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1 | INTRODUCTION The objective of this study was to analyze a large body of text responses collected as a federal request for information (RFI) to uncover gaps in policy [...], Objective: Analyze responses to a national request for information (RFI) to uncover gaps in policy, practice, and understanding of veteran suicide to inform federal research strategy. Data source: An RFI with 21 open-ended questions generated from Presidential Executive Order #1386, administered nationally from July 3 to August 5, 2019. Study design: Semi-structured, open-ended responses analyzed using a collaborative qualitative and text-mining data process. Data extraction methods: We aligned traditional qualitative methods with natural language processing (NLP) text-mining techniques to analyze 9040 open-ended question responses from 722 respondents to provide results within 3 months. Narrative inquiry and the medical explanatory model guided the data extraction and analytic process. Results: Five major themes were identified: risk factors, risk assessment, prevention and intervention, barriers to care, and data/research. Individuals and organizations mentioned different concepts within the same themes. In responses about risk factors, individuals frequently mentioned generic terms like "illness" while organizations mentioned specific terms like "traumatic brain injury." Organizations and individuals described unique barriers to care and emphasized ways to integrate data and research to improve points of care. Organizations often identified lack of funding as barriers while individuals often identified key moments for prevention such as military transitions and ensuring care providers have military cultural understanding. Conclusions: This study provides an example of a rapid, adaptive analysis of a large body of qualitative, public response data about veteran suicide to support a federal strategy for an important public health topic. Combining qualitative and text-mining methods allowed a representation of voices and perspectives including the lived experiences of individuals who described stories of military transition, treatments that worked or did not, and the perspective of organizations treating veterans for suicide. The results supported the development of a national strategy to reduce suicide risks for veterans as well as civilians. KEYWORDS health policy/politics/law/regulation, mental health, natural language processing, qualitative research, veterans What is known on this topic * Suicide is a leading cause of death in the United States, and veterans are at high risk for suicide. * Veterans not receiving care within the veteran affairs (VA) health care system are at a higher risk of suicide than the general population. * Veterans have unique risk factors for suicide including combat exposure and deployment conditions that can exacerbate physical and mental stress. What this study adds * Findings from the analyses identified risk factors, assessments, and prevention strategies that are currently known, but also identified unique barriers to care, and ways in which data and research could be better aligned to improve outcomes. * Specifically, veterans need a greater connection to the community from the point of military service transition, and health care professionals who understand and/or have experience with military culture. * The findings emphasize that metrics for evidence-based risk prevention and treatment methods need to incorporate veteran perspectives to ensure suicide prevention efforts address veteran needs and concerns.

Conditional cash transfer (CCT) programs have been implemented globally to alleviate poverty. Although tuberculosis (TB) is closely linked to poverty, the effects of CCT on TB outcomes among populations facing social and economic vulnerabilities remain uncertain. Here we estimated the associations between participation in the world’s largest CCT program, the Brazilian Bolsa Família Program (BFP), and the reduction of TB incidence, mortality and case-fatality rates using the nationwide 100 Million Brazilian Cohort between 2004 and 2015. We also evaluated these relationships according to race, ethnicity, wealth levels, sex and age. Exposure to the BFP was associated with a large reduction in TB incidence (adjusted rate ratio (aRR): 0.59; 95% confidence interval (CI): 0.58–0.60) and mortality (aRR: 0.69; 95% CI: 0.65–0.73). The strongest BFP association was observed in individuals of Indigenous ethnicity both for TB incidence (aRR: 0.37; 95% CI: 0.32–0.42) and mortality (aRR: 0.35; 95% CI: 0.20–0.62), and in individuals of Black and Pardo ethnicity (incidence—aRR: 0.58; 95% CI: 0.57–0.59; mortality—aRR: 0.69; 95% CI: 0.64–0.73). BFP associations were considerably stronger among individuals living in extreme poverty both for TB incidence (aRR: 0.49; 95% CI: 0.49–0.50) and mortality (aRR: 0.60; 95% CI: 0.55–0.65). CCT can strongly reduce TB incidence and mortality in individuals living in extreme poverty, and of Indigenous, Black and Pardo ethnicity, and could significantly contribute to achieving the End TB Strategy targets and TB-related Sustainable Development Goals.

