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Many families, despite need and eligibility, struggle to meet programme deadlines to retain critical benefits. When families fail to complete programme recertification on time, they lose needed support. While scholars have tested behavioural theories like chunking, implementation intention, and loss framing to promote programme uptake, less is known about how well-designed communications can promote continuity through successful recertification, especially where recertification entails a significant administrative burden. Further, scant evidence guides how best to frame recertification deadlines. In a randomised trial with government partners (n = 3,539), we find that sending a reminder letter informed by these behavioural theories increased the number of families maintaining participation by 14 per cent. Further, anchoring people to a deadline month may suffice to thread the motivational needle: overcoming procrastination without lowering self-efficacy by anchoring them to a specific day. Adopting the most effective letter in Washington, DC, would lead 766 more families to participate uninterrupted each year.
Electroanatomic mapping systems are increasingly used during ablations to decrease the need for fluoroscopy and therefore radiation exposure. For left-sided arrhythmias, transseptal puncture is a common procedure performed to gain access to the left side of the heart. We aimed to demonstrate the radiation exposure associated with transseptal puncture.
Data were retrospectively collected from the Catheter Ablation with Reduction or Elimination of Fluoroscopy registry. Patients with left-sided accessory pathway-mediated tachycardia, with a structurally normal heart, who had a transseptal puncture, and were under 22 years of age were included. Those with previous ablations, concurrent diagnostic or interventional catheterisation, and missing data for fluoroscopy use or procedural outcomes were excluded. Patients with a patent foramen ovale who did not have a transseptal puncture were selected as the control group using the same criteria. Procedural outcomes were compared between the two groups.
There were 284 patients in the transseptal puncture group and 70 in the patent foramen ovale group. The transseptal puncture group had a significantly higher mean procedure time (158.8 versus 131.4 minutes, p = 0.002), rate of fluoroscopy use (38% versus 7%, p < 0.001), and mean fluoroscopy time (2.4 versus 0.6 minutes, p < 0.001). The acute success and complication rates were similar.
Performing transseptal puncture remains a common reason to utilise fluoroscopy in the era of non-fluoroscopic ablation. Better tools are needed to make non-fluoroscopic transseptal puncture more feasible.
This study aimed to explore the association between hyperglycemia in pregnancy (type 2 diabetes (T2D) and gestational diabetes mellitus (GDM)) and child developmental risk in Europid and Aboriginal women.
PANDORA is a longitudinal birth cohort recruited from a hyperglycemia in pregnancy register, and from normoglycemic women in antenatal clinics. The Wave 1 substudy included 308 children who completed developmental and behavioral screening between age 18 and 60 months. Developmental risk was assessed using the Ages and Stages Questionnaire (ASQ) or equivalent modified ASQ for use with Aboriginal children. Emotional and behavioral risk was assessed using the Strengths and Difficulties Questionnaire. Multivariable logistic regression was used to assess the association between developmental scores and explanatory variables, including maternal T2D in pregnancy or GDM.
After adjustment for ethnicity, maternal and child variables, and socioeconomic measures, maternal hyperglycemia was associated with increased developmental “concern” (defined as score ≥1 SD below mean) in the fine motor (T2D odds ratio (OR) 5.30, 95% CI 1.77–15.80; GDM OR 3.96, 95% CI 1.55–10.11) and problem-solving (T2D OR 2.71, 95% CI 1.05–6.98; GDM OR 2.54, 95% CI 1.17–5.54) domains, as well as increased “risk” (score ≥2 SD below mean) in at least one domain (T2D OR 5.33, 95% CI 1.85–15.39; GDM OR 4.86, 95% CI 1.95–12.10). Higher maternal education was associated with reduced concern in the problem-solving domain (OR 0.27, 95% CI 0.11–0.69) after adjustment for maternal hyperglycemia.
Maternal hyperglycemia is associated with increased developmental concern and may be a potential target for intervention so as to optimize developmental trajectories.
