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Challenges to the legitimacy of mental capacity over the past 10 years have been spearheaded by the Committee on the Rights of Persons with Disabilities, the treaty body for the UN Convention on the Rights of Persons with Disabilities (CRPD). This challenge has been asserted to have produced a ‘paradigm shift’. In this article, we examine why that interpretation has had such limited traction in the legal policy arena, and whether it should have traction. We also analyse whether the Committee has subtly but importantly shifted its position. We then develop an argument that the true goal, compatible with the CRPD, is the satisfactory determination of whether a person has or lacks mental capacity to make or take a relevant decision. Our article contextualises multi-disciplinary, research-informed guidelines designed as a contribution to satisfactory determination. While our article is based upon the position in England and Wales, we suggest that our conclusions are of wider application.

Ronit Stahl and Ezekiel Emanuel have recently issued a stark challenge to conscience protections in medical law and ethics. Their argument is flawed, however. They misrepresent the nature and relevance of conscientious protection in the military, misinterpret the scope of consent tendered by modern medical professionals, and offer no reason to think either that conscientious objection harms patient well-being or that such harm should solely determine the permissibility of conscientious objection. Moreover, and most fundamentally, Stahl and Emanuel do not recognize that conscience protections promote moral integrity, a basic aspect of human well-being that justifies protective action.

A mathematical model for the formation of condensation aerosols from highly supersaturated vapor-air mixtures is presented. The model is suitable for systems with very high nucleation rates that re...

BackgroundAssessment of capacity for treatment and discharge decisions is common in the general hospital. Liaison psychiatrists are often asked to support the treating medical or surgical team in difficult capacity assessments. However, empirical research on identification and resolution of difficult capacity cases is limited. Some studies have identified certain patient, decisional, and interpersonal factors which cause difficulty, but no study has explored how these issues are resolved in practice. Our study therefore aimed to describe how experienced liaison psychiatrists identify and resolve difficult capacity cases in a general hospital setting.MethodsWe carried out semi-structured interviews with 26 liaison psychiatrists from England, Scotland, and New Zealand, on their most difficult capacity cases. Thematic analysis was used to examine types of difficulty and how these were resolved in practice. Summaries were prepared and example quotes extracted to illustrate phenomena described.ResultsWe identified four types of difficulty in capacity assessment, spanning both clinical and ethical domains: 1) Difficulty determining whether the decision is the patient's own or driven by illness, 2) Difficulty in applying ethical principles, 3) Difficulty in avoiding personal bias, and 4) Procedural difficulties. The liaison psychiatrists presented as self-reflective and aware of challenges and pitfalls in hard cases. We summarized their creative strategies to resolve difficulty in assessment.ConclusionPractitioners approaching difficult capacity cases require both clinical skills, e.g., to uncover subtle illness impairing decision-making and to consider interpersonal dynamics, and ethical skills, e.g., to negotiate the role of values and risks in capacity assessment. Education and training programmes should incorporate both aspects and could include the resolution strategies identified in our study. Practitioners, supported by health and social care systems, should work to develop self-aware and reflective capacity assessment practice.

Differences in building operator strategies can significantly affect building energy use and occupant comfort. However, it seems that the daily work of building operators and facility managers is still largely based on heuristics and individual experiences. In this work, we have investigated the current data collection methods during the operation and its daily use in buildings as well as the handling of occupant behavior, comfort, and user complaints based on interviews with ten building operators in Germany. These interviews were conducted as part of an international study of building operator OCC (Occupant-Centric Control) strategies, under the auspices of the IEA EBC Annex 79. The results of the interviews clearly reflect, that until now, communication between building operators and building occupants plays a more important role in optimizing or adjusting building operations to meet occupant needs than the data collected by BAS, which is mainly used to detect faults and check the system status of key HVAC components when faults occur. In some cases, the real-time data are applied for the adjustment of set points and schedules depending on measured conditions; however, customization of set points considering the user’s preferred temperature or ventilation rate or building operation based on occupancy detection has not yet been implemented in the considered buildings. The overall objective of this contribution to building operation research is to highlight best practices and identify white spaces that fulfill occupant requirements and achieve a high level of energy-efficiency. The presented findings identify current gaps between science and practice in the field of sustainable optimization of building operation, but also point out real-world starting points for future research and development.

Infrastructure resilience for a scenario can be assessed quantitatively from resilience curves that plot the evolution of system performance. Summary metrics map these curves to a single value to facilitate comparisons of different systems, scenarios, and policies. Commonly, these metrics are integral-based, e.g., cumulative infrastructure performance. However, since these curves and metrics only examine infrastructure performance, they fail to consider the dynamics of when stakeholders value the performance. For example, a power failure at a hospital during an ordinary day would be of less concern to emergency managers than during a hurricane recovery. This manuscript defines value weighting functions to represent the evolution of stakeholders’ value of performance. Temporal correlation between the performance and value weighting functions is described through a stochastic offset. Together, these concepts are used to define a holistic resilience metric: percent value satisfied. Through analytical and numerical approaches, percent value satisfied is treated as a resilience assessment’s stochastic output, and its distribution is compared to the naïve metric, cumulative infrastructure performance. The naïve summary metric is shown to be misleading in multiple potential scenarios; this work establishes that resilience assessments must consider the impact of time-varying stakeholder value and its correlation with infrastructure performance. These elements also provide new considerations for resilience assessments: opportunities to improve holistic system resilience without directly affecting infrastructure performance; hazard categories to inform value-weighted resilience analysis; and general insights to guide extensions from performance-based to value-weighted assessment.

Measuring the aerosol particle size of electronic cigarettes can be particularly challenging due to the volatile and dynamic nature of these aerosols. In particular, electronic cigarette aerosol pa...

