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Chemical, biological, radiological, and nuclear (CBRN) incidents require meticulous preparedness, particularly in the Middle East and North Africa (MENA) region. This study evaluated CBRN response operational flowcharts, tabletop training scenarios methods, and a health sector preparedness assessment tool specific to the MENA region.
Methods
An online Delphi survey engaging international disaster medicine experts was conducted. Content validity indices (CVIs) were used to validate the items. Consensus metrics, including interquartile ranges (IQRs) and Kendall’s W coefficient, were utilized to assess the panelists’ agreement levels. Advanced artificial intelligence computing methods, including sentiment analysis and machine-learning methods (t-distributed stochastic neighbor embedding [t-SNE] and k-means), were used to cluster the consensus data.
Results
Forty experts participated in this study. The item-level CVIs for the CBRN response flowcharts, preparedness assessment tool, and tabletop scenarios were 0.96, 0.85, and 0.84, respectively, indicating strong content validity. Consensus analysis demonstrated an IQR of 0 for most items and a strong Kendall’s W coefficient, indicating a high level of agreement among the panelists. The t-SNE and k-means identified four clusters with greater European response engagement.
Conclusions
This study validated essential CBRN preparedness and response tools using broad expert consensus, demonstrating their applicability across different geographic areas.
Pathogenic CACNA1A mutations can result in paroxysmal attacks of encephalopathy, hemiplegia and cerebral edema. We report two patients with CACNA1A-associated encephalopathy, hemiplegia and contralateral hemispheric cerebral edema treated successfully with intravenous magnesium sulfate and dexamethasone. One patient met the clinical criteria for familial hemiplegic migraine. There is a paucity of guidance in the literature on how to manage these patients. Despite some discrepancies in the treatment protocols in our two cases, they indicate that magnesium and dexamethasone could be part of the treatment algorithm for these patients. Further research to delineate appropriate dosing and duration of therapy is needed.
Tools for analysing additive manufacturability often employ complex models that lack transparency; this impedes user understanding and has detrimental effects on the implementation of results. An expert system tool that transparently learns features for successful printing has been created. The tool uses accessible data from STL models and printer configurations to create explainable parameters and identify risks. Testing has shown good agreement to print behaviour and easy adaptability. The tool reduces the learning curves designers face in understanding design for additive manufacturing.
Social Network Analysis is a method of analyzing coauthorship networks or relationships through graph theory. Institutional Development Award (IDeA) Networks for Clinical and Translational Research (IDeA-CTR) was designed to expand the capability for clinical and translational research to enhance National Institutes of Health funding.
Methods:
All publications from a cohort of clinical and translational scientists in Oklahoma were collected through a PubMed search for 2014 through 2021 in October 2022. For this study’s bibliometric portion, we pulled the citations from iCite in November of 2022.
Results:
There were 2,391 articles published in 1,019 journals. The number of papers published by year increased from 56 in 2014 to 448 in 2021. The network had an average of 6.4 authors per paper, with this increasing by year from 5.3 in 2014 to 6.9 in 2021. The average journal impact factor for the overall network was 7.19, with a range from 0.08 to 202.73. The Oklahoma Shared Clinical and Translational Resources (OSCTR) network is a small world network with relatively weak ties.
Conclusions:
This study provides an overview of coauthorship in an IDeA-CTR collaboration. We show the growth and structure of coauthorship in OSCTR, highlighting the importance of understanding and fostering collaboration within research networks.
