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Youth undergo numerous social, biological, and cognitive changes from late childhood through young adulthood. Many of these changes impact their temperament, or individual differences in reactivity and self-regulation that are present from an early age and relatively enduring. Temperament, in turn, is related to various domains of psychological adjustment, especially mental health. This dissertation is comprised of three chapters. In Chapter 1, I examined the latent structure of the most commonly used measure of adolescent temperament, the Early Adolescent Temperament Questionnaire-Revised (EATQ-R), and then showed that the resulting factors (i.e., Effortful Control, Negative Emotionality, and Positive Emotionality) had theoretically meaningful concurrent associations with several measures of adolescent functioning, supporting the construct validity of the EATQ-R. In Chapter 2, I examined how temperament from age 12 to 16 is associated with the onset of suicidal ideation and behaviors during adolescence and young adulthood. Finally, in Chapter 3, I examined how temperament develops across adolescence (age 10 to 16) and whether the developmental trajectories of temperament are associated with anxiety/depression during young adulthood (ages 19 and 21). Together, the results suggest that (1) the EATQ-R is a valid measure of adolescent temperament, (2) adolescents undergo meaningful temperament change across adolescence, and (3) these changes are associated with various aspects of psychological adjustment, especially mental health.

Background Racial and ethnic minorities have borne a disproportionate burden from COVID-19. Certain essential occupations, including food processing and farm work, employ large numbers of Hispanic migrant workers and have been shown to carry an especially high risk of infection. Methods We conducted an observational cohort study measuring the seroprevalence of SARS-CoV-2 and assessing risk factors for seropositivity among North Carolina food processing and farm workers and members of their households. Participants completed questionnaires and we collected blood samples and used an enzyme-linked immunosorbent assay to assess SARS-CoV-2 seropositivity. Univariate and multivariate analyses were carried out to identify risk factors associated with seropositivity, using generalized estimating equations to account for household clustering. Findings Among the 218 participants, 94.5% were Hispanic, and SARS-CoV-2 seropositivity was 50.0%. Most seropositive individuals did not report a history of illness compatible with COVID-19. Attending church, having a prior history of COVID-19, having a seropositive household member, and speaking Spanish as one's primary language were associated with SARS-CoV-2 seropositivity, while preventive behaviors were not. Interpretation These findings underscore the substantial burden of COVID-19 among a population of mostly Hispanic essential workers and their households in rural North Carolina. Our study contributes to a large body of evidence showing that Hispanic Americans have suffered a disproportionate COVID-19 burden. We also highlight the epidemiologic importance of viral transmission within the household.

Introduction: Ealing Community Partners delivers community services in one of London’s largest boroughs, including an enhanced primary care service for nursing home residents.In early 2020 it was rapidly recognised that our care home residents were vulnerable and at substantially elevated risk of death from Covid-19.Outbreaks within care homes were challenging to contain due to factors related to the homes, workforce, residents, and nature of Covid-19. Acute hospitals experienced significant demand and there was sustained need to discharge patients rapidly. Care homes raised alarm about risks posed from patients being (re)admitted from hospitals where they may have been treated for, or acquired, Covid-19. Aims: West London NHS Trust opened the Mary Robinson Unit as England’s first dedicated Transitional Facility, with the support of the NW London Health/Care System (payer), Bupa (private care home provider), public health teams, and regulators (CQC). This involved identifying/procuring a site, recruiting/training a team of nursing/care staff, and establishing referral pathways from local hospitals. The unit was one of a number of supportive interventions commissioned.We measured-Patient characteristics, experiences and outcomes -Information about outbreaks across care homes in context of local outbreaks -Excess mortality in the local care home population over the subsequent 12 monthsKey Findings: -Between June 2020 - April 2021, MRU admitted 147 patients from across NW London’s eight boroughs. 79 (54%) from Ealing.-Bed occupancy (≤22) mirrored population Covid-19 prevalence, with peak in January 2021.-Mortality within registered nursing home population (~1250 beds) in Ealing has typically been ~30 deaths per month 2014-2019. The first peak of Covid-19 resulted in peak of 121 deaths in April 2020. Following this peak, there was a brief deficit in monthly mortality suggesting that some individuals died prematurely who may have died in subsequent months. Data for January and February 2021 (subsequent Covid-19 peak) supports our hypothesis that the Unit contributed to an absence of excess deaths in our local area.-Patient experience was captured from 59 patients (40%). Of these 52 (88%) would recommend the unit. One said “I want to come on holiday here”.Conclusions: Care home residents were especially vulnerable to Covid-19, but the development of a specialist unit to provide Transitional Care is likely to have been a significant contributor to the protection of other care home residents, whilst supporting acute hospital flow.Implications: Our NHS-led model was rapidly mobilised and staffed with a high ratio of qualified nursing staff compared to typical care homes. Following the successful implementation of the vaccination programme locally, we decommissioned the MRU and transferred the patient pathway to a smaller unit hosted in a private nursing home with cheaper unit cost.Subsequent to our project launch, UK Government policy required that every Local Authority in England commission a similar facility, and this requirement remains in place.There may be learning applicable for the management of discharge pathways for other infectious diseases.