Introduction : Chaque année l'OMS dénombre près d'un million de nouveaux cas de méningites bactériennes avec une létalité de 10%. Depuis l'introduction du vaccin contre l'Haemophilus influenzae b (Hib) en 2005, du vaccin contre le Streptococcus pneumoniæ en 2011 et les campagnes de vaccinations de masse contre le Neisseriameningitidis A, aucune étude n'a porté sur les méningites bactériennes dans le service de pédiatrie de l'hôpital du Mali d'où l'initiation de ce travail.Matériels et méthodes : Il s'agissait d'une étude descriptive rétrospective couvrant la période de 01Janvier 2012 au 31 Décembre 2017 et prospective allant du 01 Janvier au 31 Décembre 2018 chez les enfants d'un mois à 15 ans hospitalisés pour méningite bactérienne dans le service de pédiatrie de l'Hôpital du Mali.Résultats : Durant la période de notre étude nous sur les 6429 enfants hospitalisés nous avons enregistré 88 cas de méningites bactériennes soit, une fréquence hospitalière de 1,4%. Le sex ratio était de 1,5. Les enfants de moins de 5 ans étaient les plus touchés (71,6%). Les enfants étaient immunisés contre Hib (72,7%) et pneumocoque (71,6%) . La fièvre était présente chez 80,6% de nos enfants associées ou non au coma (68.2%%, à la convulsion (56,8%) et à l'agitation (13,6%). Les principaux germes isolés étaient : le Streptococcus pneumoniæ (36,4 %), le NeisseriameningitidisW135, X, C (12,5%) et l'Haemophilus influenzae (9,1%). L'association du Ceftriaxone et de la gentamycine a été utilisée avec succès chez 77.3% de nos enfants. Le taux de guérison était de 64,8%, le taux des séquelles (12, 5%) et le taux de létalité (18, 2%).Conclusion : Le pneumocoqueest le germe majoritairement responsable des méningites bactériennes malgré l'introduction du vaccin antipneumococcique conjugué treize valent. Les sérogroupes W135, X, et C de méningocoque qui sont aussiresponsables des méningites dans notre service

Introduction : le tétanos néonatal constitue une cause importante de morbidité et de mortalité néonatales dans les pays en développement. Méthodologie : il s’agissait de 3 cas de tétanos néonatal hospitalisés de janvier 2017 à juillet 2018 à la néonatologie de l’hôpital du Mali. Résultats : les nouveau-nés ont été reçus pour trismus. Ils étaient nés à terme par voie basse après une grossesse mal suivie. Leurs mamans n’étaient pas vaccinées contre le tétanos. Dès la première semaine de vie, ils ont présenté une fièvre et un trismus. Sous traitement, le premier est guéri au bout de 15 jours. Les deux autres sont décédés dès les premiers jours de leur hospitalisation dans un tableau d’hypertonie fébrile. Conclusion : le tétanos néonatal est une maladie grave évitable par la vaccination qui sévit encore dans les pays en développement.

Due to the uncontrollable generators, islanded microgrids powered only by renewable energy require costly energy storage systems. Energy storage needs are amplified when load and generation are misaligned on hourly, monthly, or seasonal timescales. Diversification of both loads and generation can smooth out such mismatches. However, the ideal type of battery to smooth out remaining generation deficits will depend on the duration(s) that energy is stored. This study presents a controls co-design approach to design an islanded microgrid, showing the benefit of hybridizing tidal and solar generation and hybridizing lithium-ion and flow battery energy storage. The optimization of the microgrid’s levelized cost of energy is initially studied in grid-search slices to understand convexity and smoothness. Then, a particle swarm optimization is proposed and used to study the sensitivity of the hybrid system configuration to variations in component costs. The study highlights the benefits of controls co-design, the need to model premature battery failure, and the importance of using battery cost models that are applicable across orders of magnitude variations in energy storage durations. The results indicate that such a hybrid microgrid would currently produce energy at five times the cost of diesel generation, but flow battery innovations could bring this closer to only twice the cost while using 100% renewable energy.

La cryptococcose neuroméningée (CNM) est une mycose cosmopolite grave, affectant généralement les sujets ayant un déficit de l’immunité cellulaire surtout les séropositifs au virus de l'immunodéficience humaine (VIH).Nous rapportons l’observation d’un cas chez une fille de 7 ans, admise pour altération de l’état général, trouble de la conscience (Glasgow à 8/15), syndrome méningé (raideur de la nuque, signe de Kernig et de Brudzinski) et tétraplégie prédominant à gauche. La tomodensitométrie (TDM) cérébrale avait mis en évidence une dilatation de l’ensemble des cavités ventriculaires avec hypodensité périventriculaire cérébrale.La ponction lombaire (PL) avait ramené un liquide cérébrospinal (LCS) clair. L’analyse du LCS avait permis de retrouver une méningite pléiocytaire, hyperprotéinorachique, hypoglycorachique et un Cryptococcusneoformans. Un traitement antifungique associant amphotéricine B et fluconazole avait été instauré.La patiente avait aussi subit un drainage chirurgical de l’hydrocéphalie. Après 12 semaines d’hospitalisation, le décès était survenu dans un contexte d’altération de l’état général, de convulsions à répétition et de coma profond. La cryptococcose neuroméningée pose un sérieux problème de diagnostic et de traitement chez l’enfant immunocompétent à cause de l’insuffisance des moyens d’investigation et de traitement.

Introduction : le paludisme est un problème de santé publique au Mali. Cependant il est si rare chez le nouveau-né que sa recherche n’est pas systématique chez ce dernier même fébrile. Observation : il s’agissait un nouveau-né prématuré de 21 jours admis pour fièvre à la néonatologie de l’Hôpital du Mali. Le diagnostic a été posé au test rapide (TDR) du paludisme. Un traitement comprenant l’artésunate, la transfusion de concentré globulaire et la perfusion du sérum glucosé 10% a été institué. L’évolution a été marquée par l’apyrexie, la reprise de l’alimentation et du poids, la diminution de la parasitémie et l’augmentation du taux de l’hémoglobine. Conclusion : le TDR du paludisme doit être systématique chez les nouveau-nés fébriles en zone d’endémie palustre pour ne pas passer à côté d’un paludisme néonatal.

This study investigates the association between neighborhood disadvantage from adolescence to young adulthood and metabolic syndrome using a life course epidemiology framework. Data from the United States-based National Longitudinal Study of Adolescent to Adult Health (n = 9500) and a structural equation modeling approach were used to test neighborhood disadvantage across adolescence, emerging adulthood, and young adulthood in relation to metabolic syndrome. Adolescent neighborhood disadvantage was directly associated with metabolic syndrome in young adulthood. Evidence supporting an indirect association between adolescent neighborhood disadvantage and adult metabolic syndrome was not supported. Efforts to improve cardiometabolic health may benefit from strategies earlier in life.