Background: Neonates colonized with methicillin-resistant Staphylococcus aureus (MRSA) are at high risk of developing life-threatening MRSA infection. Due to lack of evidence, national guidelines do not currently recommend a specific methodology for detecting MRSA colonization. We hypothesize that surveillance for MRSA colonization via polymerase chain reaction (PCR) is superior to culture for the detection of colonization. Methods: In this retrospective study, we compared results of MRSA surveillance by 2 methodologies, culture and PCR, after implementation of an MRSA surveillance and decolonization protocol in the Texas Children’s Hospital Pavilion for Women, a 42-bed neonatal intensive care unit. MRSA colonization of 3 body sites via the 2 methodologies was assessed from June 2017 through December 2020. All neonates were screened for MRSA upon admission to the NICU and weekly thereafter until MRSA-positive or discharged. Swab specimens were initially tested by PCR (Xpert MRSA NxG, Cepheid) and when MRSA-positive reflexed to culture to recover the organism for further characterization. This study was approved through the Baylor College of Medicine Institutional Review Board. Results: During the study period, 2,351 neonates were assessed for MRSA colonization by PCR; 81 (3.4%) infants were PCR positive (Fig. 1). Of those 81, 57 (70.4%) had concordant MRSA PCR and culture results, and 24 (29.6%) were MRSA PCR positive but no isolate was recovered in culture. Also, 8 specimens were indeterminate by PCR. However, 1 infant who was negative by culture but was PCR positive developed an MRSA orbital infection. Compared to PCR, the overall sensitivity of MRSA culture was 70.4% (range, 57.7%–80.8%, depending on the year) (Table 1). Conclusions: PCR is more sensitive than culture for detecting MRSA colonization in neonates. Utilizing a PCR method enhances the ability to identify MRSA colonized infants more readily and allows for prompt initiation of infection control interventions including isolation precautions and decolonization strategies. Reflex to culture remains important for strain characterization during outbreak investigations and for additional susceptibility testing. Resource utilization and cost–benefit analyses should be done in future studies to influence changes in national guidelines for the control of Staphylococcus aureus colonization and infection in neonatal intensive care units.
When The Viking-Age Gold and Silver of Scotland (AD 850–1100) was published in 1995, the catalogue detailed the contents of thirty-four hoards containing coins and/or ornaments and bullion (in the form of ingots and hack-silver) which could be linked to Viking activity and Norse settlement in Scotland during the 9th to 11th centuries, together with all of the known single finds. A subsequent paper (Graham-Campbell 2008) brought to attention more recent discoveries and some further (lost) antiquarian material (summarised below). In this update, it was pointed out (ibid.: 194) that the total of thirty-four hoards was in no way definitive, given the likelihood of some duplication, with [7] being recommended for deletion, as subsequently [16] and now also [21], but with the addition of a (lost) coin hoard reportedly discovered in St Kilda in the 18th century [2a], and since then a small gold hoard from Jura, found in 1869 [25a], and the Galloway (2014) Hoard [35]. Finally, renewed consideration is given to the inclusion of two further hoards, both from south-west Scotland [6a] and [30a], originally rejected as probably ‘non-Viking’. Their addition to the overall total means that the revised corpus currently consists of thirtysix hoards. For a recent survey of the use of silver in Scotland 75–1000 ad, see Blackwell, Goldberg and Hunter, Scotland’s Early Silver (2017), and for Scandinavian Scotland, see Horne (2021).
Hoards: Addenda and corrigenda
[1] Port Glasgow (near), Renfrewshire (1699)
Hugh Pagan (2014) has recovered important information pertaining to this mixed hoard, augmenting our knowledge of both its provenance and contents, from letters written by (or addressed to) the Rev. Robert Wodrow (1679–1734), who at the time of its discovery was the newly appointed Librarian of the University of Glasgow. Pagan confirms that ‘a date of deposit of c. 970’ is ‘appropriate’ (ibid.: 419) and concludes that: … it can now be seen that the hoard was found ‘within a mile of Port Glasgow’ and on a ‘brae’ [‘by the falling doun of some earth’], i.e.
Already by the time our volume Vikings in Scotland: An Archaeological Survey came to fruition in 1998, it was becoming clear that even two authors could not fully encompass the range of developing evidence. Scientific endeavours, new methodologies and the explosion of environmental data, with burgeoning analysis, were beginning to dominate research agendas beyond our specialisms. During the succeeding decades, these aspects have developed into commonly applied approaches, complementing the study of antiquarian sources, place-names and historical documentation. Taken together, all these aspects provide a unique suite of interdisciplinary tools. The contents of this current – and most timely – volume highlight both the richness of the evidence and the results of a collegiate approach within our discipline as a whole.
