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Variant Creutzfeldt-Jakob disease in UK children after 27 years of active prospective surveillance
Get PDFOBJECTIVE: To determine whether any children in the UK had variant Creutzfeldt-Jakob disease (vCJD).DESIGN: This active prospective epidemiological study used the British Paediatric Surveillance Unit, asking UK paediatricians to notify all childhood cases of progressive intellectual and neurological deterioration (PIND), a group that would include all cases of vCJD. Clinical data were obtained by questionnaire or via a site visit. An independent expert group classified the cases. If vCJD was suspected, referral to the National Creutzfeldt-Jakob Disease Research and Surveillance Unit was recommended.RESULTS: Between May 1997 and April 2024 (27 years), 5222 children were notified. There were four groups. (1) 2540 were 'not cases'-they did not meet the case definition or there were notification errors. (2) 2367 had a known underlying diagnosis other than vCJD; the group contained more than 220 different diseases. (3) 309 had no diagnosis to explain their deterioration; there was evidence that none of these cases had vCJD. (4) There were six cases of vCJD: two males and four females. They developed symptoms between 1998 and 2000, aged 12-15 years, and the last two died in 2003. Their clinical features were similar to those of adults. Four were classified as definite vCJD and two as probable vCJD.CONCLUSIONS: This study has provided unique data about neurodegenerative diseases in UK children. There is no reliable vCJD screening test; so for 27 years, the PIND study has provided reassurance that childhood vCJD cases were not missed. New vCJD cases with the methionine/valine genotype could appear.</p
Press freedom and stock price crash risk
Get PDFThis paper examines the impact of press freedom, an important institutional factor, on stock price crash risk. Using a large international sample of firms across 52 economies between 2002 and 2021, we find that firms in economies with higher degrees of press freedom are associated with lower levels of future stock price crash risk. Our analysis further shows that press freedom helps to deter the hoarding of bad news by increasing the intensity of reporting, extending the reporting period, and broadening local media coverage. Firms operating in economies with press freedom demonstrate stronger corporate governance and lower levels of firm-specific and long-term overvaluation, which are likely mechanisms through which press freedom mitigates crash risk. The negative impact of press freedom on crash risk is weakened by corruption but strengthened for firms facing higher short interest and less analyst coverage. Additional tests reveal that this negative relationship is driven by a collective influence from multiple dimensions of press freedom. Our results survive a battery of robustness checks. In sum, our findings suggest that press freedom enhances the stability of the global stock market by discouraging the concealment of negative information
Reforms or deforms? The rise and decline of the rentier middle class in the United Arab Emirates
Get PDFThis article examines the dual bargains of the United Arab Emirates’ (UAE) government that are vital to its political stability. Using interviews with middle-class Emiratis as well as publicly available primary and secondary sources, I shed light on how these Emiratis perceive the changes that these bargains have undergone. Oil wealth fueled the emergence of a new, educated middle class that came to occupy public sector jobs, buffeted by the Kafala system. Due to recent policy shifts, citizens now report anxieties owing to a decline in material government benefits, a push out of secure public sector employment into precarious private sector jobs and the termination of “Arbab entrepreneurship.” At the same time, the government is seen to cater more to noncitizens, resulting in a diminishing citizen or noncitizen differential, going so far as to elicit fear of a reversal of roles. As a result, the discourse on labor reforms and economic growth does not connote positive change for Emiratis.</p
RF-Based Sensing and AI Decision Support for Stroke Patient Monitoring: A Digital Twin Approach
No full textStroke occurs when the blood flow to a certain region of the brain is disrupted. It is a leading cause of long-term disability and can result in cognitive impairments, speech difficulties, and motor dysfunction. Regular monitoring and timely intervention are critical to minimizing the damage and improving outcomes. This article presents a novel Radio Frequency (RF) sensing and Artificial Intelligence (AI) based Digital Twin (DT) model for effective detection of stroke. Through backscattering RF signals, the proposed Ultra Wide Band (UWB) antenna provides stroke detection. The implementation of Machine Learning (ML) and Deep Learning (DL) technologies for stroke classification provides the necessary decision support to healthcare professionals in DT stroke patient monitoring. The statistical and autonomous (AutoEncoders (AE) and Stacked AutoEncoders (SAE) with structure 32-16-32, 64-32-16-32-64, and 128-64-32-16-32-64-128) feature data is enlarged through Gaussian noise feature data augmentation. The Fine KNN algorithm provides the 93.4% and 92.3% classification accuracies of binary and multi-class classification respectively. Out of the 4 autonomous feature extraction methods, the Fine KNN algorithm with SAE structure 64-32-16-32-64 provided the highest accuracies of 88.2% and 74.8% for binary and multi-class classification