Despite the numerous advantages of central venous catheters (CVCs), they have been associated with a variety of complications. Surveillance for mechanical complications of CVCs is not routine, so the true incidence and impact of this adverse patient outcome remains unclear.
Setting and methods:
Prospectively collected CVC data on mechanical complications were reviewed from a centralized database for all in-hospital patient days at our tertiary-care hospital from January 2001 to June 2016 in patients aged <19 years. Patient demographics, CVC characteristics, and rates of mechanical complications per 1,000 days of catheter use were described.
In total, 8,747 CVCs were placed in 5,743 patients during the study period, which captured 780,448 catheter days. The overall mechanical complication rate was 6.1 per 1,000 catheter days (95% confidence interval [CI], 5.9–6.3). The highest complication rates were in nontunneled lines; this was consistent throughout the 15-year study period. Also, 521 CVCs (∼6%) were removed due to mechanical complications before therapy termination. Catheters with tip location in the superior vena cava or right atrium had the fewest complications.
Mechanical complications of CVCs are a common and significant event in the pediatric population. We propose that CVC-associated mechanical complications become a routinely reported patient safety outcome.
We implemented a parent–teacher Vanderbilt agreement program to increase return rates of Vanderbilt assessment scales for children in our primary care practice, and compared the assessment return rate before and after agreement signature.
We retrospectively reviewed children diagnosed with attention-deficit/hyperactivity disorder (ADHD) who had a signed Vanderbilt agreement and were under continuous care at our clinic. Return rates were compared 1 year before and 1 year after the agreement date.
Among 195 children, prior to the agreement, 71% returned teacher assessments, and 59% returned parent forms; after the intervention, assessment rates were not significantly different (76%, p = .255; and 65%, p = .185, respectively). The median number of returned assessments increased after the agreement.
Lack of documented parent and teacher Vanderbilt assessments remain a barrier to appropriate management of ADHD. Improving the rate of assessments returned is an important outcome for treating ADHD in the primary care setting.
Carole Crumley’s (1979; 1995a; 1995b; 2015) explorations on the applicability of heterarchy as a concept within archaeology have been highly influential in Anglo-American discourse on social organization. Despite largely emerging from Crumley’s work on Iron Age France (Crumley, 1979), however, the relevance of heterarchy as a concept for challenging hierarchical models of European Iron Age societies has largely been restricted to Britain (e.g. Moore, 2007a; Hill, 2011), where evidence for “elites” seems most obviously lacking. Northwestern Iberia has also been a locus for discussion of acephalous and nonhierarchical social forms (Fernández-Posse & Sánchez-Palencia, 1998; González-García et al., 2011; González-Ruibal, 2012; Sastre-Prats, 2011), but one where explicit discussions of heterarchy have rarely featured. More recently, it has been argued that almost all European Iron Age societies can be regarded as “broadly heterarchical” (e.g. Bradley et al., 2015: 260), although the wider implications of this have yet to be explored. What is the place, then, of heterarchy in Iron Age studies? Has it merely become a label for all nonhierarchical models (Fernández-Götz, 2014: 36), creating various Iron Age “societies against the state” (Clastres, 1977), or does it offer ways of exploring not just alternatives to hierarchies but thicker descriptions of how all Iron Age societies worked?
