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Background: There is a paucity of information on maternal multiple sclerosis (MS) and risk of adverse pregnancy and perinatal outcomes. Objective: The aim of this study was to determine the association between MS and risks of adverse pregnancy and perinatal outcomes in women with MS. In women with MS, the influence of exposure to disease-modifying therapy (DMT) was also investigated. Methods: Population-based retrospective cohort study on singleton births to mothers with MS and matched MS-free mothers from the general population in Sweden between 2006 and 2020. Women with MS were identified through Swedish health care registries, with MS onset before child’s birth. Results: Of 29,568 births included, 3418 births were to 2310 mothers with MS. Compared with MS-free controls, maternal MS was associated with increased risks of elective caesarean sections, instrumental delivery, maternal infection and antepartum haemorrhage/ placental abruption. Compared with offspring of MS-free women, neonates of mothers with MS were at increased risks of medically indicated preterm birth and being born small for gestational age. DMT exposure was not associated with increased risks of malformations. Conclusions: While maternal MS was associated with a small increased risk of few adverse pregnancy and neonatal outcomes, DMT exposure close to pregnancy was not associated with major adverse outcomes.

In the last 15 years, mindfulness programs have become more popular in schools. However, bringing mindfulness into schools involves more than selecting a curriculum. It entails creating the conditions for mindfulness that requires a particular kind of leadership: the capacity to lead for and with mindfulness. Authors Deborah L. Schussler, Karen Krisch, Julia Mahfouz, Rebecca N. Baelen, and Laura Feagans Gould highlight common principles and practical examples from educational leaders engaging in this work and share some of the emerging research into mindfulness in education.

We examine an approach to case screening where prosecutors screen requests for charges before a felony arrest is made. In 2016, Franklin County prosecutors declined to authorize arrests in 17.5% of felony cases. Declination rates, however, varied widely between offense types. Prosecutors most commonly did not authorize an arrest due to insufficient evidence, no crime having occurred, or follow-up needed. Among other findings, the cases of Black defendants, as compared to White defendants, were more likely to be declined due to insufficient evidence and additional follow-up needed. We conclude that prearrest screening by prosecutors can filter out weak cases early, increasing efficiency for the prosecutor’s office, saving the government money, and minimizing the impact of a “bad” arrest on a defendant.

For employers and their associations, 2021 began with the prospect of significant industrial relation change and a return to business as usual. However, the enduring implications of the pandemic, and defeat of many employer-supported aspects of the Coalition Government's legislative changes in the Senate, quickly dashed these dreams. Through a review of public submissions, media reports and interviews, this article explores the key activities and interests of employers and their associations throughout 2021. This year saw welcomed clarity regarding casual employment, renewed government interest in (if not support for) skilled migration, and through the enhanced use of online communication platforms, the opportunity for better member–association relationships. As the year progressed, employer attention shifted back to the pandemic, and more specifically, the challenge of managing vaccine mandates. For employers and their associations, 2021 was then a year of mixed results and enduring uncertainty.

Critical illness-related cardiac arrest (CIRCA) as a distinct entity is not well described epidemiologically. There is currently a knowledge gap regarding how many occur in the UK or the impact on patient outcome. The CIRCA study is a prospective multi-centre observational cohort study of patients in the United Kingdom experiencing a cardiac arrest while in a Critical Care Unit embedded in the Case Mix Programme and National Cardiac Arrest Audit. The duration of data collection is 12 months, with surviving patients and family members receiving questionnaire follow-up at 90 days, 180 days and 12 months. This paper describes the protocol for the CIRCA study which received favourable ethical opinion from South Central – Berkshire Research Ethics Committee and approval from the Health Research Authority. Study registration is on clinicaltrials.gov (NCT04219384).

