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Neural activity cannot be directly observed using fMRI; rather it must be inferred from the hemodynamic responses that neural activity causes. Solving this inverse problem is made possible through the use of forward models, which generate predicted hemodynamic responses given hypothesised underlying neural activity. Commonly‐used hemodynamic models were developed to explain data from healthy young participants; however, studies of ageing and dementia are increasingly shifting the focus toward elderly populations. We evaluated the validity of a range of hemodynamic models across the healthy adult lifespan: from basis sets for the linear convolution models commonly used to analyse fMRI studies, to more advanced models including nonlinear fitting of a parameterised hemodynamic response function (HRF) and nonlinear fitting of a biophysical generative model (hemodynamic modelling, HDM). Using an exceptionally large sample of participants, and a sensorimotor task optimized for detecting the shape of the BOLD response to brief stimulation, we first characterised the effects of age on descriptive features of the response (e.g., peak amplitude and latency). We then compared these to features from more complex nonlinear models, fit to four regions of interest engaged by the task, namely left auditory cortex, bilateral visual cortex, left (contralateral) motor cortex and right (ipsilateral) motor cortex. Finally, we validated the extent to which parameter estimates from these models have predictive validity, in terms of how well they predict age in cross‐validated multiple regression. We conclude that age‐related differences in the BOLD response can be captured effectively by models with three free parameters. Furthermore, we show that biophysical models like the HDM have predictive validity comparable to more common models, while additionally providing insights into underlying mechanisms, which go beyond descriptive features like peak amplitude or latency, and include estimation of nonlinear effects. Here, the HDM revealed that most of the effects of age on the BOLD response could be explained by an increased rate of vasoactive signal decay and decreased transit rate of blood, rather than changes in neural activity per se. However, in the absence of other types of neural/hemodynamic data, unique interpretation of HDM parameters is difficult from fMRI data alone, and some brain regions in some tasks (e.g., ipsilateral motor cortex) can show responses that are more difficult to capture using current models. [ABSTRACT FROM AUTHOR]

Depression is a common mental health problem that is associated with significant disability and mortality. Electroconvulsive therapy (ECT) has been demonstrated to be effective at resolving expression of suicidal intent in patients with depression. In less acute situations, patients are usually referred for ECT after several medication trials. Neuromuscular blocking agents (NMBAs) are used to block tonic-clonic motor activity and associated physical harm during the delivery of ECT. Succinylcholine (Sch), with its rapid onset of muscle relaxation, short self-terminating duration of action, and rapid subsequent return of spontaneous ventilation, is the NMBA of choice for ECT. However, the use of Sch is problematic or contraindicated is some situations. Although non-depolarizing NMBAs can be used, the variable time to onset of adequate muscle relaxation and prolonged duration of action have limited their widespread acceptance as alternatives to Sch. Recently, however, with the widespread availability of sugammadex, a chemically modified γ-cyclodextrin that rapidly and predictably reverses the effect of non-depolarizing NMBAs, the muscle relaxation achieved by rocuronium can predictably and effectively be reversed. In situations where Sch is contraindicated or otherwise problematic, rocuronium, followed by pharmacological antagonism with sugammadex, can provide a safe and effective muscle relaxation approach comparable to that of Sch in terms of duration of action. This review provides a summary of the current state of evidence for the use of sugammadex during ECT, which should lend support to further acceptance and future studies of sugammadex in the context of ECT. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis (MS) is a chronic autoimmune/neurodegenerative disease associated with progressing disability affecting mostly women. We aim to estimate transition probabilities describing MS-related disability progression from no disability to severe disability. Transition probabilities are a vital input for health economics models. In MS, this is particularly relevant for pharmaceutical agency reimbursement decisions for disease-modifying therapies (DMTs). Methods: Data were obtained from Australian participants of the MSBase registry. We used a four-state continuous-time Markov model to describe how people with MS transition between disability milestones defined by the Expanded Disability Status Scale (scale 0–10): no disability (EDSS of 0.0), mild (EDSS of 1.0–3.5), moderate (EDSS of 4.0–6.0), and severe (EDSS of 6.5–9.5). Model covariates included sex, DMT usage, MS-phenotype, and disease duration, and analysis of covariate groups were also conducted. All data were recorded by the treating neurologist. Results: A total of N = 6369 participants (mean age 42.5 years, 75.00% female) with 38,837 person-years of follow-up and 54,570 clinical reviews were identified for the study. Annual transition probabilities included: remaining in the no, mild, moderate, and severe states (54.24%, 82.02%, 69.86%, 77.83% respectively) and transitioning from no to mild (42.31%), mild to moderate (11.38%), and moderate to severe (9.41%). Secondary-progressive MS was associated with a 150.9% increase in the hazard of disability progression versus relapsing–remitting MS. Conclusions: People with MS have an approximately 45% probability of transitioning from the no disability state after one year, with people with progressive MS transitioning from this health state at a much higher rate. These transition probabilities will be applied in a publicly available health economics simulation model for Australia and similar populations, intended to support reimbursement of a plethora of existing and upcoming interventions including medications to reduce progression of MS. [ABSTRACT FROM AUTHOR]

Firearm injury is a major yet understudied public health issue in the U.S. This qualitative study explored firearm retailers' perspectives to inform messaging and communication approaches to promote firearm safety among the gun owning population. Semi-structured interviews were conducted with 17 retailers at a single gun shop in Texas. Thematic analysis identified key themes related to (1) audience segmentation, (2) appropriate use of language, and (3) trusted messengers and modalities for the communication of firearm safety information. This formative work provides practical insights to optimize public health messaging in this arena and ultimately reduce firearm injuries. Overall, this study provides valuable insights to guide the development and implementation of evidence-based, social marketing efforts aiming to promote firearm safety across various gun-owning audiences. [ABSTRACT FROM AUTHOR]