Despite the presence of strategically positioned anatomical barriers designed to protect the central nervous system (CNS), it is not entirely isolated from the immune system1,2. In fact, it remains physically connected to, and can be influenced by, the peripheral immune system1. How the CNS retains such responsiveness while maintaining an immunologically unique status remains an outstanding question. Here, in searching for molecular cues that derive from the CNS and enable its direct communication with the immune system, we identified an endogenous repertoire of CNS-derived regulatory self-peptides presented on major histocompatibility complex class II (MHC-II) molecules in the CNS and at its borders. During homeostasis, these regulatory self-peptides were found to be bound to MHC-II molecules throughout the path of lymphatic drainage from the brain to its surrounding meninges and its draining cervical lymph nodes. However, in neuroinflammatory disease, the presentation of regulatory self-peptides diminished. After boosting the presentation of these regulatory self-peptides, a population of suppressor CD4+T cells was expanded, controlling CNS autoimmunity in a CTLA-4- and TGFβ-dependent manner. CNS-derived regulatory self-peptides may be the molecular key to ensuring a continuous dialogue between the CNS and the immune system while balancing overt autoreactivity. This sheds light on how we conceptually think about and therapeutically target neuroinflammatory and neurodegenerative diseases.

Background: Chronic kidney disease (CKD) patients with limited health literacy are at risk for faster disease progression. To counteract this problem, we developed ‘Grip on your Kidneys’ (GoYK), an intervention targeting patients and health care professionals. We assessed the effect on self-management, patient activation, clinical parameters, consultation quality, and the professionals’ use of health literacy strategies. We further evaluated the process. Methods: A quasi-experimental study included 147 patients with CKD and 48 professionals from Dutch general practices and nephrology clinics. Patients and professionals in the intervention group (IG) received GoYK. Control patients received care-as-usual from the participating professionals. Data were collected with questionnaires and from patient records at baseline (T0), 4 months (T1) and 9 months (T2). Results: No effects on self-management and patient activation were found. Conversely, at T2, the proportion of patients with hypertension decreased in the intervention group (odds ratio = 0.45, 95% confidence interval (95%CI) [0.20, 0.99]). In the intervention group, more lifestyle topics were discussed, at T1 (difference = 0.80, 95%CI [0.28, 1.31]) and T2 (difference = 0.69, 95%CI [0.14, 1.25]). Furthermore, several outcomes related to consultation quality improved. Professionals in the intervention group improved the use of health literacy strategies more, at T1 (difference = 0.64, 95%CI [0.33, 0.95]) and T2 (difference = 0.56, 95%CI [0.19, 0.93]). In general, patients and professionals considered GoYK to be useful. Conclusions: GoYK is promising, and offers a blueprint to optimize care for patients with limited health literacy. Researchers should develop and test interventions like GoYK, focusing on patients at risk for CKD, and with very low health literacy. Graphical abstract:

Rhombohedral graphene multilayers provide a clean and highly reproducible platform to explore the emergence of superconductivity and magnetism in a strongly interacting electron system. Here we reveal a subtle competition between valley-imbalanced orbital ferromagnets and intervalley-coherent states in which electron wavefunctions in the two momentum-space valleys develop a macroscopically coherent relative phase. We focus on a rhombohedral trilayer in the quarter-metal regime—where there is a single Fermi surface that spontaneously breaks spin and valley-isospin symmetry—and employ local magnetometry and global charge sensing techniques. Comparing the in-plane spin susceptibility of the intervalley-coherent and valley-imbalanced phases reveals the influence of graphene’s intrinsic spin–orbit coupling, which drives the emergence of a distinct correlated phase that is their hybrid. Spin–orbit coupling also suppresses the in-plane magnetic susceptibility of the valley-imbalanced phase, allowing us to extract the spin–orbit-coupling strength of approximately 50 μeV for our hexagonal-boron-nitride-encapsulated graphene system. We discuss the implications of a finite spin–orbit coupling on the spin-triplet superconductors observed in both rhombohedral and twisted graphene multilayers.

