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BACKGROUND AND OBJECTIVES: The Management of Myelomeningocele Study (MOMS), a randomized trial of prenatal versus postnatal repair for myelomeningocele, found that prenatal surgery resulted in reduced hindbrain herniation and need for shunt diversion at 12 months of age and better motor function at 30 months. In this study, we compared adaptive behavior and other outcomes at school age (5.9-10.3 years) between prenatal versus postnatal surgery groups. METHODS: Follow-up cohort study of 161 children enrolled in MOMS. Assessments included neuropsychological and physical evaluations. Children were evaluated at a MOMS center or at a home visit by trained blinded examiners. RESULTS: The Vineland composite score was not different between surgery groups (89.0 ± 9.6 in the prenatal group versus 87.5 ± 12.0 in the postnatal group; P = .35). Children in the prenatal group walked without orthotics or assistive devices more often (29% vs 11%; P = .06), had higher mean percentage scores on the Functional Rehabilitation Evaluation of Sensori-Neurologic Outcomes (92 ± 9 vs 85 ± 18; P < .001), lower rates of hindbrain herniation (60% vs 87%; P < .001), had fewer shunts placed for hydrocephalus (49% vs 85%; P < .001) and, among those with shunts, fewer shunt revisions (47% vs 70%; P = .02) than those in the postnatal group. Parents of children repaired prenatally reported higher mean quality of life z scores (0.15 ± 0.67 vs 0.11 ± 0.73; P = .008) and lower mean family impact scores (32.5 ± 7.8 vs 37.0 ± 8.9; P = .002). CONCLUSIONS: There was no significant difference between surgery groups in overall adaptive behavior. Long-term benefits of prenatal surgery included improved mobility and independent functioning and fewer surgeries for shunt placement and revision, with no strong evidence of improved cognitive functioning.

Evidence from numerous animal models shows that vagal activity regulates inflammatory responses by decreasing cytokine release. Heart rate variability (HRV) is a reliable index of cardiac vagal regulation and should be inversely related to levels of inflammatory markers. Inflammation is also regulated by sympathetic inputs, but only one previous paper controlled for this. In a larger and more representative sample, we sought to replicate those results and examine potential sex differences in the relationship between HRV and inflammatory markers. Using data from the MIDUS II study, we analyzed the relationship between 6 inflammatory markers and both HF-HRV and LF-HRV. After controlling for sympathetic effects measured by urinary norepinephrine as well as a host of other factors, LF-HRV was found to be inversely associated with fibrinogen, CRP and IL-6, while HF-HRV was inversely associated with fibrinogen and CRP. We did not observe consistent sex differences. These results support the existence of the vagal anti-inflammatory pathway and suggest that it has similar effects in men and women.

This study describes the chemical conversion and heat treatment of Ti6Al4V microspheres (Ti6_MS), and the resulting effects on their electrocatalytic properties. The wet‐chemical conversion (5.0 m NaOH, 60 °C, 24 h; Sample label: Ti6_TC) converts the top surface of the Ti6_MS powder into an ≈820 nm thick sodium titanate surface. Heat‐treatment (Ti6_TC_HT) at 450 °C increases the stability of the surface, through partial titanate crystallization, while mitigating excess rutile formation. All samples are analyzed chemically (XPS, EDX, Raman, EELS), structurally (XRD and TEM), and morphologically (SEM, TEM), demonstrating the characteristic formation of sodium titanate dendritic structures, with minimal chemical, structural, and morphological differences due to the 450 °C heat‐treatment. The effect of the preparation methodology on oxygen reduction reaction (ORR) electrocatalytic performance is also tested. The introduction of the sodium titanate layer changes the mechanism of the ORR, from a mixed 4 electron/2 electron pathway to a predominantly 2‐electron pathway. By maintaining the microspherical nature of the material while also tuning the surface of the material toward different reaction mechanisms, a design strategy for new electrocatalyst materials is explored. [ABSTRACT FROM AUTHOR]