Acute studies have consistently demonstrated small-to-medium glycaemic responses to breaking prolonged sitting, yet it is not known whether acute effects are maintained following a period of intervention or whether behavioural interventions lead to sustained benefits. A single arm, 4-week intervention with pre and post “two-arm” randomised cross-over conditions, study was conducted to investigate whether reducing prolonged sitting in free-living affects acute and chronic glucose and insulin responses. Adults aged 40–75 years living with overweight or obesity with an elevated HbA1c (5.7–7.5%) underwent four experimental conditions (two prolonged sitting [CON], two sitting with a self-paced light upright movement breaks [LUMB]) in a randomised order. One of each condition was conducted before and after the intervention. A total of 33 participants completed the study. There was no change in sitting or glucose/insulin levels over the 4-week intervention. However, glucose and insulin were reduced acutely in the LUMB conditions compared with CON (glucose [mmol/L]: CON: 5.77 [5.51; 6.02], LUMB: 5.55 [5.30; 5.81], p = 0.006, insulin [mIU/L]: (CON: 77.70 [61.58; 93.83], LUMB: 61.28 [51.19; 71.38], p =  <0.001); these responses did not change over time. In conclusion, the intervention did not lead to reduced sitting time or chronic changes to postprandial metabolism. [ABSTRACT FROM AUTHOR]

Functional compensation is a common notion in the neuroscience of healthy ageing, whereby older adults are proposed to recruit additional brain activity to compensate for reduced cognitive function. However, whether this additional brain activity in older participants actually helps their cognitive performance remains debated. We examined brain activity and cognitive performance in a human lifespan sample (N = 223) while they performed a problem-solving task (based on Cattell's test of fluid intelligence) during functional magnetic resonance imaging. Whole-brain univariate analysis revealed that activity in bilateral cuneal cortex for hard vs. easy problems increased both with age and with performance, even when adjusting for an estimate of age-related differences in cerebrovascular reactivity. Multivariate Bayesian decoding further demonstrated that age increased the likelihood that activation patterns in this cuneal region provided non-redundant information about the two task conditions, beyond that of the multiple demand network generally activated in this task. This constitutes some of the strongest evidence yet for functional compensation in healthy ageing, at least in this brain region during visual problem-solving. [ABSTRACT FROM AUTHOR]

Over the years, there has been an increase in the number of people sent to prison for a sexual offence, yet there is a lack of research exploring the experiences of those with sexual convictions within the prison system, and the factors that help or hinder their progression towards release. This research aimed to explore the experiences of individuals with sexual convictions who have progressed to an open prison but have been recalled back to a closed prison. The research took a qualitative approach, undertaking semi-structured interviews with 10 individuals who had moved back to a closed prison. Thematic analysis was used, eliciting two main themes. First, failure was the only option, relays how participants felt they were bound to fail at open conditions, largely due to a lack of information which meant they did not know what to expect, and a lack of support upon arrival. They also felt stigmatised because of their convictions. A different world centres around participants reporting entering into an unfamiliar environment in open conditions, leaving them unsettled. It also describes the difficulties participants had adjusting to the freedom of open conditions but also the delays they experienced. Implications for practice and future research are discussed. [ABSTRACT FROM AUTHOR]

Extensive literature demonstrates that parents of children with disruptive behaviors consistently report lower parenting self-esteem (i.e., satisfaction and efficacy) compared to parents of children without disruptive behaviors. However, little is known about whether having low parenting self-esteem results in negative parenting behavior while managing disruptive child behavior, and whether associations vary in strength depending on the clinical significance of the child's disruptive behavior. The current study examines 90 parent couples who were randomly assigned to interact with a 9- to 12-year-old confederate exhibiting either typical or disruptive behaviors. Parenting self-esteem moderated the association between disruptive child behavior and positive parenting behavior, such that mothers with low efficacy had a stronger positive association between disruptive child behavior and positive parenting behaviors. However, fathers with low efficacy had a stronger negative association between disruptive behaviors and positive parenting behavior. Exploratory analyses yielded mixed results. Specifically, mothers with low self-esteem and a child with ADHD had a stronger negative association between disruptive child behaviors and positive parenting compared to mothers who interacted with a confederate or did not have a child with ADHD. Results from the current study extend findings regarding the influence of parenting self-esteem on the association of disruptive child behavior and parenting behaviors, as moderating effects of parenting self-esteem was demonstrated for both mothers and fathers within the study. [ABSTRACT FROM AUTHOR]

Introduction This scoping review mapped evidence on physical activity (including structured exercise) and sedentary behaviour interventions (interventions to reduce sedentary behaviour) in people living with both frailty and multiple long-term conditions (MLTCs) and their informal carers. Methods Ten databases and grey literature were searched from 2000 to October 2023. Two reviewers screened studies and one extracted data. Results were shared with three stakeholder groups (n  = 21) in a consultation phase. Results After screening, 155 papers from 144 studies (1 ongoing) were retained. The majority were randomised controlled trials (86, 55%). Participants' mean age was 73 ± 12 years, and 73% were of White ethnicity. MLTC and frailty measurement varied widely. Most participants were pre-to-moderately frail. Physical health conditions predominated over mental health conditions. Interventions focused on structured exercise (83 studies, 60%) or combined interventions (55 studies, 39%). Two (1%) and one (0.7%) focused solely on habitual physical activity or sedentary behaviour. Adherence was 81% (interquartile range 62%–89%) with goal setting, monitoring and support important to adherence. Carers were only involved in 15 (11%) studies. Most interventions reported positive outcomes, primarily focusing on body functions and structures. Conclusions A modest volume of evidence exists on multicomponent structured exercise interventions, with less focus on habitual physical activity and sedentary behaviour. Interventions report largely positive effects, but an updated systematic review is required. The field could be advanced by more rigorous characterisation of MLTCs, socioeconomic status and ethnicity, increased informal carer involvement and further evaluation of habitual physical activity and sedentary behaviour interventions. [ABSTRACT FROM AUTHOR]

This article explores the concept of impulsive magnetic damping (IMD) and its application to a physical pendulum. It discusses how circular magnets passing over a bar induce eddy currents, resulting in the dissipation of mechanical energy and damping of the oscillation. The article provides mathematical equations to calculate the power of dissipation and loss of energy for each swing. It also describes the experimental setup used to study IMD and concludes that it leads to linear damping instead of exponential damping. The authors suggest that this experiment could be used for physics instruction at the undergraduate level. [Extracted from the article]

