quarter of persons consume ≥50 % of their daily calories from UPF, this being significantly higher in younger persons. The ultra-processed diet fraction contained about six times the mean of free sugars and about 0⋅8 times the dietary fibre of the non-ultra-processed fraction (NOVA groups 1–3). Targeted interventions to decrease the consumption of UPF especially in younger persons is thus of high priority to improve the diet quality of Barbadians.
Among patients with schizophrenia (SZ) and bipolar I disorder (BD-I) treated with second-generation antipsychotics (SGAs), clinically-significant weight gain (CSWG) and treatment interruptions (TIs) are challenges that may result in morbidity/mortality.
CSWG and TIs were assessed among patients who initiated oral SGAs of moderate-to-high weight gain risk (no exposure to index SGAs/first-generation antipsychotics for =12 months) using medical records/claims (OM1 Data Cloud; January 2013-February 2020). Outcomes included CSWG (=7% increase in baseline weight) and TIs (switches [to SGAs of low weight gain risk/long-acting injectables] or discontinuations [no SGAs for >30 days]). Descriptive analyses included proportions of patients with CSWG and TIs, and median time to these outcomes.
Approximately three-quarters of patients were overweight/obese at baseline (SZ: N=8,174; BD-I: N=9,142). Within 3 months of SGA initiation, 12% of all patients experienced CSWG. For patients on treatment with index SGAs for >6 months (SZ: 29%; BD-I: 27%), 28% (SZ) and 30% (BD-I) experienced CSWG during follow-up. Median time to CSWG was 14 weeks. CSWG results were numerically similar among patients with SZ and BD-I.
Over 96% of patients had TIs during follow-up (median time of 12 [SZ] and 13 [BD-I] weeks). Among patients with CSWG and subsequent TIs and weight measurements, 74% did not return to baseline weight after interrupting treatment; the remainder returned to baseline weight with median times of 38 (SZ) and 39 (BD-I) weeks. Results suggest that most patients with CSWG do not return to baseline weight after stopping treatment with oral SGAs of moderate-to-high weight gain risk.
Roads affect wildlife in a variety of negative ways. Road ecology studies have mostly concentrated on areas in the northern hemisphere despite the potentially greater impact of roads on biodiversity in tropical habitats. Here, we examine 4 years (January 2016–December 2019) of opportunistic observations of mammalian roadkill along a road intersecting Jozani-Chwaka Bay National Park, Unguja, Zanzibar. In particular, we assess the impact of collisions on the population of an endemic primate, the Endangered Zanzibar red colobus Piliocolobus kirkii. Primates accounted for the majority of roadkill in this dataset. Monthly rainfall was not associated with roadkill frequency for mammals generally, nor for the Zanzibar red colobus. No single age–sex class of colobus was found dead more often than expected given their occurrence in the local population. The overall effect of roadkill on colobus populations in habitats fragmented by roads is unknown given the lack of accurate, long-term life history data for this species. Our findings suggest that mortality from collisions with vehicles in some groups of colobus is within the range of mortality rates other primates experience under natural predation. Unlike natural predators, however, vehicles do not kill selectively, so their impact on populations may differ. Although a comparison with historical accounts suggests that the installation of speedbumps along the road near the Park's entrance has led to a significant decrease in colobus roadkill, further actions to mitigate the impact of the road could bring substantial conservation benefits.
Previous results have been mixed regarding the role of the apolipoprotein E e4 (APOE e4) allele in later-life depression: some studies note that carriers experience greater symptoms and increased risk while others find no such association. However, there are few prospective, population-based studies of the APOE e4-depression association and fewer that examine depressive symptom trajectory and depression risk longitudinally. We examined the association between APOE e4 allele status and longitudinal change in depressive symptoms and depression risk in later-life, over a 12-year follow-up period.
We used data from 690 participants of the Lothian Birth Cohort 1936 who took part in the Scottish Mental Survey 1947 (aged 11) and were followed-up in later-life over five waves from 2004 to 2019 (aged 70–82). We used APOE e4 allele status to predict longitudinal change in depressive symptom scores and risk of depression (defined by a symptom score threshold or use of depression-related medication). Models were adjusted for sex, childhood cognitive ability, childhood social class, education, adult social class, smoking status and functional limitations at baseline.
Depressive symptom scores increased with age. Once adjusted for covariates, APOE e4 allele status did not significantly predict symptom score trajectories or depression risk. Greater functional limitations at baseline significantly predicted poorer symptom score trajectories and increased depression risk (defined by medications). APOE e4 allele status did not significantly moderate the contribution of sex, education or functional limitations.
There was no evidence that APOE e4 carriers experience an increased risk for later-life depression.