Effective real-time execution of nonlinear model predictive control (NMPC) on embedded systems is significantly dependent on the controller formulation. This paper studies the effect of model structure and cost functions on the computation time of scalar bilinear NMPC using variational methods, with hydronic cooling applications. Two algebraically equivalent nonlinear model structures common in literature are primarily considered: a linear state equation with state-dependent control constraints and a bilinear state equation with time-invariant rectangular control constraints. Additionally, the effects of three cost function formulations are also considered: minimum-time, quadratic regulation, and efficient state constraints. High-fidelity computer simulations, hardware-in-the-loop testing, and experiments on a bench-scale hydronic cooling system are used to study sources of computational complexity, rates of convergence, initialization techniques, and overall effectiveness of the different models and costs. These results suggest that NMPC with bilinear state equations, minimizing pump power and a one-sided quadratic state cost, converges sufficiently fast and reliably. This presents an attractive alternative to the traditionally constrained linear quadratic regulator-based NMPC on embedded systems.

Recent advances in Artificial Intelligence (AI) have produced AI tools that help political campaigns to prevail in election cycles. There have been notable early successes for campaigns using this technology, particularly in 2016 for the Trump presidential campaign and, during the Brexit referendum, the U.K. Leave Campaign. Critiques of these pioneering tools argue that they have adopted unethical practices, and that monitoring the ethical use of such tools is too complex a task, particularly when tools are the intellectual property of private corporations. This article challenges that notion and proposes a way to engage in dialectics with advanced tools of AI in governance as they go about their tasks. The proposals presented here could help electorates around the world to build up observable integrity within their election cycles and thereby increase levels of trust in the societal institutions tasked with ensuring them free, fair, and open election conditions.

The development and production of engineered 2D nanomaterials are expanding exponentially, increasing the risk of their release into the aquatic environment. A recent study showed 2D MnO2 nanosheets, under development for energy and biomedical applications, dissolve upon interaction with biological reducing agents, resulting in depletion of intracellular glutathione levels within fish gill cells. However, little is known concerning their toxicity and interactions with subcellular organelles. To address this gap, we examined cellular uptake, cytotoxicity and mitochondrial effects of 2D MnO2 nanosheets using an in vitro fish gill cell line to represent a target tissue of rainbow trout, a freshwater indicator species. The data demonstrate cellular uptake of MnO2 nanosheets into lysosomes and potential mechanisms of dissolution within the lysosomal compartment. MnO2 nanosheets induced severe mitochondrial dysfunction at sub-cytotoxic doses. Quantitative, single cell fluorescent imaging revealed mitochondrial fission and impaired mitochondrial membrane potential following MnO2 nanosheet exposure. Seahorse analyses for cellular respiration revealed that MnO2 nanosheets inhibited basal respiration, maximal respiration and the spare respiratory capacity of gill cells, indicating mitochondrial dysfunction and reduced cellular respiratory activity. MnO2 nanosheet exposure also inhibited ATP production, further supporting the suppression of mitochondrial function and cellular respiration. Together, these observations indicate that 2D MnO2 nanosheets impair the ability of gill cells to respond to energy demands or prolonged stress. Finally, our data demonstrate significant differences in the toxicity of the 2D MnO2 nanosheets and their microparticle counterparts. This exemplifies the importance of considering the unique physical characteristics of 2D nanomaterials when conducting safety assessments.

Entomophagy is being explored as a sustainable food source in Western countries to combat the ever-increasing effects of climate change. Studies conducted in various European countries determine the factors affecting willingness to consume insects. The current study aims to gain the first insight on this topic in Ireland, a country with a long farming tradition. A survey including open- and closed-ended questions was developed and sent to students and staff of an institute of technology in the West of Ireland. The willingness to consume insects and the factors affecting willingness to consume them under different conditions were assessed. It was found that less neophobic males who do not follow a particular diet were most receptive to entomophagy. People who were willing to try insects were less willing if the insects were to be eaten whole. People who were not willing were more inclined to do so if they were disguised or used to feed livestock. Food neophobia, disgust and safety concerns were barriers to acceptance. Tasty products containing disguised insects in familiar foods are the most likely to be accepted. Education and taste tests are recommended first steps to introducing entomophagy. Using insects to feed livestock has the potential to improve acceptance of entomophagy by introducing insects in the supply chain. However, further research should be conducted to assess acceptance of this amongst Irish farmers. The current study agrees with findings of studies conducted in other European countries and reveals the conditions under which insects could become acceptable among Irish consumers.

Resilience curves are used to communicate quantitative and qualitative aspects of system behavior and resilience to stakeholders of critical infrastructure. Generally, these curves illustrate the evolution of system performance before, during, and after a disruption. As simple as these curves may appear, the literature contains underexplored nuance when defining "performance" and comparing curves with summary metrics. Through a critical review of 273 publications, this manuscript aims to define a common vocabulary for practitioners and researchers that will improve the use of resilience curves as a tool for assessing and designing resilient infrastructure. This vocabulary includes a taxonomy of resilience curve performance measures as well as a taxonomy of summary metrics. In addition, this review synthesizes a framework for examining assumptions of resilience analysis that are often implicit or unexamined in the practice and literature. From this vocabulary and framework comes recommendations including broader adoption of productivity measures; additional research on endogenous performance targets and thresholds; deliberate consideration of curve milestones when defining summary metrics; and cautionary fundamental flaws that may arise when condensing an ensemble of resilience curves into an "expected" trajectory., Comment: 32 pages, 4 figures. Submitted to Reliability Engineering & System Safety

The key characteristics (KC) of human carcinogens provide a uniform approach to evaluating mechanistic evidence in cancer hazard identification. Refinements to the approach were requested by organizations and individuals applying the KCs. We assembled an expert committee with knowledge of carcinogenesis and experience in applying the KCs in cancer hazard identification. We leveraged this expertise and examined the literature to more clearly describe each KC, identify current and emerging assays and in vivo biomarkers that can be used to measure them, and make recommendations for future assay development. We found that the KCs are clearly distinct from the Hallmarks of Cancer, that interrelationships among the KCs can be leveraged to strengthen the KC approach (and an understanding of environmental carcinogenesis), and that the KC approach is applicable to the systematic evaluation of a broad range of potential cancer hazards in vivo and in vitro. We identified gaps in coverage of the KCs by current assays. Future efforts should expand the breadth, specificity, and sensitivity of validated assays and biomarkers that can measure the 10 KCs. Refinement of the KC approach will enhance and accelerate carcinogen identification, a first step in cancer prevention. See all articles in this CEBP Focus section, “Environmental Carcinogenesis: Pathways to Prevention.”