The characterization of proteins and complexes in biological systems is essential to establish their critical properties and to understand their unique functions in a plethora of bioprocesses. However, it is highly difficult to analyze low levels of intact proteins in their native states (especially those exceeding 30 kDa) with liquid chromatography (LC)-mass spectrometry (MS). Herein, we describe for the first time the use of nanoflow ion-exchange chromatography directly coupled with native MS to resolve mixtures of intact proteins. Reference proteins and protein complexes with molecular weights between 10 and 150 kDa and a model cell lysate were separated using a salt-mediated pH gradient method with volatile additives. The method allowed for low detection limits (0.22 pmol of monoclonal antibodies), while proteins presented nondenatured MS (low number of charges and limited charge state distributions), and the oligomeric state of the complexes analyzed was mostly kept. Excellent chromatographic separations including the resolution of different proteoforms of large proteins (>140 kDa) and a peak capacity of 82 in a 30 min gradient were obtained. The proposed setup and workflows show great potential for analyzing diverse proteoforms in native top-down proteomics, opening unprecedented opportunities for clinical studies and other sample-limited applications.

IMPORTANCE: Redirection of care refers to withdrawal, withholding, or limiting escalation of treatment. Whether maternal social determinants of health are associated with redirection of care discussions merits understanding. OBJECTIVE: To examine associations between maternal social determinants of health and redirection of care discussions for infants born extremely preterm. DESIGN, SETTING, AND PARTICIPANTS: This is a retrospective analysis of a prospective cohort of infants born at less than 29 weeks’ gestation between April 2011 and December 2020 at 19 National Institute of Child Health and Human Development Neonatal Research Network centers in the US. Follow-up occurred between January 2013 and October 2023. Included infants received active treatment at birth and had mothers who identified as Black or White. Race was limited to Black and White based on service disparities between these groups and limited sample size for other races. Maternal social determinant of health exposures were education level (high school nongraduate or graduate), insurance type (public/none or private), race (Black or White), and ethnicity (Hispanic or non-Hispanic). MAIN OUTCOMES AND MEASURES: The primary outcome was documented discussion about redirection of infant care. Secondary outcomes included subsequent redirection of care occurrence and, for those born at less than 27 weeks’ gestation, death and neurodevelopmental impairment at 22 to 26 months’ corrected age. RESULTS: Of the 15 629 infants (mean [SD] gestational age, 26 [2] weeks; 7961 [51%] male) from 13 643 mothers, 2324 (15%) had documented redirection of care discussions. In unadjusted comparisons, there was no significant difference in the percentage of infants with redirection of care discussions by race (Black, 1004/6793 [15%]; White, 1320/8836 [15%]) or ethnicity (Hispanic, 291/2105 [14%]; non-Hispanic, 2020/13 408 [15%]). However, after controlling for maternal and neonatal factors, infants whose mothers identified as Black or as Hispanic were less likely to have documented redirection of care discussions than infants whose mothers identified as White (Black vs White adjusted odds ratio [aOR], 0.84; 95% CI, 0.75-0.96) or as non-Hispanic (Hispanic vs non-Hispanic aOR, 0.72; 95% CI, 0.60-0.87). Redirection of care discussion occurrence did not differ by maternal education level or insurance type. CONCLUSIONS AND RELEVANCE: For infants born extremely preterm, redirection of care discussions occurred less often for Black and Hispanic infants than for White and non-Hispanic infants. It is important to explore the possible reasons underlying these differences.

