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When Mikhail Gorbachev became the leader of the Soviet Union in 1985, the Warsaw Pact was a robust military alliance. It was capable of waging a large-scale war in Europe and was an instrument of Soviet hegemony in Eastern Europe, keeping orthodox Communist regimes in power. The alliance over the years had also become an effective mechanism of political coordination and consultation. In April 1985, the Warsaw Pact leaders met in Warsaw and renewed the Pact for another thirty years. Yet only six years later, the alliance was disbanded, having been rendered obsolete by the political transformation of Eastern Europe in 1989–1990. This monograph recounts what happened to the Warsaw Pact during its final years and explains why the organization ceased to exist in 1991.
The coronavirus disease 2019 (COVID-19) pandemic challenged health care systems in an unprecedented way. Due to the enormous amount of hospital ward and intensive care unit (ICU) admissions, regular care came to a standstill, thereby overcrowding ICUs and endangering (regular and COVID-19-related) critical care. Acute care coordination centers were set up to safely manage the influx of COVID-19 patients. Furthermore, treatments requiring ICU surveillance were postponed leading to increased waiting lists.
Hypothesis:
A coordination center organizing patient transfers and admissions could reduce overcrowding and optimize in-hospital capacity.
Methods:
The acute lack of hospital capacity urged the region West-Netherlands to form a new regional system for patient triage and transfer: the Regional Capacity and Patient Transfer Service (RCPS). By combining hospital capacity data and a new method of triage and transfer, the RCPS was able to effectively select patients for transfer to other hospitals within the region or, in close collaboration with the National Capacity and Patient Transfer Service (LCPS), transfer patients to hospitals in other regions within the Netherlands.
Results:
From March 2020 through December 2021 (22 months), the RCPS West-Netherlands was requested to transfer 2,434 COVID-19 patients. After adequate triage, 1,720 patients with a mean age of 62 (SD = 13) years were transferred with the help of the RCPS West-Netherlands. This concerned 1,166 ward patients (68%) and 554 ICU patients (32%). Overcrowded hospitals were relieved by transferring these patients to hospitals with higher capacity.
Conclusion:
The health care system in the region West-Netherlands benefitted from the RCPS for both ward and ICU occupation. Due to the coordination by the RCPS, regional ICU occupation never exceeded the maximal ICU capacity, and therefore patients in need for acute direct care could always be admitted at the ICU. The presented method can be useful in reducing the waiting lists caused by the delayed care and for coordination and transfer of patients with new variants or other infectious diseases in the future.
The triarchic model was advanced as an integrative, trait-based framework for investigating psychopathy using different assessment methods and across developmental periods. Recent research has shown that the triarchic traits of boldness, meanness, and disinhibition can be operationalized effectively in youth, but longitudinal research is needed to realize the model's potential to advance developmental understanding of psychopathy. We report on the creation and validation of scale measures of the triarchic traits using questionnaire items available in the University of Southern California Risk Factors for Antisocial Behavior (RFAB) project, a large-scale longitudinal study of the development of antisocial behavior that includes measures from multiple modalities (self-report, informant rating, clinical-diagnostic, task-behavioral, physiological). Using a construct-rating and psychometric refinement approach, we developed triarchic scales that showed acceptable reliability, expected intercorrelations, and good temporal stability. The scales showed theory-consistent relations with external criteria including measures of psychopathy, internalizing/externalizing psychopathology, antisocial behavior, and substance use. Findings demonstrate the viability of measuring triarchic traits in the RFAB sample, extend the known nomological network of these traits into the developmental realm, and provide a foundation for follow-up studies examining the etiology of psychopathic traits and their relations with multimodal measures of cognitive-affective function and proneness to clinical problems.
The coronavirus disease (COVID-19) pandemic causes a large number of patients to simultaneously be in need of specialized care. In the Netherlands, hospitals scaled up their intensive care unit and clinical admission capacity at an early stage of the pandemic. The importance of coordinating resources during a pandemic has already been emphasized in the literature. Therefore, in order to prevent hospitals from being overwhelmed by COVID-19 admissions, national and regional task forces were established for the purpose of coordinating patient transfers. This review describes the experience of Regionaal Overleg Acute Zorg (ROAZ) region Noord-Holland Flevoland, in coordinating patient transfers in the Amsterdam region. In total, 130 patient transfers were coordinated by our region, of which 73% patients were transferred to a hospital within the region. Over a 2-month period, similarities regarding days with increased patient transfers were seen between our region and the national task force. In parallel, an increased incidence in hospital admissions in the Netherlands was observed. During a pandemic, an early upscale (an increase in surge spaces) of hospital admission capacity is imperative. Furthermore, it is preferred to establish national and regional task forces, coordinated by physicians experienced and trained in handling crisis situations, adhering full transparency regarding hospital admission capacity.