Adhering to a Mediterranean diet (MD) is associated with reduced CVD risk. This study aimed to explore methods of increasing MD adoption in a non-Mediterranean population at high risk of CVD, including assessing the feasibility of a developed peer support intervention. The Trial to Encourage Adoption and Maintenance of a MEditerranean Diet was a 12-month pilot parallel group RCT involving individuals aged ≥ 40 year, with low MD adherence, who were overweight, and had an estimated CVD risk ≥ 20 % over ten years. It explored three interventions, a peer support group, a dietician-led support group and a minimal support group to encourage dietary behaviour change and monitored variability in Mediterranean Diet Score (MDS) over time and between the intervention groups, alongside measurement of markers of nutritional status and cardiovascular risk. 118 individuals were assessed for eligibility, and 75 (64 %) were eligible. After 12 months, there was a retention rate of 69 % (peer support group 59 %; DSG 88 %; MSG 63 %). For all participants, increases in MDS were observed over 12 months (P < 0·001), both in original MDS data and when imputed data were used. Improvements in BMI, HbA1c levels, systolic and diastolic blood pressure in the population as a whole. This pilot study has demonstrated that a non-Mediterranean adult population at high CVD risk can make dietary behaviour change over a 12-month period towards an MD. The study also highlights the feasibility of a peer support intervention to encourage MD behaviour change amongst this population group and will inform a definitive trial.
Laboratory and greenhouse studies were conducted to evaluate the effects of chemical treatments applied to Palmer amaranth seeds or gynoecious plants that retain seeds to determine seed germination and quality. Treatments applied to physiologically mature Palmer amaranth seed included acifluorfen, dicamba, ethephon, flumioxazin, fomesafen, halosulfuron, linuron, metribuzin, oryzalin, pendimethalin, pyroxasulfone, S-metolachlor, saflufenacil, trifluralin, and 2,4-D plus crop oil concentrate applied at 1× and 2× the suggested use rates from the manufacturer. Germination was reduced by 20% when 2,4-D was used, 15% when dicamba was used, and 13% when halosulfuron and pyroxasulfone were used. Use of dicamba, ethephon, halosulfuron, oryzalin, trifluralin, and 2,4-D resulted in decreased seedling length by an average of at least 50%. Due to the observed effect of dicamba, ethephon, halosulfuron, oryzalin, trifluralin, and 2,4-D, these treatments were applied to gynoecious Palmer amaranth inflorescence at the 2× registered application rates to evaluate their effects on progeny seed. Dicamba use resulted in a 24% decrease in seed germination, whereas all other treatment results were similar to those of the control. Crush tests showed that seed viability was greater than 95%, thus dicamba did not have a strong effect on seed viability. No treatments applied to Palmer amaranth inflorescence affected average seedling length; therefore, chemical treatments did not affect the quality of seeds that germinated.
The earliest stage in the innovation lifecycle, problem formulation, is crucial for setting direction in an innovation effort. When faced with an interesting problem, engineers commonly assume the approximate solution area and focus on ideating innovative solutions. However, in this project, NASA and their contracted partner, Accenture, collaboratively conducted problem discovery to ensure that solutioning efforts were focused on the right problems, for the right users, and addressing the most critical needs—in this case, exploring weather tolerant operations (WTO) to further urban air mobility (UAM) – known as UAM WTO. The project team leveraged generative, qualitative methods to understand the ecosystem, players, and where challenges in the industry are inhibiting development. The complexity of the problem area required that the team constantly observe and iterate on problem discovery, effectively “designing the design process.” This paper discusses the approach, methodologies, and selected results, including significant insights on the application of early-stage design methodologies to a complex, system-level problem.
Given the aging population of people with HIV (PWH), along with increasing rates of binge drinking among both PWH and the general older adult population, this study examined the independent and interactive effects of HIV, binge drinking, and age on neurocognition.
Participants were 146 drinkers stratified by HIV and binge drinking status (i.e., ≥4 drinks for women and ≥5 drinks for men within approximately 2 h): HIV+/Binge+ (n = 30), HIV−/Binge+ (n = 23), HIV+/Binge− (n = 55), HIV−/Binge− (n = 38). All participants completed a comprehensive neuropsychological battery measuring demographically-corrected global and domain-specific neurocognitive T scores. ANCOVA models examined independent and interactive effects of HIV and binge drinking on neurocognitive outcomes, adjusting for overall alcohol consumption, lifetime substance use, sex, and age. Subsequent multiple linear regressions examined whether HIV/Binge group moderated the relationship between age and neurocognition.