The Chern insulator displays a quantized Hall effect without Landau levels. Theoretically, this state can be realized by engineering complex next-nearest-neighbour hopping in a honeycomb lattice—the so-called Haldane model. Despite its profound effect on the field of topological physics and recent implementation in cold-atom experiments, the Haldane model has not yet been realized in solid-state materials. Here we report the experimental realization of a Haldane Chern insulator in AB-stacked MoTe2/WSe2moiré bilayers, which form a honeycomb moiré lattice with two sublattices residing in different layers. We show that the moiré bilayer filled with two holes per unit cell is a quantum spin Hall insulator with a tunable charge gap. Under a small out-of-plane magnetic field, it becomes a Chern insulator with a finite Chern number because the Zeeman field splits the quantum spin Hall insulator into two halves with opposite valleys: one with a positive and the other with a negative moiré band gap. We also demonstrate experimental evidence of the Haldane model at zero external magnetic field by proximity coupling the moiré bilayer to a ferromagnetic insulator.

Conventional underwater intervention operations using robotic vehicles require expert teleoperators and limit interaction with remote scientists. In this article, we present the shared autonomy for remote collaboration (SHARC) framework that enables novice operators to cooperatively conduct underwater sampling and manipulation tasks. With SHARC, operators can plan and complete manipulation tasks using natural language or hand gestures through a virtual reality (SHARC-VR) interface. The interface provides remote operators with a contextual 3-D scene understanding that is updated according to bandwidth availability. Evaluation of the SHARC framework through controlled lab experiments demonstrates that SHARC-VR enables novice operators to complete manipulation tasks in framerate-limited conditions (i.e., 0.1–0.5 frames per second) faster than expert pilots using a conventional topside controller. For both novice and expert users, the SHARC-VR interface also increases the task completion rate and improves sampling precision. The SHARC framework is readily extensible to other hardware architectures, including terrestrial and space systems.

Objective: This study evaluates the 24-month follow-up for the NICHD Neonatal Research Network (NRN) Inositol for Retinopathy Trial. Study design: Bayley Scales of Infants Development-III and a standardized neurosensory examination were performed in infants enrolled in the main trial. Moderate/severe NDI was defined as BSID-III Cognitive or Motor composite score <85, moderate or severe cerebral palsy, blindness, or hearing loss that prevents communication despite amplification were assessed. Results: Primary outcome was determined for 605/638 (95%). The mean gestational age was 25.8 ± 1.3 weeks and mean birthweight was 805 ± 192 g. Treatment group did not affect the risk for the composite outcome of death or survival with moderate/severe NDI (60% vs 56%, p= 0.40). Conclusions: Treatment group did not affect the risk of death or survival with moderate/severe NDI. Despite early termination, this study represents the largest RCT of extremely preterm infants treated with myo-inositol with neurodevelopmental outcome data.

Objective: Determine how neurodevelopmental impairment (NDI) relates to concurrent outcomes for children born extremely preterm. Study design: Retrospective cohort study children born 22 0/7–26 6/7 weeks’ gestation at NICHD Neonatal Research Network hospitals. Outcomes were ascertained at 18–22 months’ corrected age. Result: Of 6562 children, 2618 (40%) died and 441 (7%) had no follow-up. Among the remaining 3483 children, 825 (24%), 1576 (45%), 657 (19%), and 425 (12%) had no, potential/mild, moderate, and severe NDI, respectively. Rehospitalization, respiratory medications, surgery, and medical support services were associated with greater NDI severity but affected >10% of children without NDI. Rehospitalization occurred in 40% of children with no NDI (mean (SD): 1.7 (1.3) episodes). Conclusion: Medical, functional, and social outcomes at 18–22 months’ corrected age were associated with NDI; however, many children without NDI were affected. These data should contribute to counseling families and the design of studies for childhood outcomes beyond NDI.