Traumatic brain injury (TBI) can cause major disability and increases the risk of neurodegeneration. Post-TBI, there is infiltration of peripheral myeloid and lymphoid cells; there is limited information on the peripheral immune response post-TBI in the immature brain—where injury may interfere with neurodevelopment. We carried out two injury types in juvenile mice: invasive TBI with a controlled cortical impact (CCI) and repetitive mild TBI (rmTBI) using weight drop injury and analysed the response at 5- and 35-days post-injury. In the two models, we detected the brain infiltration of immune cells (e.g., neutrophils, monocytes, dendritic cells, CD4+ T cells, and NK cells). There were increases in macrophages, neutrophils, and dendritic cells in the spleen, increases in dendritic cells in blood, and increases in CD8+ T cells and B cells in lymph nodes. These results indicate a complex peripheral immune response post-TBI in the immature brain, with differences between an invasive injury and a repetitive mild injury. [ABSTRACT FROM AUTHOR]

Background: Sleep disturbance is a significant symptom associated with both rotator cuff tears and arthroscopic rotator cuff repair. Melatonin has been shown to be safe and effective in managing multiple sleep disorders, including secondary sleep disorders, with relatively minor adverse effects and lack of addictive potential. Purpose: To investigate the effects of oral melatonin on postoperative sleep quality after arthroscopic rotator cuff repair. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: This was a prospective randomized clinical trial evaluating patients undergoing arthroscopic rotator cuff repair. Exclusion criteria included history of alcohol abuse, current antidepressant or sedative use, revision rotator cuff repair, severe glenohumeral arthritis, and concurrent adhesive capsulitis. Patients were randomly assigned in a 1:1 ratio to 1 of 2 groups: 5-mg dose of melatonin 1 hour before bedtime or standard sleep hygiene (≥6 hours per night, avoiding caffeine and naps in the evening). Patients in the melatonin group took their assigned melatonin dose for 6 weeks beginning the day of surgery. Patient-reported outcome assessments, including the Pittsburgh Sleep Quality Index (PSQI), the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and the Single Assessment Numeric Evaluation (SANE), and pain medication charts were collected preoperatively as well as at 2 weeks, 6 weeks, 3 months, 4 months, and 6 months postoperatively. Numeric variables were analyzed using paired and unpaired t tests, with significance set at P <.05. Results: Eighty patients were included for final analysis (40 in the control group, 40 in the melatonin group). Patient characteristics such as age, sex, race, body mass index, and laterality did not differ significantly (P ≥.05). Preoperative ASES, SANE, and PSQI scores did not differ between groups (P ≥.055). PSQI scores were significantly lower (better quality sleep) in the melatonin group at the 6-week postoperative period (P =.036). There was a positive correlation between how patients rated the intensity of their pain and the PSQI at the 6-week postoperative period (0.566). The PSQI question regarding sleep quality was found to be significantly lower in the melatonin group at the 3-month, 4-month, and 6-month postoperative periods (P =.015, P =.041, and P ≤.05, respectively). SANE scores were significantly lower in the melatonin group (P =.011) at 6 weeks and then higher in the melatonin group (P =.017) at 6 months. ASES scores were significantly higher in the melatonin group at 4 and 6 months (P =.022 and P =.020, respectively). Lastly, patients who were randomized into the melatonin group were found to use significantly less narcotic medication at the 4-month postoperative period (P =.046). Conclusion: Melatonin use after arthroscopic rotator cuff repair led to improved sleep quality (PSQI) in the early postoperative period as well as improved functional outcomes (ASES and SANE scores) and decreased narcotic use in the later postoperative period. Patients with significant sleep disturbances associated with rotator cuff repairs may benefit from the use of melatonin. Registration: NCT04278677 (ClinicalTrials.gov identifier). [ABSTRACT FROM AUTHOR]

Although the literature on veteran differences in science, technology, engineering, and mathematics (STEM) occupational outcomes by gender is established and veteran/nonveteran differences in STEM outcomes are well studied, we fill a gap in the literature by examining the following two research questions in this study: (1) are rural veterans less likely than urban veterans to be employed in a STEM occupation and how does race/ethnicity modify this relationship; (2) among veterans in a STEM occupation, does total income vary by rural/urban location and race/ethnicity? We retrieved data on employed military veterans (n = 845,467) aged 18 to 65 years from the 2008–2020 American Community Survey. Results showed that rural-dwelling Black and Hispanic veterans were less likely than Whites to be employed in a STEM field. Among veterans employed in a STEM field, rural-dwelling Hispanics had lower annual incomes than Whites. As such, future STEM education programs should target rural-dwelling veterans of color. [ABSTRACT FROM AUTHOR]

Phosphorus plays a multifaceted role for all known life and hence understanding its sources on the early Earth provides constraints on how life developed to incorporate this element into its biochemistry. Currently, the major phosphorus mineral group on the surface of the Earth are the apatites, which are poorly soluble calcium phosphates and hence may not have been a good source of phosphorus on the early Earth. An alternative source of phosphorus may be the mineral olivine. Given that olivine makes up a large part of the upper mantle of Earth and presumably other rocky planets and moons, it stands to reason that olivine may be a potential phosphorus reservoir for prebiotic chemical environments. Here we examine the phosphorus content of 10 olivine samples from different terrestrial localities to determine their P content and P speciation. We find that extracts of the samples contain varying amounts of phosphate, and some contain pyrophosphate. Olivine may have served as a source of phosphate on the early Earth and possibly elsewhere in the solar system, and its dissolution could have supplied this nutrient to a nascent biosphere. [ABSTRACT FROM AUTHOR]

Objectives: Subjective wellbeing has been defined as an individual's personal appraisal of their quality of life. Subjective wellbeing is associated with positive health behaviours and improved coping abilities. This study aimed to investigate the subjective wellbeing of people living with multiple sclerosis (MS), using the novel Personal Wellbeing Index, and make comparisons with the general population. Methods: Cross-sectional data was obtained from the Australian Multiple Sclerosis Longitudinal Study and the How Is Your Life Australian general population study in August-October 2020. Subjective wellbeing was measured as life satisfaction using the Personal Wellbeing Index. This instrument measures life satisfaction globally and in seven life domains, allowing the importance of domain-specific life satisfaction to be explored. Descriptive and multivariable regression analyses were conducted. Results: One thousand six hundred eighty-three MS and 1,021 general population participants entered the study (mean age 52.4 and 58.6; female 79.9% and 52.4%, respectively). For people living with MS the most important life domains were standard of living and achieving in life. The domain of personal health was more influential for people living with MS (p < 0.01) than the general population. The life domains most susceptible to MS-related disability were personal health, achieving in life, and community connectedness (p < 0.01 for these domains). Conclusion: Personal health and achieving in life are key domains through which the subjective wellbeing of people living with MS is modified. This study recommends the development of interventions to support healthy perceptions of illness and continued employment as paramount in improving the subjective wellbeing of people living with MS. [ABSTRACT FROM AUTHOR]