The combination of ultrasound and microbubbles allows treatment of indications that would be impossible or too risk adverse with conventional surgery. During treatment, subharmonic and ultraharmonic components that can only be generated from microbubbles are of great interest for intraoperative monitoring. However, the microbubble emissions are several orders of magnitude lower in power compared to that of the fundamental frequency component from the ultrasound applicator, resulting in a low signal‐to‐noise ratio (SNR) for monitoring. A 3D acoustic metamaterial (AMM) immersed in water is proposed for suppressing unwanted ultrasound waves, which allows the improved sensitivity for detecting weak microbubble emissions. Numerically, the importance of shear waves on the AMM transfer properties is highlighted, though only longitudinal ultrasound waves are transmitted through water. Experimentally, the design is implemented in titanium using additive manufacturing, with an attenuation level of 40 dB at the fundamental frequency. Consequently, the application of the AMM efficiently improves the SNR for subharmonic and ultraharmonic microbubble emissions by 11.8 and 11.9 dB, respectively. The subharmonic components originally overwhelmed by noise are recovered. This is the first time that AMMs have been applied to passive acoustic monitoring and this work stands to improve treatment outcomes from cavitation‐mediated focused ultrasound therapy. [ABSTRACT FROM AUTHOR]

Images in movement and images of movement take a central place in iterations of Islamic material and visual piety. Yet the still image remains the default object of inquiry in most studies of devotional visuality. Taking movement rather than stasis as the prerequisite for engagement, many popular decorative items and technologies that share the status of "moving images" evoke the affective experience of pilgrimage. In what follows, close analysis of a repertoire of one such image technology, the lenticular print, formed through its circulation in Pakistan, provides insights into the kind of engagement expected from images whose efficacy is governed by their mobility. By testing the application of some significant theories on the phenomenology of film experience, combined with ways of understanding the forms of presence elicited by virtual pilgrimage, this essay attempts to better grasp the kinds of engagement invited by devotional objects characterized by their evocation of movement. [ABSTRACT FROM AUTHOR]

For many city dwellers in Pakistan the distant memory of outdoor cinemas in their ancestral villages rekindles the thrill of first contact with film exhibition. This paper considers attempts made in colonial British India and postcolonial Pakistan to understand, wield, and benefit from the staging of such memorable and affective filmic events. In its cultivation of "cinema-minded" subjects, the British Empire commissioned studies of audiences and their reactions to film exhibition in hopes of managing the unruly morality and materiality of the cinematic apparatus. After Partition and the creation of the Dominion of Pakistan, similar studies continued, evincing a residual strategy of elicited contact. The elicitation of film contact aimed at the exertion and commandment of the event of film exhibition for the purposes of knowing their constituent subjects at a moment of malleability. Yet the Empire's struggle with the perceived problems of "Muslim tastes" and audience members' ambivalence over rural screenings in post-Partition Pakistan calls for a reconsideration of the efficacy of these tactics. I argue that what complicated these encounters are affective responses that questioned the address, permissibility, and efficacy of film exhibition. In these tactics of elucidation, disenchantment, and denial, ruptures are refused and the new is dismissed as inoperable, incompatible, or impermissible. [ABSTRACT FROM AUTHOR]

This article explores site-responsiveness in the context of a collaborative work, Tide Times, by Laura Bissell (writer) and Timothy Cooper (electroacoustic composer) created for the island of Cramond. In this co-written submission we examine the ways in which the work responded to our experience of exploring the tidal island on the East Coast of Scotland during five visits between April and August 2018. Contextualising Tide Times through Ingold's ideas of atmosphere and place (Ingold, 2015), theories of soundwalking (Westerkamp, 2007) and acoustic ecology (Clarke, 2005) we discuss our attempt to heighten the participants' experience of the island and encourage a playful exploration of place. This article will discuss the ways in which the electroacoustic compositions and texts responded to site, environmental sound, the natural flora and fauna of the island and its visitors. Tim's electroacoustic compositions were combined with a palimpsest of texts including reflective accounts of visits to Cramond (written by Laura and Tim), site-responsive poems (written by Laura), fragments of found text, poems and excerpts from oceanographer Rachel Carson's The Edge of the Sea (Carson, 2014)(curated by Laura). These audio tracks attempt to explore an experience of this place, its tidal qualities, and the multiple identities of Cramond Island over time. Inspired by the geocache we found on our first visit to the island (a global treasure hunt using GPS), we created nine treasure chests to be found using a map to accompany the audio exploration which included invitations for visitors to the island to engage in making their own creative responses to this site. Whilst the pre-recorded tracks and the invitations remain constant, the way that the participants respond to these will continue to reshape the precise nature of the work: in this way the participants become active collaborators in the creation of Tide Times. [ABSTRACT FROM AUTHOR]