Building occupants are continuously exposed to multiple indoor environmental stimuli, including thermal, visual, acoustic, and air quality related factors. Moreover, personal and contextual aspects can be regarded as additional domains influencing occupants' perception and behaviour. The scientific literature in this area typically deals with these multiple stimuli in isolation. In contrast to single-domain research, multi-domain research analyses at least two different domains, for example, visual and thermal. The relatively few literature reviews that have considered multi-domain approaches to indoor-environmental perception and behaviour covered only a few dozen articles each. The present contribution addresses this paucity by reviewing 219 scientific papers on interactions and cross-domain effects that influence occupants’ indoor environmental perception and behaviour. The objective of the present review is to highlight motivational backgrounds, key methodologies, and major findings of multi-domain investigations of human perception and behaviour in indoor environments. The in-depth review of these papers provides not only an overview of the state of the art, but also contributes to the identification of existing knowledge gaps in this area and the corresponding need for future research. In particular, many studies use “convenience” variables and samples, there is often a lack of theoretical foundation to studies, and there is little research linking perception to action.

Introduction : le paludisme est un problème de santé publique au Mali. Cependant il est si rare chez le nouveau-né que sa recherche n'est pas systématique chez ce dernier même fébrile. Observation : il s'agissait un nouveau-né prématuré de 21 jours admis pour fièvre à la néonatologie de l'Hôpital du Mali. Le diagnostic a été posé au test rapide (TDR) du paludisme. Un traitement comprenant l'artésunate, la transfusion de concentré globulaire et la perfusion du sérum glucosé 10% a été institué. L'évolution a été marquée par l'apyrexie, la reprise de l'alimentation et du poids, la diminution de la parasitémie et l'augmentation du taux de l'hémoglobine. Conclusion : le TDR du paludisme doit être systématique chez les nouveau-nés fébriles en zone d'endémie palustre pour ne pas passer à côté d'un paludisme néonatal.

Objective: The International Medical Informatics Association (IMIA) Open Source Working Group (OSWG) initiated a group discussion to discuss current privacy and security issues in the open data movement in the healthcare domain from the perspective of the OSWG membership. Methods: Working group members independently reviewed the recent academic and grey literature and sampled a number of current large-scale open data projects to inform the working group discussion. Results: This paper presents an overview of open data repositories and a series of short case reports to highlight relevant issues present in the recent literature concerning the adoption of open approaches to sharing healthcare datasets. Important themes that emerged included data standardisation, the inter-connected nature of the open source and open data movements, and how publishing open data can impact on the ethics, security, and privacy of informatics projects. Conclusions: The open data and open source movements in healthcare share many common philosophies and approaches including developing international collaborations across multiple organisations and domains of expertise. Both movements aim to reduce the costs of advancing scientific research and improving healthcare provision for people around the world by adopting open intellectual property licence agreements and codes of practice. Implications of the increased adoption of open data in healthcare include the need to balance the security and privacy challenges of opening data sources with the potential benefits of open data for improving research and healthcare delivery.

The seven articles in this special issue aim to evaluate the social impact and social implications of new and emerging technologies on governance, politics, public administration, and policymaking; and to evaluate the future prospects of digital democracy, and its transformative potential for increasing public engagement, community empowerment, and social entrepreneurship. Innovative Information and Communication Technologies (ICT) already play an important role in e-governance and digital democracy, both at national and community levels. There is unprecedented opportunity for community collective choice, whereby citizens who are affected by a set of governing rules can help to select policy options, rank spending priorities, and can, in partnership with their local government representatives, participate in the approval, implementation, modification, and application of those rules.

Tree plantations represent an important component of the global carbon (C) cycle and are expected to increase in prevalence during the 21st century. We examined how silvicultural approaches that optimize economic returns in loblolly pine (Pinus taeda L.) plantations affected the accumulation of C in pools of vegetation, detritus, and mineral soil up to 100 cm across the loblolly pine’s natural range in the southeastern United States. Comparisons of silvicultural treatments included competing vegetation or ‘weed’ control, fertilization, thinning, and varying intensities of silvicultural treatment for 106 experimental plantations and 322 plots. The average age of the sampled plantations was 17 years, and the C stored in vegetation (pine and understory) averaged 82.1 ± 3.0 (±std. error) Mg C ha−1, and 14.3 ± 0.6 Mg C ha−1 in detrital pools (soil organic layers, coarse-woody debris, and soil detritus). Mineral soil C (0–100 cm) averaged 79.8 ± 4.6 Mg C ha−1 across sites. For management effects, thinning reduced vegetation by 35.5 ± 1.2 Mg C ha−1 for all treatment combinations. Weed control and fertilization increased vegetation between 2.3 and 5.7 Mg C ha−1 across treatment combinations, with high intensity silvicultural applications producing greater vegetation C than low intensity (increase of 21.4 ± 1.7 Mg C ha−1). Detrital C pools were negatively affected by thinning where either fertilization or weed control were also applied, and were increased with management intensity. Mineral soil C did not respond to any silvicultural treatments. From these data, we constructed regression models that summarized the C accumulation in detritus and detritus + vegetation in response to independent variables commonly monitored by plantation managers (site index (SI), trees per hectare (TPH) and plantation age (AGE)). The C stored in detritus and vegetation increased on average with AGE and both models included SI and TPH. The detritus model explained less variance (adj. R2 = 0.29) than the detritus + vegetation model (adj. R2 = 0.87). A general recommendation for managers looking to maximize C storage would be to maintain a high TPH and increase SI, with SI manipulation having a greater relative effect. From the model, we predict that a plantation managed to achieve the average upper third SI (26.8) within our observations, and planted at 1500 TPH, could accumulate ~85 Mg C ha−1 by 12 years of age in detritus and vegetation, an amount greater than the region’s average mineral soil C pool. Notably, SI can be increased using both genetic and silviculture technologies. Published version

