Headpulse measurement can reliably identify large-vessel occlusion stroke in prehospital suspected stroke patients: Results from the EPISODE-PS-COVID study.

BACKGROUND: Large-vessel occlusion (LVO) stroke represents one-third of acute ischemic stroke (AIS) in the United States but causes two-thirds of poststroke dependence and >90% of poststroke mortality. Prehospital LVO stroke detection permits efficient emergency medical systems (EMS) transport to an endovascular thrombectomy (EVT)-capable center. Our primary objective was to determine the feasibility of using a cranial accelerometry (CA) headset device for prehospital LVO stroke detection. Our secondary objective was development of an algorithm capable of distinguishing LVO stroke from other conditions. METHODS: We prospectively enrolled consecutive adult patients suspected of acute stroke from 11 study hospitals in four different U.S. geographical regions over a 21-month period. Patients received device placement by prehospital EMS personnel. Headset data were matched with clinical data following informed consent. LVO stroke diagnosis was determined by medical chart review. The device was trained using device data and Los Angeles Motor Scale (LAMS) examination components. A binary threshold was selected for comparison of device performance to LAMS scores. RESULTS: A total of 594 subjects were enrolled, including 183 subjects who received the second-generation device. Usable data were captured in 158 patients (86.3%). Study subjects were 53% female and 56% Black/African American, with median age 69 years. Twenty-six (16.4%) patients had LVO and 132 (83.6%) were not LVO (not-LVO AIS, 33; intracerebral hemorrhage, nine; stroke mimics, 90). COVID-19 testing and positivity rates (10.6%) were not different between groups. We found a sensitivity of 38.5% and specificity of 82.7% for LAMS ≥ 4 in detecting LVO stroke versus a sensitivity of 84.6% (p < 0.0015 for superiority) and specificity of 82.6% (p = 0.81 for superiority) for the device algorithm (CA + LAMS). CONCLUSIONS: Obtaining adequate recordings with a CA headset is highly feasible in the prehospital environment. Use of the device algorithm incorporating both CA and LAMS data for LVO detection resulted in significantly higher sensitivity without reduced specificity when compared to the use of LAMS alone.

Nanoscale imaging of Fe-rich inclusions in single-crystal zircon using X-ray ptycho-tomography.

We apply X-ray ptycho-tomography to perform high-resolution, non-destructive, three-dimensional (3D) imaging of Fe-rich inclusions in paleomagnetically relevant materials (zircon single crystals from the Bishop Tuff ignimbrite). Correlative imaging using quantum diamond magnetic microscopy combined with X-ray fluorescence mapping was used to locate regions containing potential ferromagnetic remanence carriers. Ptycho-tomographic reconstructions with voxel sizes 85 nm and 21 nm were achievable across a field-of-view > 80 µm; voxel sizes as small as 5 nm were achievable over a limited field-of-view using local ptycho-tomography. Fe-rich inclusions 300 nm in size were clearly resolved. We estimate that particles as small as 100 nm-approaching single-domain threshold for magnetite-could be resolvable using this "dual-mode" methodology. Fe-rich inclusions (likely magnetite) are closely associated with apatite inclusions that have no visible connection to the exterior surface of the zircon (e.g., via intersecting cracks). There is no evidence of radiation damage, alteration, recrystallisation or deformation in the host zircon or apatite that could provide alternative pathways for Fe infiltration, indicating that magnetite and apatite grew separately as primary phases in the magma, that magnetite adhered to the surfaces of the apatite, and that the magnetite-coated apatite was then encapsulated as primary inclusions within the growing zircon. Rarer examples of Fe-rich inclusions entirely encapsulated by zircon are also observed. These observations support the presence of primary inclusions in relatively young and pristine zircon crystals. Combining magnetic and tomography results we deduce the presence of magnetic carriers that are in the optimal size range for carrying strong and stable paleomagnetic signals but that remain below the detection limits of even the highest-resolution X-ray tomography reconstructions. We recommend the use of focused ion beam nanotomography and/or correlative transmission electron microscopy to directly confirm the presence of primary magnetite in the sub 300 nm range as a necessary step in targeted paleomagnetic workflows.

