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While most English words are multisyllabic, research on literacy acquisition has tended to focus on early acquisition of monosyllabic words. The processes involved in multisyllabic word reading and spelling in middle childhood are likely to differ from those in monosyllabic reading and spelling. The current paper examines the contributions of morphological awareness (MA; awareness of derivational morphemes), prosodic sensitivity (sensitivity to lexical stress), and phonological awareness (PA; awareness of phonemes) for multisyllabic word reading and spelling, after accounting for background variables (age, vocabulary, nonverbal IQ, short-term memory). Seventy 7–10-year-old children completed a battery of tasks. MA and prosodic sensitivity were independent predictors of multisyllabic reading, while MA and PA were independent predictors of multisyllabic spelling. These results contrast with previous research, which instead found that PA plays a more prominent role while prosodic sensitivity appears to demonstrate only an indirect influence. However, those studies largely examined reading of shorter, one to three syllable words. These findings indicate when words are longer and multisyllabic, prosodic sensitivity, PA, and MA have differing direct influences on literacy. MA and prosodic sensitivity relate to word reading, while MA and PA are important for spelling.
Recurrent outbreaks of haemolytic uraemic syndrome (HUS) caused by Shiga toxin-producing Escherichia coli (STEC) serotype O55:H7 occurred in England between 2014 and 2018. We reviewed the epidemiological evidence to identify potential source(s) and transmission routes of the pathogen, and to assess the on-going risk to public health. Over the 5-year period, there were 43 confirmed and three probable cases of STEC O55:H7. The median age of cases was 4 years old (range 6 months to 69 years old) and over half of all cases were female (28/46, 61%). There were 36/46 (78.3%) symptomatic cases, and over half of all cases developed HUS (25/46, 54%), including two fatal cases. No common food or environmental exposures were identified, although the majority of cases lived in rural or semi-rural environments and reported contact with both wild and domestic animals. This investigation informed policy on the clinical and public health management of HUS caused by STEC other than serotype O157:H7 (non-O157 STEC) in England, including comprehensive testing of all household contacts and household pets and more widespread use of polymerase chain reaction assays for the rapid diagnosis of STEC-HUS.
In George R. R. Martin's A Song of Ice and Fire and its HBO adaptation Game of Thrones, toxic masculinity is one of the central issues facing the nobility of Westeros in their day-to-day lives. Much of the conflict stems from expectations on men and their frequent inability or lack of desire to live up to these expectations. In the book series, Martin figures toxic masculinity as a major part of a patriarchal, feudal system, a system that the books ultimately argue is unsustainable and flawed. “Toxic masculinity” includes traits such as rigid gender roles, male dominance, aggressive competition with others, misogyny, and homophobia. Toxic masculinity is enforced through social pressure; those who do not or cannot conform are deemed “less than men,” or “womanish,” and may have their social standing lowered or stripped from them entirely.
Under the philosophy that creates toxic masculinity, men are not and cannot be victims, are not and cannot be abused or raped, and must always be in charge of their own fates. Therefore, any man who does find himself a victim of violence or sexual assault, or suffering from post-traumatic stress, or expressing any emotion besides anger, is removed from the category of “real man” and is blamed for his own abuse or mental health. Many of Martin's male characters find ways to live outside the expectations of toxic masculinity and are happier for it. However, in Game of Thrones, the nuance of Martin's critique is lost, and toxic masculinity is instead celebrated and rewarded.
This approach to masculinity is far from unusual in medievalist texts. Amy Kaufman has referred to this approach as “muscular medievalism,” arguing that toxic masculinity and its attendant violence and rape are used as “markers of medieval authenticity” in these texts. Susan Aronstein has also examined masculinist approaches to the Middle Ages, claiming that medievalisms such as reinterpretations of Arthurian legend allow men who fear loss of status or prestige a “history” in which to root their “restored patriarchy.”
Over the last decade, the Iraq War (2003-2011) has become a common subject in mainstream literary fiction. In this chapter, I analyze three key examples of veteran-authored novels: Nico Walker’s Cherry (2018), Michael Pitre’s Fives and Twenty-Fives (2014), and Kevin Powers’ The Yellow Birds (2012). I argue that it is important to read these novels not only as war literature but also as significant cultural representations of contemporary white masculinity. I show how, through their representations of the soldier as both a laboring white body and (as veteran) the traumatized bearer of witness to combat violence, these novels place their white, male protagonists in an exceptional space in which they are insulated from accountability. As such, they illustrate how trauma is used to shore up a particular version of white masculinity that is vulnerable in many ways but still claims a particular kind of authority and narrative control.