HIV+/Binge+ participants had worse global neurocognition, processing speed, delayed recall, and working memory than HIV−/Binge− participants (p’s < .05). While there were significant main effects of HIV and binge drinking, their interaction did not predict any of those neurocognitive outcomes (p’s > .05). Significant interactions between age and HIV/Binge group showed that HIV+/Binge+ participants demonstrated steeper negative relationships between age and neurocognitive outcomes of learning, delayed recall, and motor skills compared to HIV−/Binge− participants (p’s < .05).
Results showed adverse additive effects of HIV and binge drinking on neurocognitive functioning, with older adults demonstrating the most vulnerability to these effects. Findings support the need for interventions to reduce binge drinking, especially among older PWH.
Field studies were conducted to evaluate linuron for POST control of Palmer amaranth in sweetpotato to minimize reliance on protoporphyrinogen oxidase (PPO)-inhibiting herbicides. Treatments were arranged in a two by four factorial in which the first factor consisted of two rates of linuron (420 and 700 g ai ha−1), and the second factor consisted of linuron applied alone or in combinations of linuron plus a nonionic surfactant (NIS; 0.5% vol/vol), linuron plus S-metolachlor (800 g ai ha−1), or linuron plus NIS plus S-metolachlor. In addition, S-metolachlor alone and nontreated weedy and weed-free checks were included for comparison. Treatments were applied to ‘Covington’ sweetpotato 8 d after transplanting (DAP). S-metolachlor alone provided poor Palmer amaranth control because emergence had occurred at applications. All treatments that included linuron resulted in at least 98% and 91% Palmer amaranth control 1 and 2 wk after treatment (WAT), respectively. Including NIS with linuron did not increase Palmer amaranth control compared to linuron alone, but it resulted in greater sweetpotato injury and subsequently decreased total sweetpotato yield by 25%. Including S-metolachlor with linuron resulted in the greatest Palmer amaranth control 4 WAT, but increased crop foliar injury to 36% 1 WAT compared to 17% foliar injury from linuron alone. Marketable and total sweetpotato yields were similar between linuron alone and linuron plus S-metolachlor or S-metolachlor plus NIS treatments, though all treatments resulted in at least 39% less total yield than the weed-free check resulting from herbicide injury and/or Palmer amaranth competition. Because of the excellent POST Palmer amaranth control from linuron 1 WAT, a system that includes linuron applied 7 DAP followed by S-metolachlor applied 14 DAP could help to extend residual Palmer amaranth control further into the critical period of weed control while minimizing sweetpotato injury.
As humans have spread across the globe, travel and trade have deliberately or inadvertently carried and released animals and plants as well as microbes into new geographies. With human populations concentrated along rivers and coasts, it is not surprising that many exotic species have been released in coastal areas and a few can survive and thrive, especially in habitats similar to those where they evolved. In tidal marshes, organisms experience some of the most extreme physical conditions on earth: temperatures from −20 to 40°C, flooding twice a day but only a few times a month at higher elevations, sediments ranging from oxidized to severely reduced (Eh of +700 to −300 mV), soil salinity from hypersaline (40–90 ppt) to fresh depending on floodwater source and precipitation, and erosive forces from waves, currents, and ice at higher latitudes. Despite these harsh and variable conditions, there are many organisms adapted to tidal marshes, and new introductions and hybrids that can thrive given the opportunity.
Questions remain regarding whether genetic influences on early life psychopathology overlap with cognition and show developmental variation.
Using data from 9,421 individuals aged 8–21 from the Philadelphia Neurodevelopmental Cohort, factors of psychopathology were generated using a bifactor model of item-level data from a psychiatric interview. Five orthogonal factors were generated: anxious-misery (mood and anxiety), externalizing (attention deficit hyperactivity and conduct disorder), fear (phobias), psychosis-spectrum, and a general factor. Genetic analyses were conducted on a subsample of 4,662 individuals of European American ancestry. A genetic relatedness matrix was used to estimate heritability of these factors, and genetic correlations with executive function, episodic memory, complex reasoning, social cognition, motor speed, and general cognitive ability. Gene × Age analyses determined whether genetic influences on these factors show developmental variation.