Adulteration and substitution of drugs purchased in Australia from cryptomarkets: An analysis of Test4Pay.

INTRODUCTION: Prohibited drugs in unregulated markets may be adulterated, resulting in increased risks for people who use drugs. This study investigated levels of drug adulteration and substitution of drugs purchased in Australia from cryptomarkets. METHODS: Data were collected from a darknet forum called Test4Pay from 1 September 2022 to 23 August 2023. Posts were included if they reported the results of drug samples submitted by post to the Vancouver-based Get Your Drugs Tested service, which uses Fourier-transform infrared spectroscopy with immunoassay strip tests (fentanyl and benzodiazepines). RESULTS: Of 103 samples, 65% contained only the advertised substance, 14% contained the advertised substance in combination with other psychoactive and/or potentially harmful substances and for 21%, the advertised substance was absent. Substances sold as MDMA, methamphetamine or heroin were consistently found to contain only the advertised substance, while substances sold as 2C-B, alprazolam or ketamine were the most likely to be completely substituted. Only 4 samples sold as cocaine contained solely the advertised substance, with 13 containing cocaine with adulterants like lidocaine, creatine, levamisole and boric acid (n = 19). No fentanyl contamination was detected. Novel dissociatives and novel benzodiazepines were detected, as well as a nitazene compound. DISCUSSION AND CONCLUSIONS: Drug markets under prohibition continue to contain numerous unexpected substances, some of which can elevate risk of harm. Cryptomarkets are not immune to this problem, despite review systems, which should, in theory, make vendors more accountable for the quality of their stock. These findings demonstrate a need for expansion of local drug checking services in Australia.

Comparison of the Scope of Practice of the Army Combat Medic Specialist and Civilian National EMS Certification Levels.

INTRODUCTION: The transition of Army Combat Medic Specialists (Military Occupational Specialty Code: 68W) from military to civilian emergency medical services (EMS) is challenging, and the pathway is not clearly defined. Our objective was to evaluate the current military requirements for 68W and how they compare to the 2019 EMS National Scope of Practice Model (SoPM) for the civilian emergency medical technician (EMT) and advanced emergency medical technician (AEMT). METHODS: This was a cross-sectional evaluation of the 68W skill floor as defined by the Soldier's Manual and Trainer's Guide Healthcare Specialist and Medical Education and Demonstration of Individual Competence in comparison to the 2019 SoPM, which categorizes EMS tasks into seven skill categories. Military training documents were reviewed and extracted for specific information on military scope of practice and task-specific training requirements. Descriptive statistics were calculated. RESULTS: Army 68Ws were noted to perform all (59/59) tasks that coincide with the EMT SoPM. Further, Army 68W practiced above scope in the following skill categories: airway/ventilation (3 tasks); medication administration route (7 tasks); medical director approved medication (6 tasks); intravenous initiation maintenance fluids (4 tasks); and miscellaneous (1 task). Army 68W perform 96% (74/77) of tasks aligned with the AEMT SoPM, excluding tracheobronchial suctioning of an intubated patient, end-tidal CO2 monitoring or waveform capnography, and inhaled nitrous oxide monitoring. Additionally, the 68W scope included six tasks that were above the SoPM for AEMT; airway/ventilation (2 tasks); medication administration route (2 tasks); and medical director approved medication (2 tasks). CONCLUSIONS: The scope of practice of U.S. Army 68W Combat Medics aligns well with the civilian 2019 Scope of Practice Model for EMTs and AEMTs. Based on the comparative scope of practice analysis, transitioning from Army 68W Combat Medic to civilian AEMT would require minimal additional training. This represents a promising potential workforce to assist with EMS workforce challenges. Although aligning the scope of practice is a promising first step, future research is needed to assess the relationship of Army 68Ws training with state licensure and certification equivalency to facilitate this transition.