With increasing commercialization of high volume, two-dimensional carbon nanomaterials comes a greater likelihood of environmental release. In aquatic environments, black carbon binds contaminants like aromatic hydrocarbons, leading to changes in their uptake, bioavailability, and toxicity. Engineered carbon nanomaterials can also adsorb pollutants onto their carbon surfaces, and nanomaterial physicochemical properties can influence this contaminant interaction. We used 2D graphene nanoplatelets and isometric carbon black nanoparticles to evaluate the influence of particle morphology and surface properties on adsorption and bioavailability of benzo(a)pyrene, a model aromatic hydrocarbon, to brine shrimp (Artemia franciscana) and a fish liver cell line (PLHC-1). Acellular adsorption studies show that while high surface area carbon black (P90) was most effective at a given concentration, 2D graphene nanoplatelets (G550) adsorbed more benzo(a)pyrene than carbon black with comparable surface area (M120). In both biological models, co-exposure to nanomaterials lead to reduced bioavailability, with G550 graphene nanoplatelets cause a greater reduction in bioavailability or response than the M120 carbon black nanoparticles. However, on a mass basis the high surface area P90 carbon black was most effective. The trends in bioavailability and adsorption were consistent across all biological and acellular studies, demonstrating the biological relevance of these results in different models of aquatic organisms. While adsorption is limited by surface area, 2D graphene nanoplatelets adsorb more benzo(a)pyrene than carbon black nanoparticles of similar surface area and charge, demonstrating that both surface area and shape play important roles in the adsorption and bioavailability of benzo(a)pyrene to carbon nanomaterials.

Recent efforts to explain the stark social and racial disparities in adverse birth outcomes that have persisted for decades in the U.S. have looked beyond prenatal factors, to explore preconception social conditions that may influence perinatal health via dysregulation of physiologic processes. The extant evidence supporting this link however remains limited, both due to a lack of data and theory. To address the latter, this manuscript generates a structured set of theoretical insights that further develop the link between two preconception social conditions — place and social relationships — and perinatal health. The insights propose the following. Place: necessarily encompasses all social contexts to which females are exposed from infancy through young adulthood; encompasses a variety of related exposures that, when possible, should be jointly considered; and may compound the effect of poverty—in childhood, adolescence, or young adulthood—on perinatal health. Social relationships: span relationships from early life through adulthood, and extend to intergenerational associations; often involve (or induce) major changes in the lives of individuals and should be examined with an emphasis on the developmental stage in which the change occurred; and necessarily encompass a lack of social integration, or, social isolation. We also identify potential biological and social-structural mechanisms linking these preconception social conditions to perinatal health, and conclude by identifying promising directions for future research.

Many layered crystal phases can be exfoliated or assembled into ultrathin two-dimensional (2D) nanosheets with novel properties not achievable by particulate or fibrous nanoforms. Among these 2D materials are manganese dioxide (MnO(2)) nanosheets, which have applications in batteries, catalysts, and biomedical probes. A novel feature of MnO(2) is its sensitivity to chemical reduction leading to dissolution and Mn(2+) release. Biodissolution is critical for nanosafety assessment of 2D materials, but the timing and location of MnO(2) biodissolution in environmental or occupational exposure scenarios are poorly understood. This work investigates the chemical and colloidal dynamics of MnO(2) nanosheets in biological media for environmental and human health risk assessment. MnO(2) nanosheets are insoluble in most aqueous phases, but react with strong and weak reducing agents in biological fluid environments. In vitro, reductive dissolution can be slow enough in cell culture media for MnO(2) internalization by cells in the form of intact nanosheets, which localize in vacuoles, react to deplete intracellular glutathione, and induce cytotoxicity that is likely mediated by intracellular Mn(2+) release. The results are used to classify MnO(2) nanosheets within a new hazard screening framework for 2D materials, and the implications of MnO(2) transformations for nanotoxicity testing and nanosafety assessment are discussed.

A spatial multiple membership model formalizes the effect of neighborhood affluence on antenatal smoking. The data are geocoded New Jersey birth certificate records linked to United States census tract-level data from 1999 to 2007. Neighborhood affluence shows significant spatial autocorrelation and local clustering. Better model fit is observed when incorporating the spatial clustering of neighborhood affluence into multivariate analyses. Relative to the spatial multiple membership model, the multilevel model that ignores spatial clustering produced downwardly biased standard errors; the effective sample size of the key parameter of interest (neighborhood affluence) is also lower. Residents of communities located in high-high affluence clusters likely have better access to health-promoting institutions that regulate antenatal smoking behaviors.

Background Multi-walled carbon nanotubes (MWCNT) have been shown to elicit the release of inflammatory and pro-fibrotic mediators, as well as histopathological changes in lungs of exposed animals. Current standards for testing MWCNTs and other nanoparticles (NPs) rely on low-throughput in vivo studies to assess acute and chronic toxicity and potential hazard to humans. Several alternative testing approaches utilizing two-dimensional (2D) in vitro assays to screen engineered NPs have reported conflicting results between in vitro and in vivo assays. Compared to conventional 2D in vitro or in vivo animal model systems, three-dimensional (3D) in vitro platforms have been shown to more closely recapitulate human physiology, providing a relevant, more efficient strategy for evaluating acute toxicity and chronic outcomes in a tiered nanomaterial toxicity testing paradigm. Results As inhalation is an important route of nanomaterial exposure, human lung fibroblasts and epithelial cells were co-cultured with macrophages to form scaffold-free 3D lung microtissues. Microtissues were exposed to multi-walled carbon nanotubes, M120 carbon black nanoparticles or crocidolite asbestos fibers for 4 or 7 days, then collected for characterization of microtissue viability, tissue morphology, and expression of genes and selected proteins associated with inflammation and extracellular matrix remodeling. Our data demonstrate the utility of 3D microtissues in predicting chronic pulmonary endpoints following exposure to MWCNTs or asbestos fibers. These test nanomaterials were incorporated into 3D human lung microtissues as visualized using light microscopy. Differential expression of genes involved in acute inflammation and extracellular matrix remodeling was detected using PCR arrays and confirmed using qRT-PCR analysis and Luminex assays of selected genes and proteins. Conclusion 3D lung microtissues provide an alternative testing platform for assessing nanomaterial-induced cell-matrix alterations and delineation of toxicity pathways, moving towards a more predictive and physiologically relevant approach for in vitro NP toxicity testing. Electronic supplementary material The online version of this article (10.1186/s12989-019-0298-0) contains supplementary material, which is available to authorized users.