Millennials' attitudes and their attendance at work pose a professional challenge that all of us are facing in education. Our goal in the Rutherford County Schools in Tennessee is to [...]

Magic-angle twisted trilayer graphene (MATTG) exhibits a range of strongly correlated electronic phases that spontaneously break its underlying symmetries1,2. Here we investigate the correlated phases of MATTG using scanning tunnelling microscopy and identify marked signatures of interaction-driven spatial symmetry breaking. In low-strain samples, over a filling range of about two to three electrons or holes per moiré unit cell, we observe atomic-scale reconstruction of the graphene lattice that accompanies a correlated gap in the tunnelling spectrum. This short-scale restructuring appears as a Kekulé supercell—implying spontaneous inter-valley coherence between electrons—and persists in a wide range of magnetic fields and temperatures that coincide with the development of the gap. Large-scale maps covering several moiré unit cells further reveal a slow evolution of the Kekulé pattern, indicating that atomic-scale reconstruction coexists with translation symmetry breaking at a much longer moiré scale. We use auto-correlation and Fourier analyses to extract the intrinsic periodicity of these phases and find that they are consistent with the theoretically proposed incommensurate Kekulé spiral order3,4. Moreover, we find that the wavelength characterizing moiré-scale modulations monotonically decreases with hole doping away from half-filling of the bands and depends weakly on the magnetic field. Our results provide essential insights into the nature of the correlated phases of MATTG in the presence of strain and indicate that superconductivity can emerge from an inter-valley coherent parent state.

In an all-van der Waals heterostructure, the active layer, gate dielectrics and gate electrodes are assembled from two-dimensional crystals that have a low density of atomic defects. This design allows two-dimensional electron systems with very low disorder to be created, particularly in heterostructures where the active layer also has intrinsically low disorder, such as crystalline graphene layers or metal dichalcogenide heterobilayers. A key missing ingredient has been nanoscale electrostatic control, with existing methods for fabricated local gates typically introducing unwanted contamination. Here we describe a resist-free local anodic oxidation process for patterning sub-100 nm features in graphite gates, and their subsequent integration into an all-van der Waals heterostructure. We define a quantum point contact in the fractional quantum Hall regime as a benchmark device and observe signatures of chiral Luttinger liquid behaviour, indicating an absence of extrinsic scattering centres in the vicinity of the point contact. In the integer quantum Hall regime, we demonstrate in situ control of the edge confinement potential, a key requirement for the precision control of chiral edge states. This technique may enable the fabrication of devices capable of single anyon control and coherent edge-state interferometry in the fractional quantum Hall regime.

This paper looks at the effects of International Monetary Fund (IMF) lending programs on banking crises in a large sample of developing countries, over the period 1970-2010. The endogeneity of the IMF intervention is addressed by adopting an instrumental variable strategy and a propensity score matching estimator. Controlling for the standard determinants of banking crises, the results indicate that countries participating in IMF-supported lending programs are significantly less likely to experience a future banking crisis than nonborrowing countries. The paper also provides evidence suggesting that compliance with conditionality and loan size matter, corroborating the importance of IMF-supported reform and liquidity provision for banking sector stability. [JEL F33, F34, F35, Oil] IMF Economic Review (2015) 63, 644-691. doi: 10.1057/imfer.2015.16; published online 20 October 2015, In this paper we look at the effects of International Monetary Fund (IMF) lending programs on the risk of banking crisis in borrowing countries and at the channels of influence [...]