All students should have opportunities to investigate issues related to their personal interests and community priorities. Teachers value these goals but often lack materials that follow students' meaningful questions about phenomena while meeting standards. This article highlights strategies for developing materials that address standards rigorously and engage diverse student interests and community priorities. The strategies include choosing meaningful phenomena, building relevance, supporting understanding of how human systems shape phenomena and problems, and enabling equitable participation through educative guidance in materials. We illustrate these strategies by highlighting how a consortium of educators and researchers created the OpenSciEd instructional materials for high school, presenting examples of how they are reflected in courses in biology, chemistry, and physics. These materials use a storyline model centered on students' questions about phenomena and addresses all high school NGSS performance expectations. The article also discusses how teacher teams can adapt these strategies to their local contexts, using resources like student surveys, Universal Design for Learning, and community-based investigations to make science education more inclusive and relevant for students from nondominant groups and communities. [ABSTRACT FROM AUTHOR]

The hypothesis of chaotic population dynamics was proposed in ecology by Robert May in the mid-1970s. At that time the idea was controversial, and it remains a fascinating and unsettled issue today. We report the results of a 20-year laboratory research programme that continued in the tradition of the pioneering ecologist Thomas Park using the Tribolium flour beetle model. We present biological evidence of complex population dynamics – including bifurcations, chaos, saddle nodes, phase switching, resonance effects, and multiple attractors – by using a low-dimensional difference equation model for Tribolium together with carefully designed, conducted, and statistically analysed experiments. The model, parameterized with data, also explains the results of historical Tribolium experiments, such as the classical competition studies of Thomas Park and his colleagues. Our research programme has inspired other studies using the Tribolium mathematical and laboratory model. This work was conducted by a multidisciplinary team, which included Jim Cushing. [ABSTRACT FROM AUTHOR]

Objectives. To describe national and city-level fatal drug overdose trends between 2005 and 2021 in Mexico. Methods. We calculated fatal overdose rates at the city level in 3-year periods from 2005 to 2021 and annually at the national level for people aged 15 to 64 years in Mexico. We calculated rate differences and rate ratios for each city between periods. Results. The national fatal overdose rate was 0.53 overdose deaths per 100 000 population and was almost twice as high in urban than in nonurban areas. The national fatal overdose rate was stable over the period 2005 to 2014 and increased monotonically to a peak in 2021. Fatal overdose rates varied across cities. Cities with the 8 highest fatal overdose rates in the period were all in states along the US–Mexico border. Conclusions. Fatal overdoses have doubled over the past 15 years in Mexico. Overdose rates are particularly high and increasing in cities close to the US–Mexico border. Public Health Implications. There is a need for enhanced overdose surveillance data and coordinated harm reduction strategies, particularly in the northern border region of Mexico. (Am J Public Health. 2024;114(7):705–713. https://doi.org/10.2105/AJPH.2024.307650) [ABSTRACT FROM AUTHOR]

Detection of extranodal extension on histopathology in surgically treated head and neck squamous cell carcinoma indicates poor prognosis. However, there is no consensus on the diagnostic criteria, interpretation, and reporting of histology detected extranodal extension, which has contributed to conflicting evidence in the literature, and likely clinical inconsistency. The Head and Neck Cancer International Group conducted a three-round modified Delphi process with a group of 19 international pathology experts representing 15 national clinical research groups to generate consensus recommendations for histology detected extranodal extension diagnostic criteria. The expert panel strongly agreed on terminology and diagnostic features for histology detected extranodal extension and soft tissue metastasis. Moreover, the panel reached consensus on reporting of histology detected extranodal extension and on nodal sampling. These consensus recommendations, endorsed by 19 organisations representing 34 countries, are a crucial development towards standardised diagnosis and reporting of histology detected extranodal extension, and more accurate data collection and analysis. [ABSTRACT FROM AUTHOR]

Extranodal extension of tumour on histopathology is known to be a negative prognostic factor in head and neck cancer. Compelling evidence suggests that extranodal extension detected on radiological imaging is also a negative prognostic factor. Furthermore, if imaging detected extranodal extension could be identified reliably before the start of treatment, it could be used to guide treatment selection, as patients might be better managed with non-surgical approaches to avoid the toxicity and cost of trimodality therapy (surgery, chemotherapy, and radiotherapy together). There are many aspects of imaging detected extranodal extension that remain unresolved or are without consensus, such as the criteria to best diagnose them and the associated terminology. The Head and Neck Cancer International Group conducted a five-round modified Delphi process with a group of 18 international radiology experts, representing 14 national clinical research groups. We generated consensus recommendations on the terminology and diagnostic criteria for imaging detected extranodal extension to harmonise clinical practice and research. These recommendations have been endorsed by 19 national and international organisations, representing 34 countries. We propose a new classification system to aid diagnosis, which was supported by most of the participating experts over existing systems, and which will require validation in the future. Additionally, we have created an online educational resource for grading imaging detected extranodal extensions. [ABSTRACT FROM AUTHOR]

This study examines child welfare worker definitions of difficult cases and how definitions change over time. Seven waves of child welfare worker responses to survey questions asking what makes a case particularly difficult were collected over 3.5 years. Findings identified eight general difficult categories: case attributes, parent/caregiver issues, case tasks, children's issues, uncooperative/non-compliant clients, communication/logistical issues, case type, and agency-related issues. Across waves, case attributes, parent/caregiver issues, and case tasks were cited most frequently. Frequencies for some categories (i.e. case attributes) changed over time. Implications for workload and caseload management are discussed. [ABSTRACT FROM AUTHOR]

The United States incarcerates more people than any other country in the world. As a result, a growing body of critical research has sought to understand the impact of the carceral experience, not only on those currently or previously incarcerated, but also on those connected to incarcerated individuals. Much of this research identifies the barriers and difficulties loved ones of incarcerated individuals (LOIs) encounter; however, few of these studies highlight the ways LOIs navigate and overcome such barriers. By using this deficits-framework, LOIs can be mischaracterized as solely powerless or disordered. Also, while many studies importantly identify difficulties in navigating the carceral experience of a loved one, few allow LOIs to speak directly to their needs. Drawing upon deidentified Facebook posts from an online LOI group, the current study takes a strengths-based approach to showcase how LOIs attempt to address their needs and assuage difficulties by engaging in storytelling, advice and information sharing, and advocacy work. [ABSTRACT FROM AUTHOR]