Topramezone and carfentrazone + 2,4-D + mecoprop-p + dicamba (SpeedZone®) are herbicides labeled for postemergence goosegrass (Eleusine indica L. Gaertn.) control in hybrid bermudagrass (C. dactylon x C. transvaalensis Burtt Davy). Field research was conducted in Knoxville, TN during 2019 and 2020 to evaluate goosegrass control and hybrid bermudagrass tolerance to these herbicides applied alone and in mixture. Treatments included topramezone (12.2 g ha-1), SpeedZone® [carfentrazone (33.6 g ha-1) + 2,4-D (1029 g ha-1) + mecoprop-p (322 g ha-1) + dicamba (91 g ha-1)] and SpeedZone® + topramezone at 12.2, 6.1, 3.6, or 2.4 g ha-1. A non-treated control was included for comparison. Hybrid bermudagrass tolerance was assessed on four cultivars (‘Northbridge’, ‘Tifway’, ‘Tahoma 31’, and ‘TifTuf’) via visual ratings of turfgrass injury and assessments of normalized difference vegetation index (NDVI). At the termination of the experiment, SpeedZone® alone and in mixture with topramezone controlled goosegrass ≥ topramezone alone. Mixtures of SpeedZone® + topramezone reduced injury on all cultivars compared to topramezone alone, particularly when mixtures delivered ≤ 6.1 g ha-1 topramezone. Injury subsided on all cultivars by 28 days after treatment regardless of herbicide. Findings suggest that SpeedZone® can be mixed with topramezone at the rates tested herein to minimize hybrid bermudagrass injury from topramezone applications for goosegrass control.
ABSTRACT IMPACT: The Independent Investigator Incubator program provides 1:1 mentoring from ‘super-mentors’ to enhance junior faculty careers in research. OBJECTIVES/GOALS: In 2014, the Indiana University School of Medicine (IUSM) in collaboration with the Indiana CTSI established the Independent Investigator Incubator (I3) Program. The I3 Program is designed to provide 1:1 mentoring for new research faculty during the crucial early years of their careers. Our goal is to provide an overview of the I3 design and 5-year data. METHODS/STUDY POPULATION: The I3 Program employs a resource-sharing, centralized design that provides concentrated 1:1 mentorship from a senior faculty ‘super mentor’ as well as other resources, such as grant writing support. Unlike many mentorship programs, I3 mentors closely interact with the mentees within the School and are compensated for their efforts (5% full-time equivalency per mentee, max of 15%). The number of ‘super mentors’ has grown from 6 to 15 faculty over 5 years, and mentors typically serve 4 to 5 mentees. Mentee applications are accepted on a rolling enrollment basis. The I3 mentees represent a diverse group based on sex, ethnicity, terminal degree, academic track, and discipline. Mentors and mentees have annual reviews through the program. RESULTS/ANTICIPATED RESULTS: In five years, 110 mentees have enrolled in the I3 program. Upon entering, 53% had no external funding, 28% had internal funding, 12% had K-awards, 7% had R03/R21 awards. Over the first five years, 75% have received extramural funding. The median funding was $340,000 with nearly a third of mentees securing grants > 1 million in direct costs. For mentees who joined the program in its first three years (n=59), the average time to a notable extramural grant (defined as a NIH or foundation grant >$300K direct costs) was 2.2 years (median - 2.6 years). Nearly all mentees were satisfied with their mentor pairing based on the mentor’s ‘availability’ and ‘valuable feedback,’ and all mentees wanted the mentoring relationship to continue DISCUSSION/SIGNIFICANCE OF FINDINGS: Since 2014, the I3 Program has had a positive impact on the careers of junior faculty at IUSM as determined by faculty satisfaction and funding metrics. Future focus areas will include developing criteria/models for graduating from the program to balance fiscal sustainability with mentee needs during their transition to mid-career.