We describe an ultra-wide-bandwidth, low-frequency receiver recently installed on the Parkes radio telescope. The receiver system provides continuous frequency coverage from 704 to 4032 MHz. For much of the band (
${\sim}60\%$
), the system temperature is approximately 22 K and the receiver system remains in a linear regime even in the presence of strong mobile phone transmissions. We discuss the scientific and technical aspects of the new receiver, including its astronomical objectives, as well as the feed, receiver, digitiser, and signal processor design. We describe the pipeline routines that form the archive-ready data products and how those data files can be accessed from the archives. The system performance is quantified, including the system noise and linearity, beam shape, antenna efficiency, polarisation calibration, and timing stability.
Studies suggest that alcohol consumption and alcohol use disorders have distinct genetic backgrounds.
Methods
We examined whether polygenic risk scores (PRS) for consumption and problem subscales of the Alcohol Use Disorders Identification Test (AUDIT-C, AUDIT-P) in the UK Biobank (UKB; N = 121 630) correlate with alcohol outcomes in four independent samples: an ascertained cohort, the Collaborative Study on the Genetics of Alcoholism (COGA; N = 6850), and population-based cohorts: Avon Longitudinal Study of Parents and Children (ALSPAC; N = 5911), Generation Scotland (GS; N = 17 461), and an independent subset of UKB (N = 245 947). Regression models and survival analyses tested whether the PRS were associated with the alcohol-related outcomes.
Results
In COGA, AUDIT-P PRS was associated with alcohol dependence, AUD symptom count, maximum drinks (R2 = 0.47–0.68%, p = 2.0 × 10−8–1.0 × 10−10), and increased likelihood of onset of alcohol dependence (hazard ratio = 1.15, p = 4.7 × 10−8); AUDIT-C PRS was not an independent predictor of any phenotype. In ALSPAC, the AUDIT-C PRS was associated with alcohol dependence (R2 = 0.96%, p = 4.8 × 10−6). In GS, AUDIT-C PRS was a better predictor of weekly alcohol use (R2 = 0.27%, p = 5.5 × 10−11), while AUDIT-P PRS was more associated with problem drinking (R2 = 0.40%, p = 9.0 × 10−7). Lastly, AUDIT-P PRS was associated with ICD-based alcohol-related disorders in the UKB subset (R2 = 0.18%, p < 2.0 × 10−16).
Conclusions
AUDIT-P PRS was associated with a range of alcohol-related phenotypes across population-based and ascertained cohorts, while AUDIT-C PRS showed less utility in the ascertained cohort. We show that AUDIT-P is genetically correlated with both use and misuse and demonstrate the influence of ascertainment schemes on PRS analyses.
Background: Migraine is a common disorder most typically presenting as headache and often associated with vertigo and motion sickness. It is a genetically complex condition with multiple genes ultimately contributing to the predisposition and development of this episodic neurological disorder. We identified a large American family of 29 individuals of which 17 members suffered from at least one of these disorders, migraine, vertigo, or motion sickness. Many of these individuals suffered from several simultaneously. We hypothesized that vertigo and motion sickness may involve genes that are independent to those directly contributing to migraine susceptibility. Methods: Genome-wide linkage analysis performed using 400 microsatellite repeat markers spaced at 10 cM throughout the genome. The members of this family were phenotyped for each condition, migraine, vertigo, and motion sickness and analyzed separately. Statistical analysis was performed using two-point and multipoint linkage analysis employing a number of models including autosomal recessive or dominant patterns of inheritance with high and low genetic penetrance. Results: We identified a novel locus for migraine, 9q13-q22 (maximum two-point logarithm of odds [LOD] score-2.51). In addition, there are suggestive LOD scores that localize to different chromosomes for each phenotype; vertigo (chromosome 18, LOD score of 1.82) and motion sickness (chromosome 4, LOD score of 2.09). Conclusions: Our analysis supports our hypothesis that the migraine-associated vertigo and motion sickness may involve distinct susceptibility genes.
Objectives: Concussions cause diverse symptoms that are often measured through a single symptom severity score. Researchers have postulated distinct dimensions of concussion symptoms, raising the possibility that total scores may not accurately represent their multidimensional nature. This study examined to what degree concussion symptoms, assessed by the Sport Concussion Assessment Tool 3 (SCAT3), reflect a unidimensional versus multidimensional construct to inform how the SCAT3 should be scored and advance efforts to identify distinct phenotypes of concussion. Methods: Data were aggregated across two prospective studies of sport-related concussion, yielding 219 high school and college athletes in the acute (<48 hr) post-injury period. Item-level ratings on the SCAT3 checklist were analyzed through exploratory and confirmatory factor analyses. We specified higher-order and bifactor models and compared their fit, interpretability, and external correlates. Results: The best-fitting model was a five-factor bifactor model that included a general factor on which all items loaded and four specific factors reflecting emotional symptoms, torpor, sensory sensitivities, and headache symptoms. The bifactor model demonstrated better discriminant validity than the counterpart higher-order model, in which the factors were highly correlated (r=.55–.91). Conclusions: The SCAT3 contains items that appear unidimensional, suggesting that it is appropriate to quantify concussion symptoms with total scores. However, evidence of multidimensionality was revealed using bifactor modeling. Additional work is needed to clarify the nature of factors identified by this model, explicate their clinical and research utility, and determine to what degree the model applies to other stages of injury recovery and patient subgroups. (JINS, 2018, 24, 793–804)
We analyze the flow of money between mutual fund categories, finding strong evidence of seasonality in investor risk aversion. Aggregate investor flow data reveal an investor preference for safe mutual funds in autumn and risky funds in spring. During September alone, outflows from equity funds average $13 billion, controlling for previously documented flow determinants (e.g., capital-gains overhang). This movement of large amounts of money between fund categories is correlated with seasonality in investor risk aversion, consistent with investors preferring safer (riskier) investments in autumn (spring). We find consistent evidence in Canada and also in Australia, where seasons are offset by 6 months.