Being pregnant and becoming a parent during the COVID-19 pandemic: a longitudinal qualitative study with women in the Born in Bradford COVID-19 research study.

BACKGROUND: Uncertainty around the risk of COVID-19 to pregnant women and their babies prompted precautionary restrictions on their health and care during the pandemic. Maternity services had to adapt to changing Government guidance. Coupled with the imposition of national lockdowns in England and restrictions on daily activities, women's experiences of pregnancy, childbirth and the postpartum period, and their access to services, changed rapidly. This study was designed to understand women's experiences of pregnancy, labour and childbirth and caring for a baby during this time. METHODS: This was an inductive longitudinal qualitative study, using in-depth interviews by telephone with women in Bradford, UK, at three timepoints during their maternity journey (18 women at timepoint one, 13 at timepoint two and 14 at timepoint three). Key topics explored were physical and mental wellbeing, experience of healthcare services, relationships with partners and general impact of the pandemic. Data were analysed using the Framework approach. A longitudinal synthesis identified over-arching themes. RESULTS: Three longitudinal themes captured what was important to women: (1) women feared being alone at critical points in their maternity journey, (2) the pandemic created new norms for maternity services and women's care, and (3) finding ways to navigate the COVID-19 pandemic in pregnancy and with a baby. CONCLUSIONS: Modifications to maternity services impacted significantly on women's experiences. The findings have informed national and local decisions about how best to direct resources to reduce the impact of COVID-19 restrictions and the longer-term psychological impact on women during pregnancy and postnatally.

Paramedic educational program attrition accounts for significant loss of potential EMS workforce.

Objective: Recent concerns for the strength and stability of the emergency medical services (EMS) workforce have fueled interest in enhancing the entry of EMS clinicians into the workforce. However, the educational challenges associated with workforce entry remain unclear. Our objective was to evaluate the educational pathway of entry into the EMS workforce and to identify factors that lead to the loss of potential EMS clinicians. Methods: This is a cross-sectional evaluation of all US paramedic educational programs, with enrolled students, in the 2019 Committee on Accreditation of Educational Programs for the EMS Professions annual report survey. This data set includes detailed program characteristics and metrics including program attrition rate (leaving before completion), and certifying exam pass rates. Descriptive statistics were calculated, and multivariable logistic regression analysis was conducted to evaluate the association between high program attrition rates (>30%) and program specific characteristics. Results: In 2019, 640 accredited programs met inclusion with 17,457 students enrolled in paramedic educational programs. Of these, 13,884 students successfully graduated (lost to attrition, 3,573/17,457 [21%]) and 12,002 passed the certifying exam on the third attempt (lost to unable to certify, 1,882/17,457 [11%]). High program attrition rates were associated with longer programs (>12 months), small class sizes (<12 students), and regional locations. Conclusions: Nearly 1 in 3 paramedic students were lost from the potentially available workforce either owing to attrition during the educational program or failure to certify after course completion. Attrition represented the largest loss, providing an avenue for future targeted research and interventions to improve EMS workforce stability.

Critical care drowning admissions in Southwest England 2009-2020, a retrospective study.

Aim: In the United Kingdom (UK), 600 deaths per annum are attributable to drowning. Despite this there is scarce critical care data on drowning patients globally. We describe drowning cases admitted to critical care units with a focus on functional outcomes. Materials and Methods: Medical records for critical care admissions following a drowning event were retrospectively reviewed across six hospitals in Southwest England for cases presenting in the period between 2009 and 2020. Data was collected according to the Utstein international consensus guidelines on drowning. Results: Forty-nine patients were included, 36 males and 13 females, including seven children. Median submersion duration was 2.5 min 20 cases were in cardiac arrest when rescued. At discharge 22 patients had preserved functional status, 10 patients had a reduced functional status. 17 patients died in hospital. Conclusion: Admission to critical care following drowning is uncommon and associated with high rates of mortality and poor functional outcomes. We find that 31% of those who survived a drowning event subsequently required an increased level of assistance with their activities of daily living.