ABSTRACT IMPACT: We present new programs aimed at training, retaining and preparing a diverse cadre of scientists to lead the field in transforming population health and advancing health equity OBJECTIVES/GOALS: To mitigate biases inherent to the R01 grant funding process, trainees from backgrounds underrepresented in medicine (URM) may benefit from enhanced mentorship and a longer ‘runway’ to funding. As such, we have deployed two synergistic programs that aim to support URM retention and advancement. METHODS/STUDY POPULATION: The URM Program for Advising in Research and Development (UPwARD) pairs URM trainees with 2 mentors: 1) an institutional leader from outside their discipline to serve as an internal advocate and 2) an external eminent scholar who will facilitate the scholar’s development and prominence within their discipline. Additionally, the KL2 Program to Launch URM Success (KL2 PLUS) offers URM trainees a third year of funding to focus on scholarship, grant writing and leadership development. Four specific training components of KL2 PLUS include: 1) PLUS II Seminar Series, 2) Faculty Success Program, 3) attendance at the AAMC Minority Faculty Leadership Conference, and 4) CTSI Committee Service. RESULTS/ANTICIPATED RESULTS: Along with measures of productivity (papers, grants, K to R transition), we will utilize social network analyses and measures of collaboration, retention, and future CTSI engagement to evaluate the programs “success’‘ as both are designed to enhance trainee scholarly development and expand their professional and social networks. UPwARD does so by supporting engagement with external mentors at professional meetings and travel to present work across institutions. PLUS writing accountability groups will enhance publication rates and grant submissions, while also building connections with other URM faculty. Trainees also serve on IN CTSI committees to groom talent for future IN CTSI leadership. DISCUSSION/SIGNIFICANCE OF FINDINGS: Systemic inequities underlie the ‘leaky pipeline’ challenge we face in cultivating a diverse cadre of senior scientists and independent investigators. With intentional programming and targeted investments, IN CTSI aims to advance more equitable funding outcomes and diverse leadership.
According to a familiar story about class actions in the United States, aggregation promotes access to counsel by increasing the amount of money from which counsel fees can be taken. Courts usually award class counsel a percentage of the monetary recovery obtained on behalf of the class, and class treatment can turn a $30 case into a $3 million case. But what about class actions that do not involve monetary relief at all?
During the eighteenth century, British publishers capitalized on a growing market for educational toys with board games aimed at teaching geography. These games used maps as game boards, encouraging children to view maps as sites of play. Yet the fixed version of the world presented in a gameboard map was often at odds both with the political realities of the period and with the rapid overturns of chance-driven gameplay. This essay analyses a series of surviving games from the period, illustrating the evolution of the geographical game from an eighteenth-century tool of nationalist propaganda to a more subversive nineteenth-century form that took advantage of board games’ inherent association with chance. In the board game, publishers found a visual form that could unite cartography with unpredictability and that could train players to read maps as stable representations of an unstable world. The mechanism of the game itself – its relationship to chance and unpredictability – ultimately came to be seen as a useful device for structuring the Romantics’ relationship to a world in flux.
Bayesian probability models uncertain knowledge and learning from observations. As a defining feature of optimal adversarial behaviour, Bayesian reasoning forms the basis of safety properties in contexts such as privacy and fairness. Probabilistic programming is a convenient implementation of Bayesian reasoning but the adversarial setting imposes obstacles to its use: approximate inference can underestimate adversary knowledge and exact inference is impractical in cases covering large state spaces. By abstracting distributions, the semantics of a probabilistic language, and inference, jointly termed probabilistic abstract interpretation, we demonstrate adversary models both approximate and sound. We apply the techniques to build a privacy-protecting monitor and describe how to trade off the precision and computational cost in its implementation while remaining sound with respect to privacy risk bounds.
Clinical decision-making in psychiatry is affected by many factors, including how best to reduce risks of harm while promoting autonomy and personal recovery. This article proposes guidance for clinical decision-making that is consistent with civil liability law. It emphasises collaboration, clarification of the available information and communication of decisions as a basis for recovery-oriented risk management.
This article examines the politics of wine making in Alsace in the two decades after the region returned to French rule in 1918. During these years Alsatian wine makers worked to transform their wines to meet the tastes of French drinkers, following five decades of producing wine for German consumption. As wine makers grappled with the question of how to secure the future of their industry, Alsatian wine became emblematic of the most contentious aspects of Alsace's reintegration into France. The introduction of new laws on viticulture raised the question of what was French about wine, the wine industry's woes symbolised the difficulties of Alsace's economic reintegration and wine became an emblem for often fierce wrangling over identity and belonging in the recovered region. This article traces this process and argues that while wine became a symbol of the complications of reintegration, its importance in understandings of French national culture equally allowed it to offer a solution to the problems that return to France caused for Alsace's wine industry in the interwar years. In this way, this case study of the politics of wine making in Alsace is suggestive of wine's broader power as a symbol of national belonging.