Our objective was to evaluate the suitability of using a capillary aerosol generator (CAG) instead of using e-cigarette devices in 90-day or longer inhalation studies. Aerosol characteristics for both the CAG (which uses heat to produce a condensation aerosol) and e-cigarette generators have been previously reported, but a side-by-side comparison with the identical formulation has not been reported. Aerosols from both devices were analyzed immediately after generation for chemicals in the formulation (propylene glycol [PG], glycerin, water, and nicotine), selected carbonyls (acetaldehyde, acrolein, and formaldehyde) by ultra-performance liquid chromatography with ultraviolet detection (UPLC-UV), and a chemical fingerprint analysis using gas chromatography-mass spectroscopy (GC-MS). Aerosol capture methods for chemical analysis included Cambridge filter pads or two impingers in series each containing solution to trap and stabilize selected carbonyl compounds. Particle size distribution (cascade imp...

This paper proposes a three-tier algorithmic framework as the basis for the flexible design of data-driven structural health monitoring (SHM) systems. The three major functions of the SHM system, including data normalization, feature extraction, and hypothesis testing (HT), are mapped to the three layers of the framework. The first tier of the framework is devoted to data normalization. Machine learning (ML) methods are adopted to normalize available data sets by binning data sets to similar environmental and operational conditions (EOCs) of the system. Specifically, affinity propagation clustering is used to delineate data into groups of similar EOC. Once data are normalized by EOC, the second tier of the framework extracts features from the data to serve as condition parameters (CPs) for damage assessment. To ascertain the health state of the structure, the third tier of the framework is devoted to statistical analysis of the CP through HT. An intrinsic goal of the study is to explore the modularity of the three tier framework as a means of offering SHM system designers opportunity to explore and test different computational block sets at each layer to maximize the detection capability of the SHM system. Various realizations of the three-tier modular framework are presented and applied to acceleration and EOC data collected from an operational 3-kW wind turbine. In total, 354 data sets are collected from the turbine, including tower lateral accelerations in two orthogonal directions at six heights, wind speed and wind direction; 317 of the data sets correspond to the wind turbine in a healthy state and 37 with the wind turbine in a damage state. Using quantitative metrics derived from receiver operating characteristic (ROC) curves, the damage classification capabilities of the framework are validated and shown to accurately identify intentionally introduced damage in the turbine.

Material stability and dissolution in aqueous media are key issues to address in the development of a new nanomaterial intended for technological application. Dissolution phenomena affect biological and environmental persistence; fate, transport, and biokinetics; device and product stability; and toxicity pathways and mechanisms. This article shows that MoS2 nanosheets are thermodynamically and kinetically unstable to O2-oxidation under ambient conditions in a vareity of aqueous media. The oxidation is accompanied by nanosheet degradation and release of soluble molybdenum and sulfur species, and generates protons that can colloidally destabilize the remaining sheets. The oxidation kinetics are pH-dependent, and a kinetic law is developed for use in biokinetic and environmental fate modelling. MoS2 nanosheets fabricated by chemical exfoliation with n-butyl-lithium are a mixture of 1T (primary) and 2H (secondary) phases and oxidize rapidly with a typical half-life of 1–30 days. Ultrasonically exfoliated sheets are in pure 2H phase, and oxidize much more slowly. Cytotoxicity experiments on MoS2 nanosheets and molybdate ion controls reveal the relative roles of the nanosheet and soluble fractions in the biological response. These results indicate that MoS2 nanosheets will not show long-term persistence in living systems and oxic natural waters, with important implications for biomedical applications and environmental risk.

© 2016 American Chemical Society. Engineered nanomaterials (ENMs) are increasingly entering the environment with uncertain consequences including potential ecological effects. Various research communities view differently whether ecotoxicological testing of ENMs should be conducted using environmentally relevant concentrations - where observing outcomes is difficult - versus higher ENM doses, where responses are observable. What exposure conditions are typically used in assessing ENM hazards to populations? What conditions are used to test ecosystem-scale hazards? What is known regarding actual ENMs in the environment, via measurements or modeling simulations? How should exposure conditions, ENM transformation, dose, and body burden be used in interpreting biological and computational findings for assessing risks? These questions were addressed in the context of this critical review. As a result, three main recommendations emerged. First, researchers should improve ecotoxicology of ENMs by choosing test end points, duration, and study conditions - including ENM test concentrations - that align with realistic exposure scenarios. Second, testing should proceed via tiers with iterative feedback that informs experiments at other levels of biological organization. Finally, environmental realism in ENM hazard assessments should involve greater coordination among ENM quantitative analysts, exposure modelers, and ecotoxicologists, across government, industry, and academia.

Both low birthweight (4000 g) are considered adverse birth outcomes and are associated with later poor health conditions, yet the social determinants of macrosomia are understudied. In this study, we explore patterning of LBW, normal birthweight, and macrosomia by race/ethnicity and nativity. We examined data from all live births between 1999 and 2014 in New Jersey with a non-missing, plausible value of birthweight (n = 1,609,516). We compared the risk for LBW and macrosomia among non-Hispanic White, non-Hispanic Black, Hispanic, and non-Hispanic Asian mothers, and between the US- and native-born. For Hispanics and Asians, we also examined differences by country of origin. The racial/ethnic patterns for macrosomia mirrored those of LBW, suggesting that the factors underlying LBW shift birthweight distributions. For example, non-Hispanic White mothers had the lowest risk for LBW and the highest risk for macrosomia. Nativity patterns differed by subgroup, however, with unique risks for macrosomia among some origin groups, such as foreign-born Cubans. The racial/ethnic and nativity patterns of macrosomia do not completely mirror those of LBW, suggesting some distinct social risk factors for macrosomia. Our findings raise questions about whether and how racial/ethnic and nativity patterning in both low and excess birthweight is retained in later conditions, such as childhood obesity.