Background: Ketamine is rapidly metabolized to norketamine and hydroxynorketamine (HNK) metabolites. In female mice, when compared to males, higher levels of ( 2R,6R;2S,6S)-HNK have been observed following ketamine treatment, and higher levels of ( 2R,6R)-HNK following the direct administration of ( 2R,6R)-HNK. Aim: The objective of this study was to evaluate the impact of sex in humans and mice, and gonadal hormones in mice on the metabolism of ketamine to form norketamine and HNKs and in the metabolism/elimination of ( 2R,6R)-HNK. Methods: In CD-1 mice, we utilized gonadectomy to evaluate the role of circulating gonadal hormones in mediating sex-dependent differences in ketamine and ( 2R,6R)-HNK metabolism. In humans (34 with treatment-resistant depression and 23 healthy controls) receiving an antidepressant dose of ketamine (0.5 mg/kg i.v. infusion over 40 min), we evaluated plasma levels of ketamine, norketamine, and HNKs. Results: In humans, plasma levels of ketamine and norketamine were higher in males than females, while ( 2R,6R;2S,6S)-HNK levels were not different. Following ketamine administration to mice (10 mg/kg i.p.), Cmax and total plasma concentrations of ketamine and norketamine were higher, and those of ( 2R,6R;2S,6S)-HNK were lower, in intact males compared to females. Direct ( 2R,6R)-HNK administration (10 mg/kg i.p.) resulted in higher levels of ( 2R,6R)-HNK in female mice. Ovariectomy did not alter ketamine metabolism in female mice, whereas orchidectomy recapitulated female pharmacokinetic differences in male mice, which was reversed with testosterone replacement. Conclusion: Sex is an important biological variable that influences the metabolism of ketamine and the HNKs, which may contribute to sex differences in therapeutic antidepressant efficacy or side effects.

Cross-relationship comparisons are an integral part of relationship processes, yet little is known about the impact of these comparisons in daily life. The present research employed a dyadic experience-sampling methodology ( N = 78 couples) with end-of-day surveys, end-of-week follow-up, and a 6-month follow-up to examine how individuals make cross-relationship comparisons in daily life, the cumulative impact of these comparisons over time, and the dyadic consequences of such comparisons. Participants made more downward than upward comparisons; however, upward comparisons had a more lasting impact, resulting in decreased satisfaction and optimism, and less positive self-perceptions and partner perceptions, at the end of each day and the week. Individuals who made more upward comparisons were also less satisfied 6 months later. Individuals were also affected by their partner’s comparisons: On days when partners made more upward comparisons, they felt less satisfied and optimistic about their relationship and less positive about themselves and their partner.

Objectives The aim of this study was to characterize gastrointestinal (GI) transit times and pH in healthy cats. Methods GI transit times and pH were measured in six healthy, colony-housed, purpose-bred spayed female cats using a continuous, non-invasive pH monitoring system in a sequential order design. For the first period (‘pre-feeding’), food was withheld for 20 h, followed by oral administration of a pH capsule. Five hours post-capsule administration, cats were meal-fed by offering them their daily allowance of food for 1 h. For the second period (‘post-feeding’), food was withheld for 24 h and cats were fed for 1 h, after which a pH capsule was orally administered. Studies in both periods were repeated three times. GI transit times and pH were compared between the two periods. Results The median transit times for the pre- and post-feeding periods, respectively, were: gastric – 94 mins (range 1–4101) and 1068 mins (range 484–5521); intestinal – 1350 mins (range 929–2961) and 1534 mins (range 442–2538); and GI – 1732 mins (range 1105–5451) and 2795 mins (range 926–6563). The median GI pH values for the first and second periods, respectively, were: esophageal – 7.0 (range 3.5–7.8) and 4.5 (range 2.9–6.4); gastric – 2.7 (range 1.7–6.2) and 2.0 (range 1.1–3.3); intestinal – 8.2 (range 7.6–8.7) and 7.8 (range 6.7–8.5); first-hour small intestinal – 8.2 (range 7.4–8.7) and 8.3 (range 7.9–8.6); and last-hour large intestinal – 8.5 (range 7.0–8.9) and 7.8 (range 6.3–8.7). Gastric ( P Conclusions and relevance Gastric and intestinal pH differed significantly when the capsule was administered 5 h prior to feeding compared with 1 h after feeding. Transit times for both periods showed high degrees of intra- and inter-individual variability.