In 2012, the American Heart Association and the American Academy of Paediatrics released a scientific statement with guidelines for the evaluation and management of the neurodevelopmental needs of children with CHD. Decades of outcome research now highlight a range of cognitive, learning, motor, and psychosocial vulnerabilities affecting individuals with CHD across the lifespan. The number of institutions with Cardiac Neurodevelopmental Follow-Up Programmes and services for CHD is growing worldwide. This manuscript provides an expanded set of neurodevelopmental evaluation strategies and considerations for professionals working with school-age children with CHD. Recommendations begin with the referral process and access to the evaluation, the importance of considering medical risk factors (e.g., genetic disorders, neuroimaging), and the initial clinical interview with the family. The neurodevelopmental evaluation should take into account both family and patient factors, including the child/family’s primary language, country of origin, and other cultural factors, as well as critical stages in development that place the child at higher risk. Domains of assessment are reviewed with emphasis on target areas in need of evaluation based on current outcome research with CHD. Finally, current recommendations are made for assessment batteries using a brief core battery and an extended comprehensive clinical battery. Consistent use of a recommended assessment battery will increase opportunities for research collaborations, and ultimately help improve the quality of care for families and children with CHD.
Background: Many institutions have reported transmission of multidrug-resistant organisms to patients from colonized sinks. Prior data have shown that bacterial colonization of the sink drain, which can occur via biofilm from a colonized p-trap or via seeding from above, results in dispersion of bacteria in the area of the sink when water from the faucet comes in contact with the drain. Heat disruption of biofilm formation between the p-trap and sink drain is a potential strategy in preventing colonization of sink drains. Methods: In an academic center hospital, 54 tail-piece heaters were installed in 3 intensive care units and 2 acute-care units in an associated regional hospital. Half of the installed devices were sham (no heat). The devices were programmed to heat the tail piece to 72C for 1 hour every fourth hour. Rooms were randomized to heating or sham devices on a 1:1 basis within each unit. Sink drains and p-traps were sampled biweekly. Samples were assessed for semiquantitative growth of gram-negative bacteria on MacConkey agar, looking especially for Pseudomonas aeruginosa and Stenotrophomonas maltophilia. Carbapenemase-producing Enterobacterales (CPE) was detected by broth enrichment followed by growth on Colorex KPC agar. Frontline personnel were blinded to device assignment. Results: Linear mixed modeling revealed reduced risk of detectable gram-negative bacteria (OR, 0.16; 95% CI, 0.037–0.536) and Enterobacterales (OR, 0.17; 95% CI, 0.368–0.668) in sink drains with a heating device (Fig. 1), but no difference in risk of detectable P. aeruginosa or S. maltophilia (Table 1). We detected a trend toward reduction in CPE that did not reach statistical significance, and there was no difference in risk for detection of any bacteria in the p-trap between heating and sham devices. Audits of devices demonstrated that few reached the target heating temperature of 72C (median, 65.9C; range, 50.1–73.7C). Conclusions: Disruption of biofilm between the p-trap and the sink drain is a promising strategy for the prevention of sink-drain colonization with clinically important bacteria. The presence of a heating device was associated with reduced risk of detectable gram-negative organisms, specifically Enterobacterales, in sink drains. The limitations of this study included low overall rates of positivity for certain pathogens, including CPE, and suboptimal, inconsistent performance across heating devices. Further work with a larger sample size and more consistent heating devices is warranted, as are data regarding patient outcomes as a result of such interventions.
Background:Staphylococcus aureus (S. aureus) is the second most common cause of healthcare-acquired infections in neonates. S. aureus colonization is a known risk factor for invasive disease. Aside from healthcare workers (HCWs), recent data suggest that parents are important reservoirs of S. aureus in the neonatal intensive care unit (NICU). S. aureus typically colonizes the nares, but it can also colonize other anatomic locations such as the throat. Objective: Our objectives were to identify and compare S. aureus colonization among HCWs and parents and to identify and compare different sites of S. aureus colonization. Methods: Between April 2015 and July 2016, we performed 4 point-prevalence surveys and collected nares and throat swabs from HCWs (nurses, respiratory therapists, nurse practitioners, and physicians) at a quaternary-care NICU. During an overlapping period, we screened parents of neonates in the NICU for S. aureus colonization using nares, throat, groin, and perianal cultures as a part of an ongoing randomized control trial. Cultures from both studies were collected using standardized methods. ESwabs were used to collect samples, which were inoculated into broth for enrichment and subsequently cultured onto chromogenic agar to differentiate between MSSA and MRSA. Results: The prevalence of methicillin susceptible S. aureus (MSSA) colonization was 46% (105/226) in HCWs and 28% (239/842) in parents. The prevalence of methicillin resistant S. aureus (MRSA) colonization was 2.2% (5/226) in HCWs and 2.2% (19/842) in parents. Of those who were colonized with S. aureus, 35% (79/226) of HCWs and 46.5% (160/344) of parents had nares and throat colonization while 11.5% (26/226) of HCWs and 12.2% (42/344) of parents had only throat colonization but not nares colonization. Of those who were MRSA colonized, 1.3% (3/226) of HCWs and 1.8% (15/842) of parents had a positive nares and throat culture as compared to 0.9% (2/226) of HCWs and 0.2% (2/842) of parents had only positive throat cultures. Additionally, 68% (175/257) were colonized with S. aureus at any swabbed site including nares, throat, groin, or perinanal areas. However, only 30% (77/257) of parents had only nares colonization as compared to 58.8% (151/257) had throat and nares colonization, 38.1% (98/257) had nares and groin colonization, and 37.4% (96/257) had nares and perianal colonization. Conclusions: HCWs had greater prevalence of S. aureus colonization compared to parents. As expected, the nares was the most common site of MSSA and MRSA, but a large proportion of S. aureus colonized HCWs and parents had only throat colonization. Given the prevalence of S. aureus in non-nares sites of HCWs and parents in the NICU, further studies should examine the role of non-nares carriers in the transmission of S. aureus in this population.