Expanded analysis of high-grade astrocytoma with piloid features identifies an epigenetically and clinically distinct subtype associated with neurofibromatosis type 1.

High-grade astrocytoma with piloid features (HGAP) is a recently recognized glioma type whose classification is dependent on its global epigenetic signature. HGAP is characterized by alterations in the mitogen-activated protein kinase (MAPK) pathway, often co-occurring with CDKN2A/B homozygous deletion and/or ATRX mutation. Experience with HGAP is limited and to better understand this tumor type, we evaluated an expanded cohort of patients (n = 144) with these tumors, as defined by DNA methylation array testing, with a subset additionally evaluated by next-generation sequencing (NGS). Among evaluable cases, we confirmed the high prevalence CDKN2A/B homozygous deletion, and/or ATRX mutations/loss in this tumor type, along with a subset showing NF1 alterations. Five of 93 (5.4%) cases sequenced harbored TP53 mutations and RNA fusion analysis identified a single tumor containing an NTRK2 gene fusion, neither of which have been previously reported in HGAP. Clustering analysis revealed the presence of three distinct HGAP subtypes (or groups = g) based on whole-genome DNA methylation patterns, which we provisionally designated as gNF1 (n = 18), g1 (n = 72), and g2 (n = 54) (median ages 43.5 years, 47 years, and 32 years, respectively). Subtype gNF1 is notable for enrichment with patients with Neurofibromatosis Type 1 (33.3%, p = 0.0008), confinement to the posterior fossa, hypermethylation in the NF1 enhancer region, a trend towards decreased progression-free survival (p = 0.0579), RNA processing pathway dysregulation, and elevated non-neoplastic glia and neuron cell content (p < 0.0001 and p < 0.0001, respectively). Overall, our expanded cohort broadens the genetic, epigenetic, and clinical phenotype of HGAP and provides evidence for distinct epigenetic subtypes in this tumor type.

Emergency medical services Milestones 2.0: What has changed?

Background: Since 2015, development of competencies by emergency medical services (EMS) fellows have been evaluated using the EMS Milestones 1.0 developed by a working group consisting of relevant stakeholders convened by the Accreditation Council for Graduate Medical Education (ACGME). Feedback from users and data collected from the milestones assessments in the interim indicated a need for revision of the original milestones. In May 2021, the Milestones 2.0 working group was convened for the purpose of revising this specialty-specific assessment tool. Methods: A working group consisting of representatives from American Board of Emergency Medicine, the Review Committee for Emergency Medicine, and volunteers selected by the ACGME Milestones Committee, chaired by the ACGME vice president for milestones development, was convened using a virtual platform to revise the milestones and develop a supplemental guide for use along with the Milestones 2.0. There were no in-person meetings of this working group due to the COVID-19 pandemic. Results: Data from milestones reporting, discussion within the working group, stakeholder input, and public commentary were used to revise the original milestones. A new supplemental guide to enhance milestone usability and provide recommended resource materials was also developed for use alongside the milestones. Discussion: The EMS Milestones 2.0 and accompanying supplemental guide provide an updated framework for fellowship programs to use as a guide for developing the competencies necessary for independent practice as EMS physicians and in the formal, competency-based evaluation of trainees as required by the ACGME.

Avascular Necrosis and Time to Surgery for Unstable Slipped Capital Femoral Epiphysis: A Systematic Review and Meta-analysis.