Free-space time domain THz spectroscopy accesses electrodynamic responses in a frequency regime ideally matched to interacting condensed matter systems. However, THz spectroscopy is challenging when samples are physically smaller than the diffraction limit of ∼0.5 mm, as is typical, for example, in van der Waals materials and heterostructures. Here, we present an on-chip, time-domain THz spectrometer based on semiconducting photoconductive switches with a bandwidth of 200 to 750 GHz. We measure the optical conductivity of a 7.5-μm wide NbN film across the superconducting transition, demonstrating spectroscopic signatures of the superconducting gap in a sample smaller than 2% of the Rayleigh diffraction limit. Our spectrometer features an interchangeable sample architecture, making it ideal for probing superconductivity, magnetism, and charge order in strongly correlated van der Waals materials.

This review summarizes the current state of evidence regarding interventions for executive function in high-risk infants and toddlers. Currently, there is a paucity of data in this area, with the interventions that have been studied highly variable in their content, dosage, target, and results. Self-regulation is the executive function construct targeted the most, with mixed results. The few studies that report later child outcomes in prekindergarten/school-aged children are encouraging, overall indicating improved cognition and behavior in the children of parents who received a parenting style intervention.

Progress in mass spectrometry lipidomics has led to a rapid proliferation of studies across biology and biomedicine. These generate extremely large raw datasets requiring sophisticated solutions to support automated data processing. To address this, numerous software tools have been developed and tailored for specific tasks. However, for researchers, deciding which approach best suits their application relies on ad hoc testing, which is inefficient and time consuming. Here we first review the data processing pipeline, summarizing the scope of available tools. Next, to support researchers, LIPID MAPS provides an interactive online portal listing open-access tools with a graphical user interface. This guides users towards appropriate solutions within major areas in data processing, including (1) lipid-oriented databases, (2) mass spectrometry data repositories, (3) analysis of targeted lipidomics datasets, (4) lipid identification and (5) quantification from untargeted lipidomics datasets, (6) statistical analysis and visualization, and (7) data integration solutions. Detailed descriptions of functions and requirements are provided to guide customized data analysis workflows.

The returns from public investment, especially during periods of scaling up, are often lower than expected. To understand the mechanisms behind this regularity we exploit original information on investment projects obtained from World Bank project reports to document the extent and the drivers of time delays in project implementation. We find that almost 60 percent of investment projects are delayed by at least one year. Time overruns are common across sectors and countries. A sound planning and preparation matter for the timing of project execution. Country characteristics also play a role, as projects undertaken in countries with weaker institutions and in periods of public investment scaling up are completed with longer delays.

OBJECTIVE--To examine 12-month effects of a booster-enhanced preconception counseling (PC) program (READY-Girls) on family planning for teen gifts with type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODS--Participants 13-19 [...]

Introduction In designing human resource systems for the public sector, a common assumption has been that there exists a group of individuals who are attracted to working for government agencies [...], Data from a nationwide survey of recent college graduates were used to investigate the question of what factors, or antecedents, might exist that would lead to an interest in working for the public sector. As antecedents, three general classes of variables were identified including: demographics, religion and volunteer experiences, and recent critical historical events (i.e., reactions to 9/11 and the Iraq war). The dependent variable was an expressed interest in working for the federal government. Secondary data analysis was carried out on survey responses from 621 graduating seniors. The results indicated that minority group status, viewing government as a form of public service, and trust in the government were all significant predictors of interest in working for the federal government.

OBJECTIVE--To evaluate the impact of a preconception counseling program tailored for teens with type 1 diabetes on cognitive, psychosocial, and behavioral outcomes and to assess its cost-effectiveness. RESEARCH DESIGN AND [...]