The European Union ("EU") has taken the remarkable step of coming to agreement to implement the first-of-its-kind comprehensive legislation regarding artificial intelligence ("AI"), the AI Act. The AI Act adopts a risk-based approach to address diverse AI system applications and potential harms associated with AI technology. The AI Act categorizes AI systems based on risk levels, ranging from unacceptable to minimal, with corresponding regulatory requirements tailored to mitigate associated risks. Efforts are underway in the United States to establish AI regulatory frameworks, as demonstrated by the Bipartisan Framework for U.S. Act, proposed by Senators Josh Hawley (R-MO) and Richard Blumenthal (D-CT); the proposed No Section 230 Immunity for AI Act; and President Biden's Executive Order on Safe, Secure, and Trustworthy Artificial Intelligence, inter alia. This Article provides a synopsis of the final provisions adopted in the AI Act. The Article then explores United States policymakers' most recent efforts to establish a regulatory path that balances principles of innovation with risk mitigation. [ABSTRACT FROM AUTHOR]

A thermal ignition model is used in parallel with single crystal solid and product fluid Equations of State (EOSs) from the literature to calculate the time and distance to homogeneous shock initiation in single crystal 1,3-propanediol-2,2-bis[(nitrooxy)methyl]-tetranitrate (PETN). The ignition model is a highly constrained, globalized representation of the temperature and pressure dependent decomposition chemistry of PETN. Initiation in the single crystal proceeds via a homogeneous initiation mechanism where thermal ignition results from a well defined initial shock state (P,V,T). The transition to steady detonation at an observed location (x*, t*) then follows when a superdetonation wave initiated by this thermal ignition overtakes the input shock wave. In the traditional approach, P and V are determined directly from measurements and conservation of mass and momentum, leaving T relatively unconstrained due to the extremely nonlinear dependence of T on P, V in the EOS. We present an iterative algorithm to calculate T and V as a function of P from the time to thermal ignition, superdetonation, and intersection at (x*, t*) observed in each experiment. These states are consistent with the unreacted EOS but allow an independent determination of the energy deposited into heating by the input shock. The calculated states compare favorably with pressures and states of compression observed in the experiment but provide a new and interesting set of temperatures associated with each state. We discuss these fully determined initial shock states in (P, V, T) in the context of PETN thermodynamics, specifically the solid/liquid phase boundary at high temperature and pressure. [ABSTRACT FROM AUTHOR]

Purpose: People living with multiple sclerosis (PwMS) in metropolitan Victoria, Australia, experienced a 112-day, COVID-19-related lockdown in mid-2020. Contemporaneously, Australian PwMS elsewhere experienced minimal restrictions, resulting in a natural experiment. This study investigated the relationships between lockdowns, COVID-19-related adversity, and health-related quality of life (HRQoL). It also generated health state utilities (HSU) representative of changes in HRQoL. Methods: Data were extracted from Australian MS Longitudinal Study surveys, which included the Assessment of Quality of Life-Eight Dimensions (AQoL-8D) instrument and a COVID-19 questionnaire. This COVID-19 questionnaire required participants to rank their COVID-19-related adversity across seven health dimensions. Ordered probits were used to identify variables contributing to adversity. Linear and logit regressions were applied to determine the impact of adversity on HRQoL, defined using AQoL-8D HSUs. Qualitative data were examined thematically. Results: N = 1666 PwMS (average age 58.5; 79.8% female; consistent with the clinical presentation of MS) entered the study, with n = 367 (22.0%) exposed to the 112-day lockdown. Lockdown exposure and disability severity were strongly associated with higher adversity rankings (p < 0.01). Higher adversity rankings were associated with lower HSUs. Participants reporting major adversity, across measured health dimensions, had a mean HSU 0.161 (p < 0.01) lower than participants reporting no adversity and were more likely (OR: 2.716, p < 0.01) to report a clinically significant HSU reduction. Themes in qualitative data supported quantitative findings. Conclusions: We found that COVID-19-related adversity reduced the HRQoL of PwMS. Our HSU estimates can be used in health economic models to evaluate lockdown cost-effectiveness for people with complex and chronic (mainly neurological) diseases. [ABSTRACT FROM AUTHOR]

Background: Loneliness has increased since the COVID-19 pandemic and negatively impacts mental health. This study examined relationships between loneliness and mental health among adults using a digital mental health platform. Methods: A purposive sample of 919 participants (97% response rate) who were newly enrolled in the platform completed a survey on loneliness, depression, anxiety, well-being, stress, social support, and comorbidities at baseline and 3 months. Platform engagement was tracked during this period. We examined baseline differences between lonely and non-lonely participants; associations between loneliness, mental health symptoms, and comorbidities; and changes in loneliness and mental health through engagement in any form of care. Results: At baseline, 57.8% of the sample were categorized as lonely. Loneliness was associated with younger age, fewer years of education, and the presence of a comorbidity (p values <.05). Baseline loneliness was associated with greater depression, anxiety, and stress and lower well-being and social support (ps <.001). The percentage of lonely participants decreased at follow-up (57.6% to 52.9%, p =.03). Those who improved in loneliness improved in mental health symptoms, well-being, and social support (ps <.001). Lonely participants who engaged in any form of care reported a greater reduction in loneliness than those who did not engage (p =.04). Conclusions: This study confirms previous findings of the high prevalence of loneliness among adults and risk factors for increased loneliness. Findings highlight the potential of digital platforms to reach lonely individuals and alleviate loneliness through remote mental health support. [ABSTRACT FROM AUTHOR]