Externalizing was heritable (h2 = 0.46, p = 1 × 10−6), but not anxious-misery (h2 = 0.09, p = 0.183), fear (h2 = 0.04, p = 0.337), psychosis-spectrum (h2 = 0.00, p = 0.494), or general psychopathology (h2 = 0.21, p = 0.040). Externalizing showed genetic overlap with face memory (ρg = −0.412, p = 0.004), verbal reasoning (ρg = −0.485, p = 0.001), spatial reasoning (ρg = −0.426, p = 0.010), motor speed (ρg = 0.659, p = 1x10−4), verbal knowledge (ρg = −0.314, p = 0.002), and general cognitive ability (g)(ρg = −0.394, p = 0.002). Gene × Age analyses revealed decreasing genetic variance (γg = −0.146, p = 0.004) and increasing environmental variance (γe = 0.059, p = 0.009) on externalizing.
Cognitive impairment may be a useful endophenotype of externalizing psychopathology and, therefore, help elucidate its pathophysiological underpinnings. Decreasing genetic variance suggests that gene discovery efforts may be more fruitful in children than adolescents or young adults.
Catheter ablation is a safe and effective therapy for the treatment of supraventricular tachycardia in children. Current improvements in technology have allowed progressive reduction in radiation exposure associated with the procedure. To assess the impact of three-dimensional mapping, we compared acute procedural results collected from the Catheter Ablation with Reduction or Elimination of Fluoroscopy registry to published results from the Prospective Assessment after Pediatric Cardiac Ablation study.
Inclusion and exclusion criteria from the Prospective Assessment after Pediatric Cardiac Ablation study were used as guidelines to select patient data from the Catheter Ablation with Reduction or Elimination of Fluoroscopy registry to compare acute procedural outcomes between cohorts. Outcomes assessed include procedural and fluoroscopy exposure times, success rates of procedure, and complications.
In 786 ablation procedures, targeting 498 accessory pathways and 288 atrioventricular nodal reentrant tachycardia substrates, average procedural time (156.5 versus 206.7 minutes, p < 0.01), and fluoroscopy time (1.2 versus 38.3 minutes, p < 0.01) were significantly shorter in the study group. Success rates for the various substrates were similar except for manifest accessory pathways which had a significantly higher success rate in the study group (96.4% versus 93.0%, p < 0.01). Major complication rates were significantly lower in the study group (0.3% versus 1.6%, p < 0.01).
In a large, multicentre study, three-dimensional systems show favourable improvements in clinical outcomes in children undergoing catheter ablation of supraventricular tachycardia compared to the traditional fluoroscopic approach. Further improvements are anticipated as technology advances.
Field studies were conducted in 2019 and 2020 to compare the effects of shade cloth light interception and Palmer amaranth (Amaranthus palmeri S. Watson) competition on ‘Covington’ sweetpotato [Ipomoea batatas (L.) Lam.]. Treatments consisted of a seven by two factorial arrangement, in which the first factor included shade cloth with an average measured light interception of 41%, 59%, 76%, and 94% and A. palmeri thinned to 0.6 or 3.1 plants m−2 or a nontreated weed-free check; and the second factor included shade cloth or A. palmeri removal timing at 6 or 10 wk after planting (WAP). Amaranthus palmeri light interception peaked around 710 to 840 growing degree days (base 10 C) (6 to 7 WAP) with a maximum light interception of 67% and 84% for the 0.6 and 3.1 plants m−2 densities, respectively. Increasing shade cloth light interception by 1% linearly increased yield loss by 1% for No. 1, jumbo, and total yield. Yield loss increased by 36%, 23%, and 35% as shade cloth removal was delayed from 6 to 10 WAP for No. 1, jumbo, and total yield, respectively. F-tests comparing reduced versus full models of yield loss provided no evidence that the presence of yield loss from A. palmeri light interception caused yield loss different than that explained by the shade cloth at similar light-interception levels. Results indicate that shade cloth structures could be used to simulate Covington sweetpotato yield loss from A. palmeri competition, and light interception could be used as a predictor for expected yield loss from A. palmeri competition.