Meat packing, produce processing, and farm workers are known to have an elevated risk of COVID-19, but occupational risk factors in this population are unclear. We performed an observational cohort study of meat packing, produce processing, and farm workers in North Carolina in fall 2020. Blood, saliva, and nasal turbinate samples were collected to assess for SARS-CoV-2 seropositivity. Risk factors for SARS-CoV-2 seropositivity were investigated using chi-square tests, two-sample t-tests, and adjusted risk ratio analyses. Among 118 enrolled workers, the baseline SARS-CoV-2 seroprevalence was 50.0%. Meat packing plant workers had the highest SARS-CoV-2 seroprevalence (64.6%), followed by farm workers (45.0%) and produce processing workers (10.0%), despite similar sociodemographic characteristics. Compared to SARS-CoV-2 seronegative workers, seropositive workers were more likely to work in loud environments that necessitated yelling to communicate (RR: 1.83, 95% CI: 1.25–2.69), work in cold environments (RR: 1.58, 95% CI: 1.12–2.24), or continue working despite developing symptoms at work (RR: 1.63, 95% CI: 1.14–2.32). After adjusting for age and working despite symptoms, high occupational noise levels were associated with a 1.72 times higher risk of SARS-CoV-2 seropositivity (95% CI: 1.16–2.55). Half of food processing workers showed evidence of past SARS-CoV-2 infection, a prevalence five times higher than most of the United States population at the time of the study. Work environments with loud ambient noise may pose elevated risks for SARS-CoV-2 transmission. Our findings also highlight the disproportionate burden of COVID-19 among underserved and economically disadvantaged Latinx communities in the United States.

This paper characterizes the actual science performance of the James Webb Space Telescope (JWST), as determined from the six month commissioning period. We summarize the performance of the spacecraft, telescope, science instruments, and ground system, with an emphasis on differences from pre-launch expectations. Commissioning has made clear that JWST is fully capable of achieving the discoveries for which it was built. Moreover, almost across the board, the science performance of JWST is better than expected; in most cases, JWST will go deeper faster than expected. The telescope and instrument suite have demonstrated the sensitivity, stability, image quality, and spectral range that are necessary to transform our understanding of the cosmos through observations spanning from near-earth asteroids to the most distant galaxies., Comment: 5th version as accepted to PASP; 31 pages, 18 figures; https://iopscience.iop.org/article/10.1088/1538-3873/acb293

Background Hospital-based studies have reported variable associations between outcome after spontaneous intracerebral hemorrhage and peri-hematomal edema volume. Aims In a community-based study, we aimed to investigate the existence, strength, direction, and independence of associations between intracerebral hemorrhage and peri-hematomal edema volumes on diagnostic brain CT and one-year functional outcome and long-term survival. Methods We identified all adults, resident in Lothian, diagnosed with first-ever, symptomatic spontaneous intracerebral hemorrhage between June 2010 and May 2013 in a community-based, prospective inception cohort study. We defined regions of interest manually and used a semi-automated approach to measure intracerebral hemorrhage volume, peri-hematomal edema volume, and the sum of these measurements (total lesion volume) on first diagnostic brain CT performed at ≤3 days after symptom onset. The primary outcome was death or dependence (scores 3–6 on the modified Rankin Scale) at one-year after intracerebral hemorrhage. Results Two hundred ninety-two (85%) of 342 patients (median age 77.5 y, IQR 68–83, 186 (54%) female, median time from onset to CT 6.5 h (IQR 2.9–21.7)) were dead or dependent one year after intracerebral hemorrhage. Peri-hematomal edema and intracerebral hemorrhage volumes were colinear ( R2 = 0.77). In models using both intracerebral hemorrhage and peri-hematomal edema, 10 mL increments in intracerebral hemorrhage (adjusted odds ratio (aOR) 1.72 (95% CI 1.08–2.87); p = 0.029) but not peri-hematomal edema volume (aOR 0.92 (0.63–1.45); p = 0.69) were independently associated with one-year death or dependence. 10 mL increments in total lesion volume were independently associated with one-year death or dependence (aOR 1.24 (1.11–1.42); p = 0.0004). Conclusion Total volume of intracerebral hemorrhage and peri-hematomal edema, and intracerebral hemorrhage volume alone on diagnostic brain CT, undertaken at three days or sooner, are independently associated with death or dependence one-year after intracerebral hemorrhage, but peri-hematomal edema volume is not. Data access statement Anonymized summary data may be requested from the corresponding author.