There is a wealth of literature investigating the role of family involvement within care homes following placement of a relative with dementia. This review summarises how family involvement is measured and aims to address two questions: (1) which interventions concerning family involvement have been evaluated? And (2) does family involvement within care homes have a positive effect on a resident’s quality of life and behavioural and psychological symptoms of dementia? After searching and screening on the three major databases PsycINFO, MEDLINE and CINAHL Plus for papers published between January 2005 and May 2021, 22 papers were included for synthesis and appraisal due to their relevance to family involvement interventions and or family involvement with resident outcomes. Results show that in 11 interventions designed to enhance at least one type of family involvement, most found positive changes in communication and family–staff relationships. Improvement in resident behavioural and psychological symptoms of dementia was reported in two randomised controlled trials promoting partnership. Visit frequency was associated with a reduction of behavioural and psychological symptoms of dementia for residents with moderate dementia. Family involvement was related to positive quality of life benefits for residents. Contrasting results and methodological weaknesses in some studies made definitive conclusions difficult. Few interventions to specifically promote family involvement within care homes following placement of a relative with dementia have been evaluated. Many proposals for further research made over a decade ago by Gaugler (2005) have yet to be extensively pursued. Uncertainty remains about how best to facilitate an optimum level and type of family involvement to ensure significant quality of life and behavioural and psychological symptoms of dementia benefits for residents with dementia.

This paper estimates the causal effect of repeated exposure to violent crime on test scores in New York City. We use two empirical strategies; value-added models linking student performance on standardised exams to violent crimes on students’ residential block, and a regression discontinuity approach that identifies the acute effect of additional crime exposure within a one-week window. Exposure to violent crime reduces academic performance. Value-added models suggest the average effect is very small (approximately −0.01 standard deviations) but grows with repeated exposure. Regression discontinuity (RD) models also find a larger effect among children previously exposed. The marginal acute effect is as large as −0.04 standard deviations for students with two or more prior exposures. Among these, it is almost one tenth of a standard deviation for Black students. We provide credible causal evidence that repeated exposure to neighbourhood violence harms test scores, and this negative effect increases with exposure.

Chlorides (frequently sodium chloride) are used to improve safety and access to roads and other surfaces in winter. However, chlorides also pose risks to aquatic life and raises human health concerns as they move to surface waterbodies and infiltrate groundwater. In response, many government bodies have adopted winter maintenance best management practices (BMPs) that reduce the amount of chlorides used while providing service and safety. Commercial businesses maintaining parking lots, driveways, and other surfaces have been shown to contribute as much as 50% of the chloride loads to local waterbodies in some areas, but less is known about the potential benefits of private contractors to implement similar BMPs. In addition, many existing resources on the topic are designed for municipal audiences, creating a knowledge gap about the feasibility of private companies to adopt these practices. The authors identified 14 BMPs common to municipal plans with the potential to be adopted by private contractors through a literature review. These practices aim to increase the efficiency of salt applications, and/or decrease environmental impacts while delivering a similar level of service and cost over time. The authors considered potential barriers and benefits to private contractors adopting and using these BMPs. Benefits included reduced liability (e.g., risk of lawsuits), costs, environmental impacts, and improved service. Barriers included additional staff time and training, increased materials, equipment, and maintenance costs. Additional research is needed to ground-truth these predicted motivations and barriers; a greater understanding of private contractor behaviors can enhance educational efforts that promote reduced salt practices.

Ankle fracture is a common injury, and depending on injury severity, treatment may be a support boot, cast or surgery. Older people, particularly those with severe injuries who are asked to restrict weight bearing, struggle with early recovery. To elicit older peoples’ experience of recovery 6 months after injury, we drew on a phenomenological approach using interviews. Findings revealed that getting on with life was a way of accepting what it feels like to ‘be vulnerable’, needing to ‘be safe’ while determinedly working hard to ‘be myself’. Being vulnerable identified endurance of inactivity, loneliness and dependency in the non-weight bearing period of recovery, followed by a struggle to weight bear while lacking confidence and being fearful of falling and causing further damage. Being safe conveyed fragility where sensations, pain and stiffness acted as bodily reminders of injury. Lack of function and awareness of danger led to carefulness where planning or curtailing of activities ensured their safety. Being myself showed a determination to push away from a disrupted self-identify of being older or disabled while being challenged by the continuous process of learning to be more mobile. A lack of readiness for old age created a drive to age well. Despite loss of ability, participants hoped to regain their pre-injury way of living. This study challenges practice that disregards the hard work required to recover from ankle fracture. As comorbidity increases with age, failure to consider this aspect may contribute to frailty in this group of older people.