BACKGROUND: Avascular necrosis (AVN) is a well-known complication of unstable slipped capital femoral epiphysis (SCFE) and its cause is multifactorial. Higher AVN rates have been reported with surgery undertaken between 24 hours to 7 days from the onset of symptoms. The current evidence regarding time to surgery and AVN rate remains unclear. The aim of our study was to investigate the rate of AVN and time to surgery in unstable SCFE. METHODS: A literature search of several databases was conducted. Eligibility criteria included all studies that reported AVN rates and time to surgery in unstable SCFE patients. We performed a meta-analysis using a random-effects model to pool the rate of AVN in unstable SCFE using different time to surgery subgroups (≤24 h, 24 h - 7 d and >7 d). Descriptive, quantitative and qualitative data were extracted. RESULTS: Twelve studies matched our eligibility criteria. In total, there were 434 unstable SCFE of which 244 underwent closed reduction (CR). The pooled AVN rates were 24% [95% CI: 16%-35%] and 29% [95% CI: 16%-45%] for the total and CR groups, respectively. The highest AVN rates were with surgery between 24 hours to 7 days, 42% and 54% for the total and CR groups, respectively. The lowest rates of AVN were with time to surgery ≤24 hours (22% and 21% respectively) and >7 days (18% and 29% respectively). These differences were not statistically significant. There was significant subgroup heterogeneity which was highest in the 24 hours - 7 days subgroup and lowest in the >7 days subgroup. CONCLUSIONS: The cumulative evidence was not conclusive for an association between AVN rate and time to surgery. The overall AVN rates were lower in unstable SCFE patients who had surgery ≤24 hours and >7 days. However, treatment techniques were very variable and there was significant heterogeneity in the included studies. Multi-centre prospective studies are required with well-defined time to surgery outcomes. LEVEL OF EVIDENCE: Level III/IV.

MRI enhancement patterns in 28 cases of clival chordomas.

Clival chordomas are classically thought of as locally aggressive tumors of the skull base and differentiate themselves from their benign counterparts by demonstrating moderate to marked contrast enhancement, reported as 95-100% in prior studies. The purpose of this review was to evaluate the imaging characteristics of lesions from a single institution classified as clival chordomas with an emphasis of highlighting lesions that do not follow the prevalent current description for chordoma. We searched our institutional databases for all patients with pathologically proven clival chordomas from 1997 to 2017 who had pre-operative imaging available. The images were evaluated for degree of contrast enhancement, MRI signal characteristics, osseous involvement, location, aggressiveness of appearance, and presence of calcifications. 28 cases were identified that had preoperative imaging available for review. Over half of the patients demonstrated either no/minimal (11/28, 39%) or mild enhancement (7/28, 25%). The remaining cases demonstrated moderate (4/28, 14%) and marked enhancement (6/28, 21%). The 4 lesions measuring less than 20 mm all had mild to minimal/no enhancement and lacked aggressive features on CT. Our experience finds that over half (64%) of clival chordomas will demonstrate mild or no enhancement at all. These findings suggest that the lack of MRI contrast enhancement should not be synonymous with a benign clival mass.

Administrative and Educational Characteristics of Paramedic Programs in the United States.

INTRODUCTION: Paramedics are a vital component of the Emergency Medical Services (EMS) workforce and the United States health care system. The continued provision of high-quality care demands constantly improving education at accredited institutions. To date, only limited characteristics of paramedic education in the United States have been documented and studied in the literature. The objective of this study was to describe the educational infrastructure of accredited paramedic programs in the United States in 2018. METHODS: This is a retrospective, cross-sectional evaluation of the 2018 paramedic program annual report from The Committee on Accreditation of Educational Programs for the EMS Professions (CoAEMSP; Rowlett, Texas USA). The dataset includes detailed program metrics. Additionally, questions concerning program characteristics, demographics, and resources were asked as part of the evaluation. Resource availability was assessed via the Resource Assessment Matrix (RAM) with a benchmark of 80%. Included in the analysis are all paramedic programs with students enrolled. Descriptive statistics were calculated (median, [interquartile range/IQR]). RESULTS: A total of 677 programs submitted data (100% response rate). Of these, 626 met inclusion criteria, totaling 17,422 students. Program annual enrollment varied greatly from one to 362 with most programs having small sizes (18 students [IQR 12-30]). Program duration was 12 months [IQR 12-16] with total hours of instruction being approximately 1,174 [IQR 1069-1304], 19% of which were dedicated to clinical experience. Full-time faculty sizes were small (two faculty members [IQR 1-3]) with most programs (80%) having annual operating budgets below USD$500,000. For programs with an annual budget below USD$100,000 (34% of programs), annual enrollment was approximately 14 students [IQR 9-21]. Degrees conferred by programs included certificates (90%), associate degrees (55%), and bachelor's degree (2%). Simulation access was assessed with nearly all (100%) programs reporting simple task trainers and 84% of programs investing in advanced simulation manikins. Seventy-eight percent of programs met the RAM benchmark. CONCLUSION: Most paramedic educational programs in the United States have small annual enrollments with low numbers of dedicated faculty and confer certificates and associate degrees. Nearly one-quarter of paramedic educational programs are not adequately resourced. This study is limited by self-reported data to the national accreditation agency. Future work is needed to identify program characteristics that are associated with high performance.