The development of maternal representations of the child during pregnancy guides a mother’s thoughts, feelings, and behavior toward her child. The association between prenatal representations, particularly those that are disrupted, and toddler social-emotional functioning is not well understood. The present study examined associations between disrupted prenatal representations and toddler social-emotional functioning and to test disrupted maternal behavior as a mediator of this association. Data were drawn from 109 women from a larger prospective longitudinal study (N=120) of women and their young children. Prenatal disrupted maternal representations were assessed using the Working Model of the Child Interview disrupted coding scheme, while disrupted maternal behavior was coded 12-months postpartum from mother-infant interactions. Mother-reported toddler social-emotional functioning was assessed at ages 12 and 24 months. Disrupted prenatal representations significantly predicted poorer toddler social-emotional functioning at 24 months, controlling for functioning at 12 months. Further, disrupted maternal behavior mediated the relation between disrupted prenatal representations and toddler social-emotional problems. Screening for disrupted representations during pregnancy is needed to facilitate referrals to early intervention and decrease the likelihood of toddler social-emotional problems.
The Athenians believed in the importance of the rule of law and implemented this ideal through their legal procedures. The courts of Athens were based on the principles of equality before the law, fairness in procedure, no punishment without law, and the accountability of officials.
A millimetre-size superhydrophobic sphere impacting on the free surface of a quiescent bath can be propelled back into the air by capillary effects and dynamic fluid forces, whilst transferring part of its energy to the fluid. We report the findings of a thorough investigation of this phenomenon, involving different approaches. Over the range from minimum impact velocities required to produce rebounds to impact velocities that cause the sinking of the solid sphere, we focus on the dependence of the coefficient of restitution, contact time and maximum surface deflection on the different physical parameters of the problem. Experiments, simulations and asymptotic analysis reveal trends in the rebound metrics, uncover new phenomena at both ends of the Weber number spectrum, and collapse the data. Direct numerical simulations using a pseudo-solid sphere successfully reproduce experimental data whilst also providing insight into flow quantities that are challenging to determine from experiments. A model based on matching the motion of a perfectly hydrophobic impactor to a linearised fluid free surface is validated against direct numerical simulations and used in the low-Weber-number regime. The hierarchical and cross-validated models in this study allow us to explore the entirety of our target parameter space within a challenging multi-scale system.
Systemic venous hypertension and low cardiac output are believed to be important mediators of liver injury after the Fontan procedure. Pulmonary vasodilators have the potential to improve such haemodynamics. The aim of this study was to assess the acute effects of exercise on liver stiffness and venous pressures and to assess the impact of inhaled Treprostinil on this response.
In this prospective, double-blind, placebo-controlled, crossover trial, 14 patients with a Fontan circulation were randomised to inhalation of placebo and Treprostinil. Incremental and constant work rate exercise tests were performed to assess the effect of Treprostinil on exercise tolerance. Venous pressures were measured throughout and liver stiffness at rest and immediately after peak exercise.
Mean age was 27.8 ± 7.9 years and 66% were females. Exercise acutely increased liver stiffness by 30% (mean shear wave speed: 2.38 ± 0.71 versus 2.89 ± 0.51 ms, p = 0.02). Peripheral venous pressures increased acutely during both incremental (12.1 ± 2.4 versus 22.6 ± 8.0 mmHg, p < 0.001) and constant work rate exercise (12.5 ± 2.5 versus 23.4 ± 5.2 mmHg, p < 0.001). Overall, Treprostinil failed to attenuate exercise-induced increases in liver stiffness. Compared with placebo, Treprostinil did not significantly impact venous pressure responses, VO2peak, nor exercise endurance times.
Peripheral venous pressure increased acutely during exercise by an average of 88% above baseline and was not altered by administration of inhaled Treprostinil. Liver stiffness measured immediately post-exercise increased acutely by an average of 30%, with no attenuation following Treprostinil inhalation.
This SHEA white paper identifies knowledge gaps and challenges in healthcare epidemiology research related to coronavirus disease 2019 (COVID-19) with a focus on core principles of healthcare epidemiology. These gaps, revealed during the worst phases of the COVID-19 pandemic, are described in 10 sections: epidemiology, outbreak investigation, surveillance, isolation precaution practices, personal protective equipment (PPE), environmental contamination and disinfection, drug and supply shortages, antimicrobial stewardship, healthcare personnel (HCP) occupational safety, and return to work policies. Each section highlights three critical healthcare epidemiology research questions with detailed description provided in supplementary materials. This research agenda calls for translational studies from laboratory-based basic science research to well-designed, large-scale studies and health outcomes research. Research gaps and challenges related to nursing homes and social disparities are included. Collaborations across various disciplines, expertise and across diverse geographic locations will be critical.
The first demonstration of laser action in ruby was made in 1960 by T. H. Maiman of Hughes Research Laboratories, USA. Many laboratories worldwide began the search for lasers using different materials, operating at different wavelengths. In the UK, academia, industry and the central laboratories took up the challenge from the earliest days to develop these systems for a broad range of applications. This historical review looks at the contribution the UK has made to the advancement of the technology, the development of systems and components and their exploitation over the last 60 years.
To determine whether electronically available comorbidities and laboratory values on admission are risk factors for hospital-onset Clostridioides difficile infection (HO-CDI) across multiple institutions and whether they could be used to improve risk adjustment.
All patients at least 18 years of age admitted to 3 hospitals in Maryland between January 1, 2016, and January 1, 2018.