In most research, prosecutors are depicted monolithically as “interchangeable parts” rather than as individuals with varied perspectives. Yet, the prosecution is becoming increasingly diverse, a shift that is likely accompanied by different approaches to prosecution. Drawing upon the concepts of role orientation and job crafting, we identify three primary orientations to the job of a prosecutor, that of the Enforcer, the Reformer, and the Advocate. Whereas Enforcers view their job as merely to apply the law, Reformers focus on rehabilitation of the defendant, and Advocates are instead concerned with retribution for victims. These three interpretations of prosecutors’ responsibilities translate into different approaches to charging. Furthermore, when there is a disconnect between a prosecutor’s personal philosophy and that of their office more generally, prosecutors develop covert ways of exercising their priorities.

Background and purpose Acute ischemic stroke has increasingly become a procedural disease following the demonstrated benefit of mechanical thrombectomy (MT) for emergent large vessel occlusion (ELVO) on clinical outcomes and tissue salvage in randomized trials. Given these data and anecdotal experience of decreased numbers of decompressive hemicraniectomies (DHCs) performed for malignant cerebral edema, we sought to correlate the numbers of strokes, thrombectomies, and DHCs performed over the timeline of the 2013 failed thrombolysis/thrombectomy trials, to the 2015 modern randomized MT trials, to post-DAWN and DEFUSE 3. Materials and methods This is a multicenter retrospective compilation of patients who presented with ELVO in 11 US high-volume comprehensive stroke centers. Rates of tissue plasminogen activator (tPA), thrombectomy, and DHC were determined by current procedural terminology code, and specificity to acute ischemic stroke confirmed by each institution. Endpoints included the incidence of stroke, thrombectomy, and DHC and rates of change over time. Results Between 2013 and 2018, there were 55,247 stroke admissions across 11 participating centers. Of these, 6145 received tPA, 4122 underwent thrombectomy, and 662 patients underwent hemicraniectomy. The trajectories of procedure rates over time were modeled and there was a significant change in MT rate ( p = 0.002) without a concomitant change in the total number of stroke admissions, tPA administration rate, or rate of DHC. Conclusions This real-world study confirms an increase in thrombectomy performed for ELVO while demonstrating stable rates of stroke admission, tPA administration and DHC. Unlike prior studies, increasing thrombectomy rates were not associated with decreased utilization of hemicraniectomy.

Across the globe, human experiences of death, dying, and grief are now shaped by digital technologies and, increasingly, by robotic technologies. This article explores how practices of care for the dead are transformed by the participation of non-human, mechanised agents. We ask what makes a particular robot engagement with death a breach or an affirmation of care for the dead by examining recent entanglements between humans, death, and robotics. In particular, we consider telepresence robots for remote attendance of funerals; semi-humanoid robots officiating in a religious capacity at memorial services; and the conduct of memorial services by robots, for robots. Using the activities of robots to ground our discussion, this article speaks to broader cultural anxieties emerging in an era of high-tech life and high-tech death, which involve tensions between human affect and technological effect, machinic work and artisanal work, humans and non-humans, and subjects and objects.

We report on Phase 1 efforts of the Hierarchical Taxonomy of Psychopathology (HiTOP) measurement subgroup tasked with developing provisional scales for the somatoform spectrum and eating disorders. In Study 1, items were written to assess five somatoform spectrum constructs (bodily distress symptoms, conversion symptoms, health anxiety, disease conviction, and somatic preoccupation). Scale development analyses were conducted on 550 university students. The conversion symptom items were too infrequently endorsed and were set aside for Phase 2. Analyses of the other items yielded four scales corresponding closely to their hypothesized structure. In Study 2, we delineated 15 specific feeding and eating disorder constructs. A sample of 400 university students were administered candidate items and several eating disorder questionnaires for criterion validity. Analyses yielded six scales capturing previously described constructs, tapping content related to body image and weight concerns, restricting and purging, cognitive restraint, binging, excessive exercise, and muscle building. Two scales representing additional constructs deemed to be of high clinical import—negative attitude towards obesity and avoidant/restrictive food intake disorder—were retained for Phase 2, for a total of eight scales. Overall, we concluded that Phase 1 had been successful at generating a comprehensive set of provisional scales for inclusion in Phase 2.