Dietary fibres can exert beneficial anti-inflammatory effects through microbially fermented short-chain fatty acid metabolites1,2, although the immunoregulatory roles of most fibre diets and their microbiota-derived metabolites remain poorly defined. Here, using microbial sequencing and untargeted metabolomics, we show that a diet of inulin fibre alters the composition of the mouse microbiota and the levels of microbiota-derived metabolites, notably bile acids. This metabolomic shift is associated with type 2 inflammation in the intestine and lungs, characterized by IL-33 production, activation of group 2 innate lymphoid cells and eosinophilia. Delivery of cholic acid mimics inulin-induced type 2 inflammation, whereas deletion of the bile acid receptor farnesoid X receptor diminishes the effects of inulin. The effects of inulin are microbiota dependent and were reproduced in mice colonized with human-derived microbiota. Furthermore, genetic deletion of a bile-acid-metabolizing enzyme in one bacterial species abolishes the ability of inulin to trigger type 2 inflammation. Finally, we demonstrate that inulin enhances allergen- and helminth-induced type 2 inflammation. Taken together, these data reveal that dietary inulin fibre triggers microbiota-derived cholic acid and type 2 inflammation at barrier surfaces with implications for understanding the pathophysiology of allergic inflammation, tissue protection and host defence.

One of the biggest challenges of the response to the AIDS epidemic is to reach the poorest people. In 2004, Brazil implemented one of the world's largest conditional cash transfer programmes, the Bolsa Família Programme (BFP). We aimed to evaluate the effect of BFP coverage on AIDS incidence, hospitalisations, and mortality in Brazil.

During mechanical ventilation, lung function and gas exchange in structurally heterogeneous lungs may be improved when volume oscillations at the airway opening are applied at multiple frequencies simultaneously, a technique referred to as multifrequency oscillatory ventilation (MFOV). This is in contrast to conventional high-frequency oscillatory ventilation (HFOV), for which oscillatory volumes are applied at a single frequency. In the present study, as a means of fully realizing the potential of MFOV, we designed and tested a computer-controlled hybrid oscillatory ventilator capable of generating the flows, tidal volumes, and airway pressures required for MFOV, HFOV, conventional mechanical ventilation (CMV), as well as oscillometric measurements of respiratory impedance. The device employs an iterative spectral feedback controller to generate a wide range of oscillatory waveforms. The performance of the device meets that of commercial mechanical ventilators in volume-controlled mode. Oscillatory modes of ventilation also meet design specifications in a mechanical test lung, over frequencies from 4 to 20 Hz and mean airway pressure from 5 to 30 cmH2O. In proof-of-concept experiments, the oscillatory ventilator maintained adequate gas exchange in a porcine model of acute lung injury, using combinations of conventional and oscillatory ventilation modalities. In summary, our novel device is capable of generating a wide range of conventional and oscillatory ventilation waveforms with potential to enhance gas exchange, while simultaneously providing less injurious ventilation.

AbstractThis article explores Joan La Barbara's appearance on Sesame Streetwith ‘The Signing Alphabet’ (1977) to engage her artistic commitments to accessibility and collaboration. The piece is an alphabet song rendered through vocal improvisation against an animation of the American Manual Alphabet by Steve Finkin. It plays with the relationships between sound, alphabets, learning and literacy, reaching new listening publics: children and their caregivers. Through the visibility it offers Deaf culture, the work generates frames through which to hear La Barbara's voice and see the limitations of her vocal extensions. The piece reveals other paths for new music in the 1970s, placing La Barbara's creativity in the context of educational programing aimed at normalising difference, especially in the context of disability, race and class. Sesame Streetand Joan La Barbara, I suggest, imbue vocal extension and exploration with an ethos of care.