Mapping the global landscape of task shifting and sharing: trends, geographic disparities, and terminology from 1970 to 2022
No full textIntroduction: Task shifting and sharing (TS/S) are strategies for redistributing healthcare services among providers, popular in settings facing workforce crunches. A comprehensive mapping of global TS/S research remains lacking despite widespread implementation. Theory: We apply bibliographic techniques to map where TS/S has been prioritised, revealing patterns that inform implementation science and future strategies. Methods: We searched five databases, Medline, CINAHL Plus, Elsevier, Global Health, and Google Scholar, in October 2022 to analyse 2,072 articles (found between 1970 and 2022), based on relevance to TS/S and geographical representation. We extracted data on countries where studies were conducted, the terminology describing TS/S, and the study’s focus. Results: TS/S research concentrates on African and South Asian countries, led by South Africa (n = 201), India (n = 130), Uganda (n = 109), Kenya (n = 106), and Malawi (n = 86). Publications increased dramatically after 2006–2008, coinciding with key WHO reports. ‘Task shifting’ was the predominant descriptor (66.0%), followed by ‘task sharing’ (24.0%), ‘task delegation’ (6.0%), and ‘task shifting and sharing’. HIV (n = 450) and depression (n = 375) were the most studied conditions, while 42.5% of articles focused on broader systems and policy issues rather than specific diseases. Discussion: Geographic disparities, language inconsistencies, and disease-specific applications suggest the need for targeted implementation in underrepresented regions, terminology standardisation, and expanded applications. Addressing these can optimise implementation strategies, enhancing outcomes
STEM education and sustainability:What role can mathematics education play in the era of climate change?
No full textClimate change is recognised globally as an urgent crisis, prompting the integration of sustainability into education to address future challenges beyond disciplinary boundaries. In STEM education, integrating science, technology, engineering, and mathematics empowers students to address environmental, societal, and economic concerns for a better future quality of life. Concerns about mathematics potentially disappearing or becoming relegated to a mere tool within STEM activities have been raised. However, these concerns have received limited and disproportionate attention in mathematics education discussions over the past decade. This study, therefore, took a step towards contributing new insights to this field by designing a STEM and sustainability (STEMS) programme for students aged 15–18 in Scotland and investigating students’ perceptions of mathematics within this programme. The study also examined changes in students’ attitudes towards mathematics before and after participating in the programme. Implications and directions for further research are also discussed
Automatic reply:Another university is possible
No full textThis chapter takes the form of an email exchange among the authors between February and June 2023 – a period characterized by an unprecedented level of disruption caused by ongoing industrial action at UK universities. Reflecting on the theme ‘Making liveable (STS) worlds through reflexive methods’, it is punctuated by real life – travel, delays, family holidays, doubts, detours, culs-de-sac, unfulfilled promises, flights of fancy, jokes, conflicting priorities, strikes and out-of-office messages – and as such embodies something of the intersecting worlds in which we live. As it precludes other possibilities, the chapter’s form becomes a material meditation on the challenges of building liveable worlds together through reflexive practices in the present moment
Habits and algorithms:Reconsidering music technology
Get PDFIn thinking about music as a set of narrative frames within a technological setting, and in the context of recent advances in AI that allow the decomposition and generation of musical corpora, the inadequacy of traditional representations of both music and the technologies associated with music become apparent. Taking the Pragmatist view, in which living selves present as bundles of habit (James, Dewey), and acknowledging both the contributions of habit to 4E Cognition and the social implications of this view developed by Bourdieu in his notion of the habitus, this paper considers the current situation of technology, the notion of habit in relation to specific technological elements, and the ways in which orientation and attachment frame the narrative forces that shape and are shaped by musical experience in order to interrogate new methods of habit formation and creative process evident within contemporary digital art practices. Rather than suggesting solutions to perceived problems, the paper sets out a conceptual frame as a ground for further investigation and critique