This book explains why some communist regimes collapsed, whereas others – China, Cuba, North Korea, Laos, and Vietnam – withstood the revolutionary upheavals of 1989–1991. To understand why these five communist regimes survived when so many others perished, we need to examine the factors and processes that led to the demise of communism in Eastern Europe, Mongolia, and the Soviet Union but did not end communist rule elsewhere. One crucial element in the downfall of communist regimes was the process of international “diffusion,” a topic I will be exploring in this chapter.
The chapter begins by briefly explaining why the spillover of political change and turmoil from one country into another played such an important role in the collapse of the Soviet and allied communist regimes. The chapter then specifies how the concept of “diffusion” has been elaborated by scholars of varying perspectives (realist, liberalist, constructivist) and applied to various geographic and temporal contexts, not just to the Soviet bloc in 1989–1991. Using this framework, the chapter distills several points about the process of diffusion that linked the Soviet Union, Eastern Europe, and Mongolia in the late 1980s and beginning of the 1990s. The concluding section explains why this process did not destabilize the resilient communist regimes. The Chinese regime did experience significant effects of diffusion in the spring of 1989 with the emergence of the Tiananmen Square protests, but the threat to the regime’s survival was abruptly eliminated in early June 1989 when the Chinese Politburo ordered troops to open fire on serried crowds of demonstrators, killing vast numbers. If the Chinese authorities had not brutally crushed the Tiananmen Square unrest, diffusion from the Soviet bloc might well have extended further, potentially undermining some of the resilient communist regimes. The decisive crackdown in Beijing not only solidified Chinese communist rule but also kept the process from subverting any of the other communist regimes outside the Soviet orbit.
Conventional triage algorithms assume unlimited medical resource availability. After a nuclear detonation, medical resources are likely to be particularly limited, suggesting that conventional triage algorithms need to be rethought. To test various hypotheses related to the prioritization of victims in this setting, we developed the model of resource- and time-based triage (MORTT). This model uses information on time to death, probability of survival if treated and if untreated, and time to treat various types of traumatic injuries in an agent-based model in which the time of medical practitioners or materials can be limited. In this embodiment, MORTT focuses solely on triage for surgical procedures in the first 48 hours after a nuclear detonation. MORTT determines the impact on survival based on user-selected prioritization of victims by severity or type of injury. Using MORTT, we found that in poorly resourced settings, prioritizing victims with moderate life-threatening injuries over victims with severe life-threatening injuries saves more lives and reduces demand for intensive care, which is likely to outstrip local and national capacity. Furthermore, more lives would be saved if victims with combined injury (ie, trauma plus radiation >2 Gy) are prioritized after nonirradiated victims with similar trauma.
(Disaster Med Public Health Preparedness. 2011;5:S98-S110)
The discovery of a pulsar or pulsars orbiting near the Galactic Center (GC) could offer an unprecedented probe of strong-field gravity, the properties of our galaxy's supermassive black hole and insights into the paradoxical star formation history of the region. However, searching for pulsars near the GC is severely hampered by the large electron densities along our line of sight and the scattering-induced pulse broadening of the pulsar emission observed through it. As the broadened pulse length approaches the pulsar period, the periodicity in pulsar emission becomes nearly undetectable. Searches extended to higher frequencies, in an effort to reduce scattering, suffer from reduced intrinsic flux, higher system temperatures and increased atmospheric opacity. We are currently attempting to mitigate the challenges associated with searching for pulsars near the GC by employing new wide bandwidth receivers, upgraded IF distribution systems and novel digital spectrometers in a GC pulsar search campaign at the Green Bank Telescope in West Virginia, USA.
Our search will cover two frequency bands, from 12-15 GHz (Ku Band) and 18-26 GHz (K Band), during a total of approximately 30 hours of observations, with expected characteristic 10-sigma sensitivities between 5-10 micro-Jy. Our first observations are scheduled for mid-March 2012. Here we will present the status of our observations and initial results.