Several different approaches are already enabling a much fuller – and potentially more accurate – understanding of the Scandinavians in Scotland. In combination with more commonly applied methods, new approaches and new scientific methodologies are already integrated, and all are providing a much wider platform for discussion. Commencing with a reassessment of accepted narratives, a number of issues can be addressed. Making use of new refinements in C14 determinations, artefactual studies (for example, Ashby on combs, this volume) and isotopic/ aDNA studies, it is becoming more likely that we will be able to establish more clearly the dating of the arrival of the Vikings on our shores, as well as the nature of that arrival and interaction between native and incoming populations. The thorny issue of whether this was peaceful or violent is less commonly dictating the agenda now, being replaced with a more nuanced understanding of regional variations and continuing regimes of landscape exploitation (see, for example, Dockrill and Bond, and Macniven, this volume). The nature of this potential population replacement is informed through isotopic examination where the origin of individuals can be interrogated. The consideration of ethnic identities and their expression in newly settled areas has fascinating potential.
Major datasets ripe for reinterpretation and amplification include little- understood early settlement excavations, markedly Jarlshof in Shetland. As an oft-cited archaeological sequence of developing farmsteads, the issues with the stratigraphy and associated (or otherwise) artefact groups have cast a long shadow over the interpretation of many artefact assemblages from broadly contemporary sites. Items are uncritically considered to be securely dated in the Jarlshof sequence and are cited as datable parallels, when in fact the stratigraphical sequence is problematic.
The ‘Pagan Norse Graves of Scotland’ Research Project (PNGS) was initiated in 1995 with the award of a research grant to James Graham- Campbell (UCL) by the Leverhulme Trust. This, together with funding from the National Museums of Scotland (NMS), enabled the creation of a temporary post at NMS to catalogue and research Viking-Age gravefinds, to which Caroline Paterson (then Richardson) was duly appointed. In 1997, NMS with Historic Scotland funded a short extension for her to accession the finds from the Norwegian excavations of the Viking cemetery at Westness, Rousay, Orkney (Kaland 1993; Sellevold 1999, 2010), then newly returned from Bergen, in part intended for display in the new Museum of Scotland.
After a fallow period, PNGS was revived in 2017 thanks again to the Leverhulme Trust, with the award to Graham-Campbell of an Emeritus Fellowship, but in the meantime there were several lesser, but no less welcome, grants in support of PNGS (to be acknowledged in the final publication). The present outline, by Graham-Campbell and Paterson, includes a review of relevant recent literature on the subject by Stephen Harrison (University of Glasgow).
The point of departure for PNGS has been the catalogue of ‘Viking antiquities in Scotland’, published in 1940 by the Norwegian archaeologist Sigurd Grieg, based on a study-tour undertaken during a couple of months in 1925 (1940: 9–10). It formed the basis for general studies of the material by both Brøgger (1929, 1930) and Shetelig (1945, 1954) and is an indispensable work, but ‘the book teems with blunders’ (Thorsteinsson 1968: 164). For anyone wishing to map the distribution of pagan Norse graves in Scotland (for example, Crawford 1987, fig. 31), it is all that there has been to go on, with the result that Grieg’s inaccuracies and errors (including duplications) have inevitably been reproduced in terms of both overall numbers and individual examples of doubtful date/provenance. In the case of numbers, for example, PNGS has been able to increase Shetland’s three accepted graves to maybe thirteen (Graham-Campbell 2016, with additions), and for Orkney, including the two burial places at Pierowall, Westray and Westness, Rousay (see below), the total has reached a possible ninety-seven.
Trinity Church, built in the British concession at Shanghai in 1847–48, was the first Christian church erected for the foreign community there. Although it was an important centre of worship for that community, within twenty years it had collapsed and been demolished; it was replaced by the current church, erected to designs by George Gilbert Scott between 1866 and 1869, since when the original church has been largely forgotten. However, the failures in construction that led to its demolition are instructive. Drawing on the transnational knowledge network of the British empire, especially the experience of the existing British settlements at Hong Kong and Canton (Guangzhou) a thousand miles to the south, the projectors of the building attempted to combine western and Chinese constructional traditions and practices. The colonists believed they were educating the workforce in the (purportedly superior) methods of the west, but they succeeded only in producing a constructional hybrid, with disastrous consequences. As a work of construction, the first Trinity Church reveals the problematic nature of building production in early treaty-port era Shanghai, while as a cultural construct it stands as a failed example of the so-called pedagogy of imperialism.