The relationship between form and function in trees is the subject of a longstanding debate in forest ecology and provides the basis for theories concerning forest ecosystem structure and metabolism. Trees interact with the wind in a dynamic manner and exhibit natural sway frequencies and damping processes that are important in understanding wind damage. Tree-wind dynamics are related to tree architecture, but this relationship is not well understood. We present a comprehensive view of natural sway frequencies in trees by compiling a dataset of field measurement spanning conifers and broadleaves, tropical and temperate forests. The field data show that a cantilever beam approximation adequately predicts the fundamental frequency of conifers, but not that of broadleaf trees. We also use structurally detailed tree dynamics simulations to test fundamental assumptions underpinning models of natural frequencies in trees. We model the dynamic properties of greater than 1000 trees using a finite-element approach based on accurate three-dimensional model trees derived from terrestrial laser scanning data. We show that (1) residual variation, the variation not explained by the cantilever beam approximation, in fundamental frequencies of broadleaf trees is driven by their architecture; (2) slender trees behave like a simple pendulum, with a single natural frequency dominating their motion, which makes them vulnerable to wind damage and (3) the presence of leaves decreases both the fundamental frequency and the damping ratio. These findings demonstrate the value of new three-dimensional measurements for understanding wind impacts on trees and suggest new directions for improving our understanding of tree dynamics from conifer plantations to natural forests.

Many layered crystal phases can be exfoliated or assembled into ultrathin two-dimensional (2D) nanosheets with novel properties not achievable by particulate or fibrous nanoforms. Among these 2D materials are manganese dioxide (MnO2) nanosheets, which have applications in batteries, catalysts, and biomedical probes. A novel feature of MnO2 is its sensitivity to chemical reduction leading to dissolution and Mn2+ release. Biodissolution is critical for nanosafety assessment of 2D materials, but the timing and location of MnO2 biodissolution in environmental or occupational exposure scenarios are poorly understood. This work investigates the chemical and colloidal dynamics of MnO2 nanosheets in biological media for environmental and human health risk assessment. MnO2 nanosheets are insoluble in most aqueous phases, but react with strong and weak reducing agents in biological fluid environments. In vitro, reductive dissolution can be slow enough in cell culture media for MnO2 internalization by cells in the form of intact nanosheets, which localize in vacuoles, react to deplete intracellular glutathione, and induce cytotoxicity that is likely mediated by intracellular Mn2+ release. The results are used to classify MnO2 nanosheets within a new hazard screening framework for 2D materials, and the implications of MnO2 transformations for nanotoxicity testing and nanosafety assessment are discussed.

Social inequalities in health and human capital are core concerns of sociologists, but little research examines the developmental stage when such inequalities are likely to emerge—the transition to adulthood. With new data and innovative statistical methods, we conceptually develop, and empirically operationalize, pathways of physical health and human capital accumulation from adolescence into young adulthood, using an autoregressive cross-lagged structural equation model. Results reveal that pathways of health and human capital accumulate at differential rates across the transition to adulthood; evidence of cross-lagged effects lends support for both social causation and health selection hypotheses. We then apply this model to assess the presence of social inequality in metabolic syndrome—the leading risk factor of cardiovascular disease in the United States. Findings document social stratification of cardiovascular health that is robust to both observed and unobserved social and health selection mechanisms. We speculate that this social stratification will only increase as this cohort ages.

Hydronic heating and cooling systems are growing in complexity as the buildings and other infrastructure systems they serve demand greater efficiency and become larger. Increasing the scale...

Most of the late 20th century wave of reforms in mental capacity or competence law were predicated upon the so-called ‘functional’ model of mental capacity, asking not merely whether a person had a mental disorder or disability but rather whether they were capable of making a specific decision (or decisions) at a specific point of time. This model is now under sustained challenge, most notably from the Committee on the Rights of Persons with Disabilities, and this challenge has focused a spotlight on the difficulty of applying the legally ‘neat’ concepts of the functional model of mental capacity across the full complex spectrum of human life. This paper presents a review, in two parts, of the first ten years of the Court of Protection, a specialist mental capacity court in England and Wales which applies a functional model of mental capacity. The first part outlines the history of the functional model in England and Wales, and the development of this specialist mental capacity court (Court of Protection), created by the Mental Capacity Act 2005. The second part presents an empirical and case-based study of 40 published cases of capacity disputes presented to the Court of Protection, or to the Court of Appeal on appeal from the Court of Protection, during the first ten years of its existence. The authors found that in 70% of cases the subject of proceedings (or P) had either a learning disability or dementia, and the court ruled on P's capacity for a wide range of issues, most commonly residence, care and contact. The judge considered the support principle, or whether practical steps were taken to maximise P's capacity, in 23 of 40 (57.5%) cases. The subject P was determined to have capacity in 13 cases, to lack capacity in 22 cases, and in 5 cases P was found to have and lack capacity for different issues before the court. The functional inability to use or weigh relevant information was most commonly cited by the judge, being cited in all but 2 cases in which P was determined to lack capacity and inabilities were cited. The propensity for the system to learn was shown by an increase in the proportion of cases which considered the ‘causative nexus’ from 2013, when a Court of Appeal case emphasised that impairment must not merely be present alongside functional inability but must be the causal basis of inability. The authors conclude that whilst the Court of Protection is still on a learning curve, its work provides a powerful illustration of what taking capacity seriously looks like, both inside and outside the courtroom. The implications for judges, lawyers and psychiatrists that can be drawn from the study are generalisable to other comparable socio-legal frameworks in which mental capacity or competence plays a role and is likely to do so for the foreseeable future.