Dexmedetomidine- or Clonidine-Based Sedation Compared With Propofol in Critically Ill Patients The A2B Randomized Clinical Trial
Get PDFImportance: Whether α 2-adrenergic receptor agonist-based sedation, compared with propofol-based sedation, reduces time to extubation in patients receiving mechanical ventilation in the intensive care unit (ICU) is uncertain. Objective: To evaluate whether dexmedetomidine- or clonidine-based sedation reduces duration of mechanical ventilation compared with propofol-based sedation (usual care). Design, Setting, and Participants: Pragmatic, open-label randomized clinical trial conducted at 41 ICUs in the UK including adults who were within 48 hours of starting mechanical ventilation, were receiving propofol plus an opioid for sedation and analgesia, and were expected to require mechanical ventilation for 48 hours or longer. The median time from intubation to randomization was 21.0 (IQR, 13.2-31.3) hours. Recruitment occurred from December 2018 to October 2023; the last follow-up occurred on December 10, 2023. Interventions: The bedside algorithms used targeted a Richmond Agitation-Sedation Scale score of -2 to 1 (unless clinicians requested deeper sedation). The algorithms supported uptitration in the dexmedetomidine- and clonidine-based sedation intervention groups and supported downtitration for propofol-based sedation followed by sedation primarily with the allocated sedation (dexmedetomidine or clonidine). If required, supplemental use of propofol was permitted. Main Outcomes and Measures: The primary outcome was time from randomization to successful extubation. The secondary outcomes included mortality, sedation quality, rates of delirium, and cardiovascular adverse events. Results: Among the 1404 patients in the analysis population (mean age, 59.2 [SD, 14.9] years; 901 [64%] were male; and the mean APACHE II score was 20.3 [SD, 8.2]), the subdistribution hazard ratio (HR) for time to successful extubation was 1.09 (95% CI, 0.96-1.25; P =.20) for dexmedetomidine (n = 457) vs propofol (n = 471) and was 1.05 (95% CI, 0.95-1.17; P =.34) for clonidine (n = 476) vs propofol (n = 471). The median time from randomization to successful extubation was 136 (95% CI, 117-150) hours for dexmedetomidine, 146 (95% CI, 124-168) hours for clonidine, and 162 (95% CI, 136-170) hours for propofol. In the predefined subgroup analyses, there were no interactions with age, sepsis status, median Sequential Organ Failure Assessment score, or median delirium risk score. Among the secondary outcomes, agitation occurred at a higher rate with dexmedetomidine vs propofol (risk ratio [RR], 1.54 [95% CI, 1.21-1.97]) and with clonidine vs propofol (RR, 1.55 [95% CI, 1.22-1.97]). Compared with propofol, the rates of severe bradycardia (heart rate <50/min) were higher with dexmedetomidine (RR, 1.62 [95% CI, 1.36-1.93]) and clonidine (RR, 1.58 [95% CI, 1.33-1.88]). Compared with propofol, mortality was similar over 180 days for dexmedetomidine (HR, 0.98 [95% CI, 0.77-1.24]) and clonidine (HR, 1.04 [95% CI, 0.82-1.31]). Conclusions and Relevance: In critically ill patients, neither dexmedetomidine nor clonidine was superior to propofol in reducing time to successful extubation. Trial Registration: ClinicalTrials.gov Identifier: NCT03653832.</p
Nest building and circulating testosterone dynamics in male zebra finches, Taeniopygia guttata
Get PDFDespite its fundamental importance for avian reproduction, the hormonal mechanisms supporting nest building remain poorly understood. While nest building by both male and female builders requires circulating sex steroids, it is not clear whether these steroids are required throughout building. We, therefore, sought to determine circulating testosterone dynamics in male zebra finches during early breeding, specifically focusing on the nest building period. We collected plasma samples from two cohorts of birds at three of the following four timepoints: before (baseline), following pairing, during, and after nest building. To dissociate the end of nest building from incubation onset we daily removed any eggs laid and terminated nest building once we had sampled males during nest building. Male circulating testosterone levels remained stable following pairing with a female and throughout nest building. However, testosterone titers dropped once nest building had stopped. We also found evidence to suggest that, following pairing with a female, circulating testosterone titers can predict a male’s future readiness to build. Together, our data suggest that circulating testosterone is important throughout nest building, not decreasing until the 34 end of nest building activities, perhaps through a ‘self-feedback’ mechanism
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