The wildland firefighter exposure and health effect (WFFEHE) study was a 2-year repeated-measures study to investigate occupational exposures and acute and subacute health effects among wildland firefighters. This manuscript describes the study rationale, design, methods, limitations, challenges, and lessons learned. The WFFEHE cohort included fire personnel ages 18–57 from six federal wildland firefighting crews in Colorado and Idaho during the 2018 and 2019 fire seasons. All wildland firefighters employed by the recruited crews were invited to participate in the study at preseason and postseason study intervals. In 2019, one of the crews also participated in a 3-day midseason study interval where workplace exposures and pre/postshift measurements were collected while at a wildland fire incident. Study components assessed cardiovascular health, pulmonary function and inflammation, kidney function, workplace exposures, and noise-induced hearing loss. Measurements included self-reported risk factors and symptoms collected through questionnaires; serum and urine biomarkers of exposure, effect, and inflammation; pulmonary function; platelet function and arterial stiffness; and audiometric testing. Throughout the study, 154 wildland firefighters participated in at least one study interval, while 144 participated in two or more study interval. This study was completed by the Centers for Disease Control and Prevention’s National Institute for Occupational Safety and Health through a collaborative effort with the U.S. Department of Agriculture Forest Service, Department of the Interior National Park Service, and Skidmore College. Conducting research in the wildfire environment came with many challenges including collecting study data with study participants with changing work schedules and conducting study protocols safely and operating laboratory equipment in remote field locations. Forthcoming WFFEHE study results will contribute to the scientific evidence regarding occupational risk factors and exposures that can impact wildland firefighter health over a season and across two wildland fire seasons. This research is anticipated to lead to the development of preventive measures and policies aimed at reducing risk for wildland firefighters and aid in identifying future research needs for the wildland fire community.

Depression is a treatable illness, yet the majority of nursing home (NH) residents may be inadequately treated. A cross sectional study in residents in 1492 NHs in five states showed 11% of the residents were identified as depressed on the Minimum Data Set assessment, and that 55% of those received antidepressant therapy. Of those, 32% received doses lower than the manufacturers' recommended minimum effective dose for treating depression. Data is given for types of medications and for groups of people by age, sex, comorbid conditions, and color.

As this issue of Clinics in Perinatology illustrates, a profound shift has occurred in the driving purpose of high-risk infant follow-up (HRIF) over the past 5 years. As a result, HRIF has evolved from primarily providing an ethical compass, concerned surveillance and documentation of outcomes, to developing novel models of care, considering new high-risk populations, settings, and psychosocial factors, and incorporating active, targeted interventions to improve outcomes.

The value of agreement on the classification of shoulder disorder diagnoses would be an agreed-upon consistency of therapy, but attempts to create such a classification system was quite limited in agreement. There was wide variance in those who were attempting to establish classifications, particularly among patients with bilateral problems, severe pain, and chronic conditions. Since the usefulness of a diagnosis depends on its reproducibility, that is the direction diagnostic analyses would find profitable to take.

In brain magnetic resonance (MR) image segmentation, the current Otsu method is often difficult to take both accuracy and anti-noise capability into consideration. So, in this paper, an adaptive trapezoid region intercept histogram based Otsu method is proposed. On the basis of bilateral filtering, the method uses Sigmoid function to identify the noise and adaptively calculate the weight of neighborhood pixel, and then constructs a 2D histogram of gray value-adaptive weight neighborhood gray mean to enhance the algorithm’s anti-noise capability and detail retention. The hierarchical threshold model is adopted: the macro-threshold T1is determined by the trapezoid region intercept histogram based Otsu method, and the micro-threshold T2is determined by the between-class variance criterion again in the trapezoid region corresponding to T1. The image is segmented by T2to improve the accuracy of image segmentation. Based on the neighborhood information, an adaptive parameter lis designed to identify and correct noise, thus enhancing the universality of the algorithm. The experimental results show that the proposed method is effective and can be well applied to MR image segmentation.

The Shoulder Disability Questionnaire (SDQ) can effectively measure changes in shoulder pain and disability over time. The SDQ presents 16 routine daily activities and the patient indicates if the activities cause shoulder pain. Researchers compared SDQ, a severity of pain scale, and a functional status assessment in 335 patients over six months. The SDQ was highly sensitive to changes in shoulder pain, appropriately detecting an improvement or decline in the patients' conditions. However, it was not clearly better than the other assessment instruments.

Introduction Pain is the primary symptom in most patients with shoulder disorders affecting the soft tissue. In many patients, painful restriction of the range of shoulder movement limits the ability [...]