Reactive astrocytes acquire neuroprotective as well as deleterious signatures in response to Tau and Aß pathology.

Alzheimer's disease (AD) alters astrocytes, but the effect of Aß and Tau pathology is poorly understood. TRAP-seq translatome analysis of astrocytes in APP/PS1 ß-amyloidopathy and MAPTP301S tauopathy mice revealed that only Aß influenced expression of AD risk genes, but both pathologies precociously induced age-dependent changes, and had distinct but overlapping signatures found in human post-mortem AD astrocytes. Both Aß and Tau pathology induced an astrocyte signature involving repression of bioenergetic and translation machinery, and induction of inflammation pathways plus protein degradation/proteostasis genes, the latter enriched in targets of inflammatory mediator Spi1 and stress-activated cytoprotective Nrf2. Astrocyte-specific Nrf2 expression induced a reactive phenotype which recapitulated elements of this proteostasis signature, reduced Aß deposition and phospho-tau accumulation in their respective models, and rescued brain-wide transcriptional deregulation, cellular pathology, neurodegeneration and behavioural/cognitive deficits. Thus, Aß and Tau induce overlapping astrocyte profiles associated with both deleterious and adaptive-protective signals, the latter of which can slow patho-progression.

Weaponizing COVID-19: How the Pandemic Influenced the Behavior of Those Who Use Violence in Domestic and Family Relationships.

COVID-19 has increased threats to women's safety in Australia and globally. This research is based on a 2020 nationwide survey about the impacts of COVID-19 on domestic and family violence (DFV) services and allied sectors throughout Australia. This study focuses on how perpetrator behaviors-coercion, control, and violence-changed and intensified during the COVID-19 pandemic. Two central themes identified from this qualitative analysis were the increase in complexity and severity of DFV during COVID-19. The analysis highlights how perpetrator behavior reflects the weaponizing of COVID-19 against women and children. The article concludes with a discussion about the theoretical, practice, and policy implications.

Predicting pituitary adenoma consistency with preoperative magnetic resonance elastography.