Two-dimensional materials have become a major focus in materials chemistry research worldwide with substantial efforts centered on synthesis, property characterization, and technological application. These high-aspect ratio sheet-like solids come in a wide array of chemical compositions, crystal phases, and physical forms, and are anticipated to enable a host of future technologies in areas that include electronics, sensors, coatings, barriers, energy storage and conversion, and biomedicine. A parallel effort has begun to understand the biological and environmental interactions of synthetic nanosheets, both to enable the biomedical developments and to ensure human health and safety for all application fields. This review covers the most recent literature on the biological responses to 2D materials and also draws from older literature on natural lamellar minerals to provide additional insight into the essential chemical behaviors. The article proposes a framework for more systematic investigation of biological behavior in the future, rooted in fundamental materials chemistry and physics. That framework considers three fundamental interaction modes: (i) chemical interactions and phase transformations, (ii) electronic and surface redox interactions, and (iii) physical and mechanical interactions that are unique to near-atomically-thin, high-aspect-ratio solids. Two-dimensional materials are shown to exhibit a wide range of behaviors, which reflect the diversity in their chemical compositions, and many are expected to undergo reactive dissolution processes that will be key to understanding their behaviors and interpreting biological response data. The review concludes with a series of recommendations for high-priority research subtopics at the “bio-nanosheet” interface that we hope will enable safe and successful development of technologies related to two-dimensional nanomaterials.

Marriage is a social tie associated with health advantages for adults and their children, as lower rates of preterm birth and low birth weight are observed among married women. This study tests two competing hypotheses explaining these marriage advantages-marriage protection versus marriage selection-using a sample of recent births to single, cohabiting, and married women from the National Survey of Family Growth, 2006-10. Propensity score matching and fixed effects regression results demonstrate support for marriage selection, as a rich set of early life selection factors account for all of the cohabiting-married disparity and part of the single-married disparity. Subsequent analyses demonstrate prenatal smoking mediates the adjusted single-married disparity in birth weight, lending some support for the marriage protection perspective. Study findings sharpen our understanding of why and how marriage matters for child well-being, and provide insight into preconception and prenatal factors describing intergenerational transmissions of inequality via birth weight.

Two-dimensional (2D) high-aspect-ratio sheet-like materials are a broad class of synthetic ultra-thin sheet-like solids whose rapid pace of development motivates systematic study of their biological effects and safe design. A challenge for this effort is the large number of new materials and their chemical diversity. Recent work suggests that many 2D materials will be thermodynamically unstable and thus non-persistent in biological environments. Such information could inform and accelerate safety assessment, but experimental data to confirm the thermodynamic predictions are lacking. Here we propose a framework for early hazard screening of nanosheet materials based on biodissolution studies in reactive media, specially chosen for each material to match chemically feasible degradation pathways. Simple dissolution and in vitro tests allow grouping of nanosheet materials into four classes: A, potentially biopersistent; B, slowly degradable (>24–48 hours); C, biosoluble with potentially hazardous degradation products; and D, biosoluble with low-hazard degradation products. The proposed framework is demonstrated through an experimental case study on MoO3 nanoribbons, which have a dual 2D/1D morphology and have been reported to be stable in aqueous stock solutions. The nanoribbons are shown to undergo rapid dissolution in biological simulant fluids and in cell culture, where they elicit no adverse responses up to 100 μg ml−1 dose. These results place MoO3 nanoribbons in Class D, and assigns them a low priority for further nanotoxicology testing. We anticipate use of this framework could accelerate the risk assessment for the large set of new powdered 2D nanosheet materials, and promote their safe design and commercialization.

Nanotechnology is an emerging industry based on commercialization of materials with one or more dimensions of 100 nm or less. Engineered nanomaterials are currently incorporated into thin films, porous materials, liquid suspensions, or filler/matrix nanocomposites with future applications predicted in energy and catalysis, microelectronics, environmental sensing and remediation, and nanomedicine. Carbon nanotubes are one-dimensional fibrous nanomaterials that physically resemble asbestos fibers. Toxicologic studies in rodents demonstrated that some types of carbon nanotubes can induce mesothelioma, and the World Health Organization evaluated long, rigid multiwall carbon nanotubes as possibly carcinogenic for humans in 2014. This review summarizes key physicochemical similarities and differences between asbestos fibers and carbon nanotubes. The “fiber pathogenicity paradigm” has been extended to include carbon nanotubes as well as other high-aspect-ratio fibrous nanomaterials including metallic nanowires. This paradigm identifies width, length, and biopersistence of high-aspect-ratio fibrous nanomaterials as critical determinants of lung disease, including mesothelioma, following inhalation. Based on recent theoretical modeling studies, a fourth factor, mechanical bending stiffness, will be considered as predictive of potential carcinogenicity. Novel three-dimensional lung tissue platforms provide an opportunity for in vitro screening of a wide range of high aspect ratio fibrous nanomaterials for potential lung toxicity prior to commercialization.

Adverse birth outcomes can lead to problematic long-term outcomes for children, and are also known to transmit socioeconomic disadvantage across generations, thereby amplifying the importance of identifying their social determinants. However, the full set of factors causing adverse birth outcomes remains unknown. Drawing together theory describing intragenerational (life course) processes linking early life adversity to adult health, and intergenerational transmissions of inequality via birthweight, this study tests a chain of risk that originates within early adolescence, impacts young women's risky health behaviors in late adolescence/early adulthood and risky health behaviors during pregnancy, and ultimately decreases offspring's birthweight. We do so using structural equation models and prospective, population-level data on a racially and socioeconomically diverse cohort of young adults (National Longitudinal Study of Adolescent to Adult Health). Results (a) reveal four pathways that fully mediate the association between a young woman's family-of-origin socioeconomic status in adolescence and her offspring's birthweight, and (b) identify a trigger effect-a place in the chain of risk where prevention efforts could be targeted, thereby breaking the chain of risk leading to poor offspring health at birth for vulnerable individuals.

Highlights • Neighborhood affluence protects against the risk of poor birth outcome. • The protective effect of affluence holds for Whites, Blacks, Hispanics and Asians. • Mediation of these pathways by prenatal smoking varies by racial group. • The discourse on neighborhoods and birth outcomes should include affluence.