Ecosystem modeling, a pillar of the systems ecology paradigm (SEP), addresses questions such as, how much carbon and nitrogen are cycled within ecological sites, landscapes, or indeed the earth system? Or how are human activities modifying these flows? Modeling, when coupled with field and laboratory studies, represents the essence of the SEP in that they embody accumulated knowledge and generate hypotheses to test understanding of ecosystem processes and behavior. Initially, ecosystem models were primarily used to improve our understanding about how biophysical aspects of ecosystems operate. However, current ecosystem models are widely used to make accurate predictions about how large-scale phenomena such as climate change and management practices impact ecosystem dynamics and assess potential effects of these changes on economic activity and policy making. In sum, ecosystem models embedded in the SEP remain our best mechanism to integrate diverse types of knowledge regarding how the earth system functions and to make quantitative predictions that can be confronted with observations of reality. Modeling efforts discussed are the Century ecosystem model, DayCent ecosystem model, Grassland Ecosystem Model ELM, food web models, Savanna model, agent-based and coupled systems modeling, and Bayesian modeling.
ABSTRACT IMPACT: The knowledge acquired from my research can inform the development of early diagnostic methods for HIV-associated neurocognitive disorders. OBJECTIVES/GOALS: In the era of combination antiretroviral therapy (cART), the prevalence of HIV-associated neurocognitive disorders (HAND) remains high but the neural mechanisms are unclear. We examined whether older people with HIV (PWH) with minimal cognitive impairment have reduced functional connectivity in frontostriatal circuits compared to controls. METHODS/STUDY POPULATION: 99 PWH (mean age 56.6 years, 75% male, 62% Black, mean duration of HIV-infection 26.2 years ±9.3, 90% viral load <50 copies, 98% on stable cART) and 38 demographically-comparable controls (mean age 54.5 years, 71% male, 58% Black) participated in a cross-sectional study. A 7-domain neuropsychological battery and an Activities of Daily Living index were used to determine HAND diagnoses: 32 PWH met criteria for asymptomatic to mild HAND. Motor skill was assessed using the Grooved Pegboard Test by measuring performance speed. Structural MRI and resting-state functional MRI were collected. Seed-to-voxel analyses were conducted using 4 distinct regions in the striatum as seed regions. We used a voxel threshold of p<0.001 and cluster threshold of p<0.05 (FDR-corrected) after controlling for demographic variables. RESULTS/ANTICIPATED RESULTS: Compared to controls, PWH had lower resting state functional connectivity between the default mode region of the striatum (i.e., medial caudate) and bilateral superior frontal gyrus, supplementary motor cortex and paracingulate gyrus (p<0.05; cluster size: 567 voxels). Also, compared to controls, PWH had reduced resting state functional connectivity between the motor division of the striatum (i.e., posterior putamen) and anterior cingulate cortex and left supplementary motor cortex (p<0.05, cluster size: 405 voxels). Performance speed on the Grooved Pegboard motor test negatively correlated with functional connectivity between the motor region of the striatum and supplementary motor frontal regions in all participants (Spearman’s rho=-0.18, p=0.04). DISCUSSION/SIGNIFICANCE OF FINDINGS: Our results support the hypothesis that frontostriatal abnormalities are widely present in PWH and might play a key role in HAND development. Our data suggest that dysfunction within the frontostriatal circuits may be involved in motor impairment in PWH, and ongoing inflammation may contribute to motor impairment and frontostriatal injury.
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.