OBJECTIVE: Pituitary adenoma is one of the most common primary intracranial neoplasms. Most of these tumors are soft, but up to 17% may have a firmer consistency. Therefore, knowing the tumor consistency in the preoperative setting could be helpful. Multiple imaging methods have been proposed to predict tumor consistency, but the results are controversial. This study aimed to evaluate the efficacy of MR elastography (MRE) in predicting tumor consistency and its potential use in a series of patients with pituitary adenomas. METHODS: Thirty-eight patients with pituitary adenomas (≥ 2.5 cm) were prospectively evaluated with MRI and MRE before surgery. Absolute MRE stiffness values and relative MRE stiffness ratios, as well as the relative ratio of T1 signal, T2 signal, and diffusion-weighted imaging apparent diffusion coefficient (ADC) values were determined prospectively by calculating the ratio of those values in the tumor to adjacent left temporal white matter. Tumors were classified into three groups according to surgical consistency (soft, intermediate, and firm). Statistical analysis was used to identify the predictive value of the different radiological parameters in determining pituitary adenoma consistency. RESULTS: The authors included 32 (84.21%) nonfunctional and 6 (15.79%) functional adenomas. The mean maximum tumor diameter was 3.7 cm, and the mean preoperative tumor volume was 16.4 cm3. Cavernous sinus invasion was present in 20 patients (52.63%). A gross-total resection was possible in 9 (23.68%) patients. The entire cohort's mean absolute tumor stiffness value was 1.8 kPa (range 1.1-3.7 kPa), whereas the mean tumor stiffness ratio was 0.66 (range 0.37-1.6). Intraoperative tumor consistency was significantly correlated with absolute and relative tumor stiffness (p = 0.0087 and 0.007, respectively). Tumor consistency alone was not a significant factor for predicting gross-total resection. Patients with intermediate and firm tumors had more complications compared to patients with soft tumors (50.00% vs 12.50%, p = 0.02) and also had longer operative times (p = 0.0002). CONCLUSIONS: Whereas other MRI sequences have proven to be unreliable in determining tumor consistency, MRE has been shown to be a reliable tool for predicting adenoma consistency. Preoperative knowledge of tumor consistency could be potentially useful for surgical planning, counseling about potential surgical risks, and estimating the length of operative time.

Deploying nationalist discourses to reduce sex-, gender- and HIV-related stigma in Thailand.

There is little research on how nationalism is adopted and deployed to foster but also to challenge sex-, gender- and HIV-related stigma in Thailand and other nation states across Southeast Asia. The available literature highlights how self-help groups for Thai people with HIV function as communities of practice, as sites of learning, and for gaining and preserving knowledge (Tanabe 2008, Liamputtong 2009, 2014). This article contributes to the literature by demonstrating how collectives of same-sex-attracted men and male-to-female transgender people living with HIV (PLHIV) in Thailand learn and teach each other how to alleviate social and personal barriers that impede access to health care. The study adopted qualitative research methods and interviewed 22 participants in five cities in Thailand. This article highlights how collective action, which adopts and reinterprets the symbols and metaphors of Thai nationalism, acts as a 'deviance disavowal' strategy (Davis 1961). By deploying Thai nationalism, same-sex attracted men and transgender PLHIV reposition 'spoiled identities' and break through the stigma they report after HIV diagnosis. Describing mechanisms of 'deviance disavowal' in Thailand may provide an opportunity to deploy strategies to manage stigma that interferes with access to health care in Thailand, and in other nation states, and may be applicable to other stigmatised groups and illnesses.

The impact of COVID-19 pandemic on Australian domestic and family violence services and their clients.

During the early stages of the COVID-19 pandemic, reports emerged that lockdowns were increasing the prevalence of domestic and family violence (DFV) in Australia and across the world. The lockdowns and restrictions were necessary to contain the pandemic. However, leaders in the domestic family violence sector expressed concerns early during 2020 that these lockdowns would lead to the escalation of domestic and family violence. Calling it a shadow pandemic, the United Nations Secretary-General urged all governments to prioritise the prevention of violence against women in their national response plan for COVID-19. To gain some insight into the Australian context, a Queensland University of Technology (QUT) Centre for Justice research team conducted a nationwide survey to assess the impact of COVID-19 pandemic on DFV services and their clients. Findings based on survey data from 362 participants from the DFV sector, including 1,507 qualitative responses, confirm the concerns raised early in the COVID-19 pandemic. This article provides an overview of the survey results, discusses the findings in the light of national international research and highlights the resources needed to strengthen the DFV sector in the future.

Impact of TCF4 Repeat Number on Resolution of Corneal Edema after Descemet's Stripping Only in Fuchs Dystrophy: A Pilot Study.