The combination of double-sided laser heating in the diamond anvil cell and detailed chemical analysis of the recovered samples is a promising approach to explore the chemistry of the Earth’s deep interior from the lower mantle to the core. Routine recovery of laser-heated samples coupled with chemical and textural characterization at the submicron scale is the key to expand knowledge of chemical interactions and melting at extreme conditions, particularly in complex systems. Recent technical developments have allowed us to investigate element partitioning and melting relations at pressures approaching the Earth’s inner-core boundary. In this chapter, we review the techniques used for recovering tiny laser-heated samples and analyzing their chemical compositions and quenched textures, while highlighting key experiments that address silicate–metal element partitioning during mantle–core differentiation, silicate melting relations with applications to early magma ocean crystallization and deep mantle melting, and melting relations in iron-alloy systems relevant to the core. The results have drastically expanded our understanding of element redistribution at deep chemical boundaries and the chemical evolution of the deep mantle and the inner core. Finally, we emphasize the need for standardized protocols to obtain consistent, reproducible results and streamlined procedures to promote good practice and increase productivity. A broad collaboration with a systematic approach would further advance the field of high-pressure geochemistry.
The combination of double-sided laser heating in the diamond anvil cell and detailed chemical analysis of the recovered samples is a promising approach to explore the chemistry of the Earth’s deep interior from the lower mantle to the core. Routine recovery of laser-heated samples coupled with chemical and textural characterization at the submicron scale is the key to expand knowledge of chemical interactions and melting at extreme conditions, particularly in complex systems. Recent technical developments have allowed us to investigate element partitioning and melting relations at pressures approaching the Earth’s inner-core boundary. In this chapter, we review the techniques used for recovering tiny laser-heated samples and analyzing their chemical compositions and quenched textures, while highlighting key experiments that address silicate–metal element partitioning during mantle–core differentiation, silicate melting relations with applications to early magma ocean crystallization and deep mantle melting, and melting relations in iron-alloy systems relevant to the core. The results have drastically expanded our understanding of element redistribution at deep chemical boundaries and the chemical evolution of the deep mantle and the inner core. Finally, we emphasize the need for standardized protocols to obtain consistent, reproducible results and streamlined procedures to promote good practice and increase productivity. A broad collaboration with a systematic approach would further advance the field of high-pressure geochemistry.
Chronic food insecurity remains a challenge globally, exacerbated by climate change-driven shocks such as droughts and floods. Forecasting food insecurity levels and targeting vulnerable households is apriority for humanitarian programming to ensure timely delivery of assistance. In this study, we propose to harness a machine learning approach trained on high-frequency household survey data to infer the predictors of food insecurity and forecast household level outcomes in near real-time. Our empirical analyses leverage the Measurement Indicators for Resilience Analysis (MIRA) data collection protocol implemented by Catholic Relief Services (CRS) in southern Malawi, a series of sentinel sites collecting household data monthly. When focusing on predictors of community-level vulnerability, we show that a random forest model outperforms other algorithms and that location and self-reported welfare are the best predictors of food insecurity. We also show performance results across several neural networks and classical models for various data modeling scenarios to forecast food security. We pose that problem as binary classification via dichotomization of the food security score based on two different thresholds, which results in two different positive class to negative class ratios. Our best performing model has an F1 of 81% and an accuracy of 83% in predicting food security outcomes when the outcome is dichotomized based on threshold 16 and predictor features consist of historical food security score along with 20 variables selected by artificial intelligence explainability frameworks. These results showcase the value of combining high-frequency sentinel site data with machine learning algorithms to predict future food insecurity outcomes.
Problematic anger is frequently reported by soldiers who have deployed to combat zones. However, evidence is lacking with respect to how anger changes over a deployment cycle, and which factors prospectively influence change in anger among combat-deployed soldiers.
Methods
Reports of problematic anger were obtained from 7298 US Army soldiers who deployed to Afghanistan in 2012. A series of mixed-effects growth models estimated linear trajectories of anger over a period of 1–2 months before deployment to 9 months post-deployment, and evaluated the effects of pre-deployment factors (prior deployments and perceived resilience) on average levels and growth of problematic anger.
Results
A model with random intercepts and slopes provided the best fit, indicating heterogeneity in soldiers' levels and trajectories of anger. First-time deployers reported the lowest anger overall, but the most growth in anger over time. Soldiers with multiple prior deployments displayed the highest anger overall, which remained relatively stable over time. Higher pre-deployment resilience was associated with lower reports of anger, but its protective effect diminished over time. First- and second-time deployers reporting low resilience displayed different anger trajectories (stable v. decreasing, respectively).