Background: Life skills development among youth in foster care is critical in helping them overcome the barriers they face when leaving care. While foster care agencies, child welfare professionals, and caregivers play important roles in life skills development, little research has examined the topic from their perspectives. Objective: This study examined the barriers and supports Florida foster care agencies, child welfare professionals, and caregivers face related to life skills development of youth in foster care. Methods: Foster care agency representatives (n = 11) completed interviews or questionnaires and identified agency-level challenges, agency-level supports, and caregiver-focused supports for life skills development. In surveys, child welfare professionals (n = 24) and caregivers (n = 23) identified the challenges and supports they experience, as well as additional supports they needed. Semi-structured interviews with three child welfare professionals and seven caregivers gathered in-depth information on the topics covered in the survey. Thematic analysis was employed to identify themes within the data. Results: While a number of challenges (i.e., lack of youth-focused resources, staff turnover) emerged across all three groups, supports were more varied across and within groups. Notably, caregivers received minimal support from the foster care system in helping youth develop life skills. Despite this, caregivers and child welfare professionals mainly identified youth-focused resources and services as needed additional supports. Conclusions: More training, support, and funding are required to address the challenges identified in this study. Broader child welfare issues, such as staff retention and turnover, must also be addressed to support the youths' development of independent living skills. [ABSTRACT FROM AUTHOR]

Public support for police reached a record low during the summer of 2020. To ameliorate police-community relations, research has sought to identify how community attitudes towards police are built. Studies often find that Black individuals are less likely to trust and be satisfied with police than their non-Black counterparts largely due to negative direct and vicarious experiences. This finding has led to an empirical focus on how officers engage, with limited research on why officers engage in certain ways. Without analyzing motives for conduct, the critical gaze remains blind to broader social and cultural issues that may inform and motivate some officers' harmful and discriminatory actions. The current study highlights how Black men implicate segregation, media-induced miseducation, cultural and contextual incompetence, and hostile police culture for mutual distrust and officers' misconduct. These findings promote harm reductionist policy to enhance officers' cultural and contextual competence and encourage researchers and practitioners to consider an abolitionist agenda that a) focuses on the implementation and evaluation of novel and existing trauma-informed, community-based means of addressing harm in order to ultimately dissolve police power, and b) promotes cultural shifts by increasing diverse learning opportunities and critical curriculum in educational spaces. [ABSTRACT FROM AUTHOR]

Within the context of racial caste and the "stickiness" of criminal labels, men struggle to craft positive masculine identities. Contesting racial-criminal stigma requires men of color to challenge controlling images of violent Black men. Analyzing narratives of 45 millennial men in Philadelphia, we identify redemption bids and redemptive generativity as ways of defying social stigma. Redemption, which has been highlighted in the desistance literature, is a central concern of the men of color we studied, regardless of prior law-breaking or system involvement. Because a criminal history is presumed regardless of past behavior, many men of color engage in performances of "making good" similar to those who were actively engaged in the work of desistance. [ABSTRACT FROM AUTHOR]

Individual muscle segmentation is the process of partitioning medical images into regions representing each muscle. It can be used to isolate spatially structured quantitative muscle characteristics, such as volume, geometry, and the level of fat infiltration. These features are pivotal to measuring the state of muscle functional health and in tracking the response of the body to musculoskeletal and neuromusculoskeletal disorders. The gold standard approach to perform muscle segmentation requires manual processing of large numbers of images and is associated with significant operator repeatability issues and high time requirements. Deep learning-based techniques have been recently suggested to be capable of automating the process, which would catalyse research into the effects of musculoskeletal disorders on the muscular system. In this study, three convolutional neural networks were explored in their capacity to automatically segment twenty-three lower limb muscles from the hips, thigh, and calves from magnetic resonance images. The three neural networks (UNet, Attention UNet, and a novel Spatial Channel UNet) were trained independently with augmented images to segment 6 subjects and were able to segment the muscles with an average Relative Volume Error (RVE) between -8.6% and 2.9%, average Dice Similarity Coefficient (DSC) between 0.70 and 0.84, and average Hausdorff Distance (HD) between 12.2 and 46.5 mm, with performance dependent on both the subject and the network used. The trained convolutional neural networks designed, and data used in this study are openly available for use, either through re-training for other medical images, or application to automatically segment new T1-weighted lower limb magnetic resonance images captured with similar acquisition parameters. [ABSTRACT FROM AUTHOR]

Aim: To investigate how 24‐h physical behaviours differ across type 2 diabetes (T2DM) subtypes. Materials and Methods: We included participants living with T2DM, enrolled as part of an ongoing observational study. Participants wore an accelerometer for 7 days to quantify physical behaviours across 24 h. We used routinely collected clinical data (age at onset of diabetes, glycated haemoglobin level, homeostatic model assessment index of beta‐cell function, homeostatic model assessment index of insulin resistance, body mass index) to replicate four previously identified subtypes (insulin‐deficient diabetes [INS‐D], insulin‐resistant diabetes [INS‐R], obesity‐related diabetes [OB] and age‐related diabetes [AGE]), via k‐means clustering. Differences in physical behaviours across the diabetes subtypes were assessed using generalized linear models, with the AGE cluster as the reference. Results: A total of 564 participants were included in this analysis (mean age 63.6 ± 8.4 years, 37.6% female, mean age at diagnosis 53.1 ± 10.0 years). The proportions in each cluster were as follows: INS‐D: n = 35, 6.2%; INS‐R: n = 88, 15.6%; OB: n = 166, 29.4%; and AGE: n = 275, 48.8%. Compared to the AGE cluster, the OB cluster had a shorter sleep duration (−0.3 h; 95% confidence interval [CI] −0.5, −0.1), lower sleep efficiency (−2%; 95% CI −3, −1), lower total physical activity (−2.9 mg; 95% CI −4.3, −1.6) and less time in moderate‐to‐vigorous physical activity (−6.6 min; 95% CI −11.4, −1.7), alongside greater sleep variability (17.9 min; 95% CI 8.2, 27.7) and longer sedentary time (31.9 min; 95% CI 10.5, 53.2). Movement intensity during the most active continuous 10 and 30 min of the day was also lower in the OB cluster. Conclusions: In individuals living with T2DM, the OB subtype had the lowest levels of physical activity and least favourable sleep profiles. Such behaviours may be suitable targets for personalized therapeutic lifestyle interventions. [ABSTRACT FROM AUTHOR]

The development of nursing evidence within hemodialysis is challenged by the vast numbers of specialized tasks clinicians undertake. Developing an evidence base is complex and multi-faceted, requiring a collaborative and well-defined process. Commonly, a process of quality improvement is initially undertaken, whereby nurses develop a plan, undertake action, study outcomes, and review results. However, when reviewing current processes to identify and develop evidence-based practices across various health services, a more detailed and planned methodology is required. This article provides nurses with knowledge to apply a well-defined framework (the Iowa Model-Revised of Evidence-Based Practice to Promote Excellence in Health Care) to transform a quality improvement project into the development of evidence-based practice. [ABSTRACT FROM AUTHOR]