Disclosures: Aaron Milstone reports consultancy with Becton Dickinson.
There is increasing evidence of a strong association between sleep and mental health in both adolescents and adults. CBT for insomnia is being applied to good effect with adults with mental health difficulties but there are few studies examining its applicability to adolescents within mental health services.
We carried out a case series analysis (n = 15) looking at the feasibility, accessibility and impact of a low-intensity sleep intervention for young people (14–25 years) being seen by a secondary care Youth Mental Health team in the UK. The intervention was based on cognitive behavioural therapy for insomnia (CBTi) and acceptance and commitment therapy (ACT) approaches and involved six individual sessions delivered on a weekly basis by a graduate psychologist. Routine outcome measures were used to monitor insomnia, psychological distress and functioning with assessments at baseline, session 3, session 6 and at 4 weeks after end of intervention. All participants scored in the clinical range for insomnia at the start of the study.
High uptake, attendance and measure completion rates were observed. Large effect sizes were observed for insomnia, psychological distress and functioning. Twelve of the fifteen participants (80%) no longer scored above threshold for insomnia at follow-up. All seven under-18s no longer met threshold for clinical ‘caseness’ on the Revised Child Anxiety and Depression Scale (RCADS) at follow-up.
The findings suggest that the intervention was well accepted by young people and feasible to apply within a secondary care setting. Strong effect sizes are encouraging but are probably inflated by the small sample size, uncontrolled design and unblinded assessments.
A GERMAN PROVERB PARAPHRASING an old Carolingian maxim observed, “He who has stayed at school till the age of twelve, and never ridden a horse, is fit only to be a priest.” The aphorism obliquely refers to the chief practitioners of the medieval horse culture, the secular nobility, who received rigorous instruction in horsemanship from an early age. One particularly demanding aspect of this lifelong education entailed the schooling of horse and rider in the performance of turns. These moves, in contrast to the one directional charge of set battles and jousts, demonstrate the maneuverability to perform feigned retreats as well as skirmishing and ravaging warfare, now considered the most prevalent form of medieval mounted combat. The topic requires laying extensive groundwork to make certain principles of horsemanship and horse training intelligible to the uninitiated reader, a process that involves enhancing the meaning of texts discussed previously.
Emergence of the Western European Equestrian Tradition
At either end of the chronological spectrum two treatises, Arrian's Ars Tactica of c. 136–37 CE and Federico Grisone's Ordini di Caualcare of 1550, explained equestrian maneuvers. For the intervening period in the Latin West, information on horse training is scattered in various sources. Medieval horse trainers were men of action who transmitted their knowledge through oral tradition. The best practitioners were not always the best explicators. The Histoire de Guillaume le Maréchal, has little to say about the subject. His career illustrates the tremendous upward social mobility that could be achieved in this medieval horse culture. William Marshal managed to parlay his skills as tournament champion into major governmental service, eventually becoming Regent of England. King Duarte of Portugal, the author of a treatise on horsemanship, had intended to write a complementary work on the training of war horses; unfortunately, the plague prematurely ended his life. Grisone, who acquired a reputation for brutal training methods, still set down in writing principles that represent the culmination of the medieval oral tradition, and the widespread acceptance of the work ensured its preeminence as the foundation of the European equestrian heritage.