Comorbid conditions were assigned using the Elixhauser comorbidity index. Multivariable log-binomial regression was conducted for each hospital using significant covariates (P < .10) in a bivariate analysis. Standardized infection ratios (SIRs) were computed using current Centers for Disease Control and Prevention (CDC) risk adjustment methodology and with the addition of Elixhauser score and individual comorbidities.
At hospital 1, 314 of 48,057 patient admissions (0.65%) had a HO-CDI; 41 of 8,791 patient admissions (0.47%) at community hospital 2 had a HO-CDI; and 75 of 29,211 patient admissions (0.26%) at community hospital 3 had a HO-CDI. In multivariable regression, Elixhauser score was a significant risk factor for HO-CDI at all hospitals when controlling for age, antibiotic use, and antacid use. Abnormal leukocyte level at hospital admission was a significant risk factor at hospital 1 and hospital 2. When Elixhauser score was included in the risk adjustment model, it was statistically significant (P < .01). Compared with the current CDC SIR methodology, the SIR of hospital 1 decreased by 2%, whereas the SIRs of hospitals 2 and 3 increased by 2% and 6%, respectively, but the rankings did not change.
Electronically available patient comorbidities are important risk factors for HO-CDI and may improve risk-adjustment methodology.
The Clinical and Translational Science Awards (CTSA) Consortium, a network of academic health care institutions with CTSA hubs, is charged with improving the national clinical and translational research enterprise. The CTSA Consortium and the NIH National Center for Advancing Translational Sciences implemented the Common Metrics Initiative comprised of standardized metrics and a shared performance improvement framework. This article summarizes hubs’ perspectives on its value during the initial implementation.
The value was assessed across 58 hubs. Survey items assessed change in perceived ability to manage performance and advance clinical and translational science. Semi-structured interviews elicited hubs’ perspectives on meaningfulness and value-added of the Common Metrics Initiative and hubs’ recommendations.
Hubs considered their abilities to manage performance to have improved, but there was no change in perceived ability to advance clinical and translational science. The initiative added value by providing a formal structured process, enabling strategic conversations, facilitating improvements in processes, providing an external impetus for improvement, and providing justification for funds invested. Hubs were concerned about the usefulness of the metrics chosen and whether the value-added was sufficient relative to the effort required. Hubs recommended useful benchmarking, disseminating best practices and promoting peer-to-peer learning, and expanding the use of data to inform the initiative.
Implementing Common Metrics and a performance improvement framework yielded concrete short-term benefits, but concerns about usefulness remained, particularly considering the effort required. The Common Metrics Initiative should focus on facilitating cross-hub collaboration around metrics that address high-priority impact areas for individual hubs and the Consortium.
It is unclear if mild-to-moderate dehydration independently affects mood without confounders like heat exposure or exercise. This study examined the acute effect of cellular dehydration on mood. Forty-nine adults (55 % female, age 39 (sd 8) years) were assigned to counterbalanced, crossover trials. Intracellular dehydration was induced with 2-h (0·1 ml/kg per min) 3 % hypertonic saline (HYPER) infusion or 0·9 % isotonic saline (ISO) as a control. Plasma osmolality increased in HYPER (pre 285 (sd 3), post 305 (sd 4) mmol/kg; P < 0·05) but remained unchanged in ISO (pre 285 (sd 3), post 288 (sd 3) mmol/kg; P > 0·05). Mood was assessed with the short version of the Profile of Mood States Questionnaire (POMS). The POMS sub-scale (confusion-bewilderment, depression-dejection, fatigue-inertia) increased in HYPER compared with ISO (P < 0·05). Total mood disturbance score (TMD) assessed by POMS increased from 10·3 (sd 0·9) to 16·6 (sd 1·7) in HYPER (P < 0·01), but not in ISO (P > 0·05). When TMD was stratified by sex, the increase in the HYPER trial was significant in females (P < 0·01) but not in males (P > 0·05). Following infusion, thirst and copeptin (surrogate for vasopressin) were also higher in females than in males (21·3 (sd 2·0), 14·1 (sd 1·4) pmol/l; P < 0·01) during HYPER. In conclusion, cellular dehydration acutely degraded specific aspects of mood mainly in women. The mechanisms underlying sex differences may be related to elevated thirst and vasopressin.
When a poorly conducting drop that is surrounded by a more conducting exterior fluid is subjected to an electric field, the drop can deform into an oblate shape at low field strengths. Such drops become unstable at high field strengths and display two types of dynamics, dimpling and equatorial streaming, the physics of which is currently not understood. If the drop is more viscous, dimples form and grow at the poles of the drop and eventually the discocyte-shaped drop breaks up to form a torus. If the exterior fluid is more viscous, the drop deforms into a lens and sheds rings from the equator that subsequently break into a number of smaller droplets. A theoretical explanation as to why dimple- and lens-shaped drops occur, and the mechanisms for the onset of these instabilities, are provided by determining steady-state solutions by simulation and inferring their stability from bifurcation analysis. For large drop viscosities, electric shear stress is shown to play a dominant role and to result in dimpling. For small drop viscosities, equatorial normal stresses (electric, hydrodynamic and capillary) become unbounded and lead to the lens shape.