For the first time, the latest American Diabetes Association/European Association for the Study of Diabetes (ADA/EASD) consensus guidelines have incorporated a growing body of evidence linking health outcomes associated with type 2 diabetes to the movement behavior composition over the whole 24-h day. Of particular note, the importance of sleep as a key lifestyle component in the management of type 2 diabetes is promulgated and presented using three key constructs: quantity, quality, and timing (i.e., chronotype). In this narrative review we highlight some of the key evidence justifying the inclusion of sleep in the latest consensus guidelines by examining the associations of quantity, quality, and timing of sleep with measures of glycemia, cardiovascular disease risk, and mortality. We also consider potential mechanisms implicated in the association between sleep and type 2 diabetes and provide practical advice for health care professionals about initiating conversations pertaining to sleep in clinical care. In particular, we emphasize the importance of measuring sleep in a free-living environment and provide a summary of the different methodologies and targets. In summary, although the latest ADA/EASD consensus report highlights sleep as a central component in the management of type 2 diabetes, placing it, for the first time, on a level playing field with other lifestyle behaviors (e.g., physical activity and diet), the evidence base for improving sleep (beyond sleep disorders) in those living with type 2 diabetes is limited. This review should act as a timely reminder to incorporate sleep into clinical consultations, ongoing diabetes education, and future interventions. [ABSTRACT FROM AUTHOR]

To estimate time spent in various cardiovascular disease (CVD) and cancer states, according to self-reported walking pace. In total, 391,744 UK Biobank participants were included (median age = 57 years; 54.7% women). Data were collected 2006–2010, with follow-up collected in 2021. Usual walking pace was self-defined as slow, steady, average, or brisk. Multistate modeling determined the transition rate and mean sojourn time in and across three different states (healthy, CVD or cancer, and death) upon a time horizon of 10 years. The mean sojourn time in the healthy state was longer, while that in the CVD or cancer state was shorter in individuals reporting an average or brisk walking pace (vs. slow). A 75-year-old woman reporting a brisk walking pace spent, on average, 8.4 years of the next 10 years in a healthy state; an additional 8.0 (95% CI: 7.3, 8.7) months longer than a 75-year-old woman reporting a slow walking pace. This corresponded to 4.3 (3.7, 4.9) fewer months living with CVD or cancer. Similar results were seen in men. Adults reporting an average or brisk walking pace at baseline displayed a lower transition to disease development and a greater proportion of life lived without CVD or cancer. Research was conducted using the UK Biobank resource under Application #33266. The UK Biobank resource can be accessed by researchers on application. Variables derived for this study have been returned to the UK Biobank for future applicants to request. No additional data are available. [ABSTRACT FROM AUTHOR]

Introduction: Inappropriate penicillin allergy labels are often acquired early in life and persist into adulthood. This leads to poorer healthcare outcomes with increased expenditures overtime. Given these adverse effects on our healthcare system, efforts to safely remove inappropriate penicillin allergy labels are being implemented worldwide. Yet these methods often depend on direct subspecialty care, limiting widespread application. Objectives: Our study investigates whether a primary care led amoxicillin challenge (PLAC) can be safely and effectively implemented in a multisite pediatric clinic setting without additional allergy specific training or specialty care oversight. A secondary objective was to investigate our PLAC screening tool to safely remove penicillin allergy labels in the pediatric population. Methods: This is an observational prospective multisite study with a retrospective chart review of 39,414 patients, ages 4 months to 18 years, screened to identify those with a low-risk penicillin allergy at two outpatient pediatric clinics from January 2021 to July 2023. Via PLAC screening questionnaire, low-risk pediatric patients were categorized as PLAC candidates by a pediatric provider. Patients were grouped for a 1-h PLAC appointment 1–2 times per month. PLAC appointment involved administering a single dose of amoxicillin 45 mg/kg (250 mg max) followed by a 1-h observation by a general trained medical technician without advance anaphylactic training. Results: A total of 141 (11.1%) out of 1269 (3.2% of the screened population) pediatric patients with a penicillin label met criteria for PLAC, of whom 89 (63.1%) completed the PLAC. All 89 (100%) tolerated it uneventfully, leading to delabeling. Nonspecific rash was the most common historic reaction leading to penicillin allergy diagnosis for those 141 PLAC patients identified. Twenty-five months was the average age of penicillin allergy labeling, and the average time from historical reaction to delabeling was 63 months. Conclusions: Our study demonstrates a pediatric specific screener and pathway for pediatric providers to safely remove penicillin allergy labels following latest allergy practice parameters. [ABSTRACT FROM AUTHOR]

The move toward evidence-based practice within counseling intervention research continues to grow. However, there are many practical barriers to implementing research designs that can support causal claims regarding counseling intervention efficacy. Overcoming these hurdles serves a larger goal of improving client care and further legitimizing the counseling profession. This article outlines an underused research design called regression discontinuity (RD), one of the strongest quasi-experimental designs available. RD allows researchers to use a cutoff score to determine treatment group assignment in situations where a randomized control trial is not feasible or ethical, such as when assigning care based on need consistent with the social justice values of the field. Historically, RD is rarely employed in counseling research. Therefore, to facilitate use, we provide a primer on key RD design concepts along with a concrete demonstration of the design, data analysis, and interpretation. We review the causal logic of the basic RD design followed by two data outcomes for a hypothetical scenario. Data and SPSS syntax are provided to allow readers to follow along and conduct their own analyses. [ABSTRACT FROM AUTHOR]

As the population of the United States continues to grow and diversify, it is critical that the medical profession follows. This study aimed to evaluate aspects of the current landscape of diversity within physical medicine and rehabilitation by surveying program directors of US-based physical medicine and rehabilitation residencies. The secondary aim was to identify program characteristics that correlate with more diverse residency classes. An online, cross-sectional 17-question survey was distributed to program directors of all US-based physical medicine and rehabilitation residencies with known contact information (95/100), with a completed survey response rate of 53% (50/ 95). Race and ethnicity categories of the survey were based on those used by the US Census. The percentages of individuals identifying as women or those underrepresented in medicine in this survey were below those of the general US population, a trend also seen within the field of physical medicine and rehabilitation overall. Linear regression revealed no statistically significant association between the percentage of underrepresented in medicine residents and commonly used diversity recruitment initiatives. There was a significant association between the presence of a departmental role for diversity, equity and inclusion and the percentage of women residents (odds ratio, 1.13; P = 0.017). Continued research is required to identify additional strategies with demonstrated efficacy in recruiting diverse residency applicants. [ABSTRACT FROM AUTHOR]