Conclusions
Change in anger from pre- to post-deployment varies based on pre-deployment factors. The observed differences in anger trajectories suggest that efforts to detect and reduce problematic anger should be tailored for first-time v. repeat deployers. Ongoing screening is needed even for soldiers reporting high resilience before deployment, as the protective effect of pre-deployment resilience on anger erodes over time.
In November 2004, the University of Cambridge announced its intention to close the Architecture Department,1 following a drop from a 5 to a 4 in the 2001 Research Assessment Exercise (RAE), which aimed to measure the quality of research activity across the Higher Education sector in the UK.2 Other departments in the University of Cambridge achieved a 5 or a 5* rating in the same exercise. In 2004 the University’s General Board, which oversees academic standards within the University, came to the conclusion that the Department of Architecture was making ‘insufficient progress towards meeting Cambridge standards in terms of research quality’ and advised that it should be shut down.3 While this remained a recommendation, with no official action having yet been made, the threat of closure sparked an outrage both within and outside Cambridge. After a campaign in the national press, the architecture department was saved [1, 2].
New Zealand has a strategy of eliminating SARS-CoV-2 that has resulted in a low incidence of reported coronavirus-19 disease (COVID-19). The aim of this study was to describe the spread of SARS-CoV-2 in New Zealand via a nationwide serosurvey of blood donors. Samples (n = 9806) were collected over a month-long period (3 December 2020–6 January 2021) from donors aged 16–88 years. The sample population was geographically spread, covering 16 of 20 district health board regions. A series of Spike-based immunoassays were utilised, and the serological testing algorithm was optimised for specificity given New Zealand is a low prevalence setting. Eighteen samples were seropositive for SARS-CoV-2 antibodies, six of which were retrospectively matched to previously confirmed COVID-19 cases. A further four were from donors that travelled to settings with a high risk of SARS-CoV-2 exposure, suggesting likely infection outside New Zealand. The remaining eight seropositive samples were from seven different district health regions for a true seroprevalence estimate, adjusted for test sensitivity and specificity, of 0.103% (95% confidence interval, 0.09–0.12%). The very low seroprevalence is consistent with limited undetected community transmission and provides robust, serological evidence to support New Zealand's successful elimination strategy for COVID-19.
The number of people over the age of 65 attending Emergency Departments (ED) in the United Kingdom (UK) is increasing. Those who attend with a mental health related problem may be referred to liaison psychiatry for assessment. Improving responsiveness and integration of liaison psychiatry in general hospital settings is a national priority. To do this psychiatry teams must be adequately resourced and organised. However, it is unknown how trends in the number of referrals of older people to liaison psychiatry teams by EDs are changing, making this difficult.
Method
We performed a national multi-centre retrospective service evaluation, analysing existing psychiatry referral data from EDs of people over 65. Sites were selected from a convenience sample of older peoples liaison psychiatry departments. Departments from all regions of the UK were invited to participate via the RCPsych liaison and older peoples faculty email distribution lists. From departments who returned data, we combined the date and described trends in the number and rate of referrals over a 7 year period.
Result
Referral data from up to 28 EDs across England and Scotland over a 7 year period were analysed (n = 18828 referrals). There is a general trend towards increasing numbers of older people referred to liaison psychiatry year on year. Rates rose year on year from 1.4 referrals per 1000 ED attenders (>65 years) in 2011 to 4.5 in 2019 . There is inter and intra site variability in referral numbers per 1000 ED attendances between different departments, ranging from 0.1 - 24.3.
Conclusion
To plan an effective healthcare system we need to understand the population it serves, and have appropriate structures and processes within it. The overarching message of this study is clear; older peoples mental health emergencies presenting in ED are common and appear to be increasingly so. Without appropriate investment either in EDs or community mental health services, this is unlikely to improve.
The data also suggest very variable inter-departmental referral rates. It is not possible to establish why rates from one department to another are so different, or whether outcomes for the population they serve are better or worse. The data does however highlight the importance of asking further questions about why the departments are different, and what impact that has on the patients they serve.