PURPOSE: To investigate whether Fuchs endothelial corneal dystrophy (FECD) genotype, specifically transcription factor 4 (TCF4) CTG triplet repeat "load" predicts time to clearance following Descemet's Stripping Only (DSO). METHODS: This prospective, interventional trial was conducted on consecutive FECD patients undergoing DSO. Genetic analysis using patients' saliva was performed to assess the extent of CTG expansion using short tandem repeat analysis, corroborated gel electrophoresis and Sanger sequencing. Polymerase chain reaction and bidirectional Sanger sequencing was undertaken. Partial least square regression and logistic regression modelling was used to evaluate the predictive power of TCF4 repeats on corneal clearance. RESULTS: Of 11 eyes of 11 patients, 8 showed complete corneal clearance. For these 8 patients, mean TCF4 allele repeat was 24.8 (SD: 23.7, range: 11-63) and 63.4 (SD: 30.3; range: 11-97), respectively. In total, 9/11 (81.8%) had expanded CTG repeats (>40) in one allele. In cases with an allele repeat ≥80, there was a significantly increased risk of corneal non-clearance (odds ratio 18.2, p = 0.009). CONCLUSION: Whilst it was not possible to predict time to corneal clearance based on CTG repeats, there is a significant correlation between allele repeats and achievement of corneal clearance.

Point absorbers in Advanced LIGO.

Small, highly absorbing points are randomly present on the surfaces of the main interferometer optics in Advanced LIGO. The resulting nanometer scale thermo-elastic deformations and substrate lenses from these micron-scale absorbers significantly reduce the sensitivity of the interferometer directly though a reduction in the power-recycling gain and indirect interactions with the feedback control system. We review the expected surface deformation from point absorbers and provide a pedagogical description of the impact on power buildup in second generation gravitational wave detectors (dual-recycled Fabry-Perot Michelson interferometers). This analysis predicts that the power-dependent reduction in interferometer performance will significantly degrade maximum stored power by up to 50% and, hence, limit GW sensitivity, but it suggests system wide corrections that can be implemented in current and future GW detectors. This is particularly pressing given that future GW detectors call for an order of magnitude more stored power than currently used in Advanced LIGO in Observing Run 3. We briefly review strategies to mitigate the effects of point absorbers in current and future GW wave detectors to maximize the success of these enterprises.

Ultrasound Use in the Prehospital Setting for Trauma: A Systematic Review.

BACKGROUND: Trauma is a leading cause of death in the United States. Ultrasound use in the prehospital environment has the potential to change trauma management. Although ultrasound use for prehospital trauma is increasing, the role of this modality is not clearly defined. OBJECTIVES: We examined the use of prehospital ultrasound (PHUS) for trauma patients and the use by different provider types. Specific factors of interest were if prehospital ultrasound has been shown to improve providers' ability to recognize conditions that can be managed in the prehospital setting, treat these conditions, change transport destination, or improve overall mortality rates for trauma patients. METHODS: We searched MEDLINE/PubMed, EBSCOhost, Cochrane Library, and Embase medical literature databases for articles that addressed our outcomes. Abstracts and articles were examined and studies that did not specifically evaluate ultrasound in the prehospital setting for trauma and duplicates were eliminated. Studies included in this comprehensive review were assessed for the use of ultrasound in the prehospital setting to aid in the diagnosis, treatment, and transport of trauma patients. We also conducted an analysis of bias in the included articles. Due to the large heterogeneity in the included studies, no meta-analysis could be performed. RESULTS: Sixteen studies were identified comprising 3,317 patients. One study evaluated Emergency Medical Services (EMS) professionals as the ultrasound operator while five studies involved mixed practitioners and ten studies involved only physicians. Diagnostic accuracy was similar amongst physicians and mixed practitioners with no studies reporting PHUS accuracy for EMS providers alone. Seven studies evaluated treatment and transport impact of PHUS though the variables measured were inconsistent and results varied by protocol and outcomes measured. There were no studies that evaluated PHUS and its impact on patient mortality. CONCLUSION: Ultrasound use in the prehospital setting for trauma is feasible and demonstrates potential. However, the evidence in the medical literature mainly consists of prospective observational studies of physicians utilizing ultrasound for trauma in a HEMS setting. Further scientific research must be undertaken to firmly establish the role of prehospital ultrasound in trauma management by all types of EMS providers.