Over the last several decades, research has demonstrated the adverse impact incarceration has on sustaining and strengthening familial bonds. Physical and communication barriers are often noted as lead sources of strain in relationships between incarcerated individuals and their loved ones. Studies have shown that the financial burden of prison can also have deleterious impacts on the family reintegration process upon release, particularly for minoritized populations. The current study adds to the discussion on collateral consequences of the carceral state by introducing temporal debt ; a novel concept similar to financial debt in that it results from oppressive policies and builds over generations. Findings detail how the carceral state impacts fathers' regard for temporal provision and enters Black men into a cycle of temporal poverty. The results encourage readers to consider novel means of addressing harm and violence to decrease the perpetuation of familial harm committed by the criminal legal system beyond reformist efforts that often aim to ease parenting from prison. [ABSTRACT FROM AUTHOR]

The article focuses on improving support for survivors of sexual violence and abuse (SVA) through integrated sexual health services and online resources. Topics include enhancing online resources for better accessibility and anonymity, addressing stigma and rape myths, and improving service pathways and trauma-informed care for survivors.

Exploding bridgewire detonators are an industry standard technology used for over 75 years and valued for their precise timing and safety characteristics. Despite widespread use, their functional mechanism remains controversial with both shock and non-shock mechanisms attributed. In this work, we reexamine the bridgewire detonator function with a suite of modern diagnostics and compare these observations with the existing literature. Traditional detonator observations consisted of voltage applied to the bridgewire and time dependent current, integral response measurements such as case motion, and more recently Schlieren imaging of the detonator surface. In this work, we add visible light emission, x-ray transmission, proton radiography, and temperature measurements during detonator function in addition to voltage, current, and function times. The addition of in situ observations of light emission, temperature, and density gives us new insight into the mechanisms of explosive bridgewire detonator function. We see a distinct separation in time, location, symmetry, and velocity of bridgewire output and detonation onset. During the time between bridgewire burst and the initiation of detonation, we observe a temperature ramp in the input pellet. In this paper, we present the suite of measurements and comparisons with the literature on integral response measurements. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Artificial intelligence chatbots could serve as an information resource for patients and a tool for clinicians. Their ability to respond appropriately to questions regarding gastroesophageal reflux disease is unknown. METHODS: Twenty-three prompts regarding gastroesophageal reflux disease management were submitted to ChatGPT, and responses were rated by 3 gastroenterologists and 8 patients. RESULTS: ChatGPT provided largely appropriate responses (91.3%), although with some inappropriateness (8.7%) and inconsistency. Most responses (78.3%) contained at least some specific guidance. Patients considered this a useful tool (100%). DISCUSSION: ChatGPT's performance demonstrates the potential for this technology in health care, although also its limitations in its current state. [ABSTRACT FROM AUTHOR]

This study presents curriculum mapping of noncore course offerings in political science curricula by an early-career librarian. It combines syllabi study and curriculum mapping methods to analyze the language of student learning objectives (SLOs) from course syllabi and to integrate SLOs with threshold concepts from the ACRL Framework for Information Literacy for Higher Education and the AAC&U Information Literacy VALUE Rubric. The methods produce two sample sets: one of core concept representation and the other of additional observances for syllabi improvements. Results analyze the frequency and percentage distributions of threshold concepts in SLOs. The author outlines strategies for engaging faculty in information literacy and suggests how librarians and faculty might inform information literacy teaching in the department. [ABSTRACT FROM AUTHOR]

Purpose: To investigate associations between 4-yr change in step cadence and markers of cardiometabolic health in people with a history of prediabetes and to explore whether these associations are modified by demographic factors. Methods: In this prospective cohort study, adults, with a history of prediabetes, were assessed for markers of cardiometabolic health (body mass index, waist circumference, high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], triglycerides, and glycated hemoglobin A1c [HbA1c]), and free-living stepping activity (activPAL3™) at baseline, 1 yr, and 4 yr. Brisk steps per day were defined as the number of steps accumulated at ≥100 steps per minute and slow steps per day as those accumulated at <100 steps per minute; the mean peak stepping cadence during the most active 10 minutes of the day was also derived. Generalized estimating equations examined associations between 4-yr change in step cadence and change in cardiometabolic risk factors, with interactions by sex and ethnicity. Results: Seven hundred ninety-four participants were included (age, 59.8 ± 8.9 yr; 48.7% women; 27.1% ethnic minority; total steps per day, 8445 ± 3364; brisk steps per day, 4794 ± 2865; peak 10-min step cadence, 128 ± 10 steps per minute). Beneficial associations were observed between change in brisk steps per day and change in body mass index, waist circumference, HDL-C, and HbA1c. Similar associations were found between peak 10-min step cadence and HDL-C and waist circumference. Interactions by ethnicity revealed change in brisk steps per day and change in peak 10-min step cadence had a stronger association with HbA1c in White Europeans, whereas associations between change in 10-min peak step cadence with measures of adiposity were stronger in South Asians. Conclusions: Change in the number of daily steps accumulated at a brisk pace was associated with beneficial change in adiposity, HDL-C, and HbA1c; however, potential benefits may be dependent on ethnicity for outcomes related to HbA1c and adiposity. [ABSTRACT FROM AUTHOR]

The police killings of unarmed Black men and women, particularly in the year 2020, fueled a moral outcry for defunding the police. The defund movement asserts that divested police funds should be invested in communities most devastated by hyper-policing. However, decisions on which community services to finance are often void of community input. To fill this gap, the current study highlights responses from 50 Black fathers living in southwest Philadelphia on community resources necessary for themselves and their children to live safe and prosperous lives. The men explained that, to enhance public safety and recover from the devastation of social stigmatization and marginalization, funds need to be invested in resources beyond the 'basics' (i.e., housing, employment, health care). Specifically, the fathers wanted local educational and entrepreneurial opportunities that would allow community members to demonstrate their full potential. The current study informs policymakers on the importance of building community capacity rather than focusing solely on service delivery. [ABSTRACT FROM AUTHOR]