For the extremely bright lensed galaxy SDSS J1723+3411 at z=1.3293 , we analyze spatially integrated MMT, Keck, and Hubble Space Telescope spectra that fully cover the rest-frame wavelength range of 1400 to 7200 Angstroms. We also analyze near-IR spectra from Gemini that cover H alpha for a portion of the lensed arc. We report fluxes for 42 detected emission lines, and upper limits for an additional 22. This galaxy has extreme emission line ratios and high equivalent widths that are characteristic of extreme emission-line galaxies. We compute strong emission line diagnostics from both the rest-frame optical and rest-frame ultraviolet (UV), to constrain physical conditions and test the spectral diagnostics themselves. We tightly determine the nebular physical conditions using the most reliable diagnostics, and then compare to results from other diagnostics. We find disappointing performance from the UV--only diagnostics: they either are unable to measure the metallicity or dramatically under-estimate it; they over-estimate the pressure; and the UV diagnostic of ionization parameter has a strong metallicity dependence in this regime. Based on these results, we suggest that upcoming James Webb Space Telescope spectroscopic surveys of galaxies in the reionization epoch should invest the additional integration time to capture the optical [O II] and [O III] emission lines, and not rely solely on the rest-frame UV emission lines. We make available the spectra; they represent one of the highest-quality emission line spectral atlases of star-forming galaxy available beyond the local universe, and will aid planning observations with JWST., Accepted for publication in ApJ

Question Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of dizziness presenting to specialist vestibular centres and accounts for approximately 20-30% of referrals to these clinics. In spite of the amount of clinical knowledge surrounding its diagnosis and management, the treatment of BPPV remains challenging for even the most experienced clinicians. This study outlines the incidence of BPPV in a specialised vestibular physiotherapy clinics and discusses the various nuances encountered during assessment and treatment of BPPV. Design Observational StudyPARTICIPANTS:314 patients with various forms of Benign Paroxysmal Positional Vertigo (BPPV)INTERVENTION:Canalith repositioning manoeuvres (CRP) for posterior canal (PC) or horizontal canal (HC) BPPV depending on the canal and variant of BPPV. Outcome measures Negative Dix-Hallpike (DHP) or Supine roll test (SRT) examination. Results In 91% of cases, PC BPPV was effectively treated in 2 manoeuvres or less. Similarly, 88% of HC BPPV presentations were effectively managed with 2 treatments. Bilateral PC, multiple canal or canal conversions required a greater number of treatments. There was no noticeable difference in treatment outcomes for patients who had nystagmus and symptoms during the Epley manoeuvre (EM) versus those who did not have nystagmus and symptoms throughout the EM. Nineteen percent of patients experienced post treatment down-beating nystagmus (DBN) and vertigo or "otolithic crisis" after the first or even the second consecutive EM. Conclusion Based on the data collected, we make several clinical recommendations for assessment and treatment of BPPV. Firstly, repeated testing and treatment of BPPV within the same session is promoted as a safe and effective approach to the management of BPPV with a low risk of canal conversion. Secondly, vertigo and nystagmus throughout the EM is not indicative of treatment success. Thirdly, clinicians must remain vigilant and mindful of the possibility of post treatment otolithic crisis following the treatment of BPPV. This is to ensure patient safety and to prevent possible injurious falls. Our results challenge several clinical assumptions about the assessment and treatment of BPPV including the utility of certain markers of treatment success; hence influencing the current clinical guidelines and clinical practice and paving the way for future studies of the assessment and management of patients with BPPV.

We present $Hubble\ Space\ Telescope$ ($HST$) imaging and grism spectroscopy of a strongly lensed LIRG at $z=0.816$, SGAS 143845.1$+$145407, and use the magnification boost of gravitational lensing to study the distribution of star formation throughout this galaxy. Based on the $HST$ imaging data, we create a lens model for this system; we compute the mass distribution and magnification map of the $z=0.237$ foreground lens. We find that the magnification of the lensed galaxy ranges between $2$ and $10$, with a total magnification (measured over all the images of the source) of $\mu=11.8^{+4.6}_{-2.4}$. We find that the total projected mass density within $\sim34$ kpc of the brightest cluster galaxy is $6.0^{+0.3}_{-0.7}\times10^{12}\,M_{\odot}$. Using the lens model we create a source reconstruction for SGAS 143845.1$+$145407, which paired with a faint detection of H$\alpha$ in the grism spectroscopy, allows us to finally comment directly on the distribution of star formation in a $z\sim1$ LIRG. We find widespread star formation across this galaxy, in agreement with the current understanding of these objects. However, we note a deficit of H$\alpha$ emission in the nucleus of SGAS 143845.1$+$145407, likely due to dust extinction., Comment: 7 pages, 8 figures, 2 tables

Background and Purpose— The characteristics of intracerebral hemorrhage (ICH) may vary by ICH location because of differences in the distribution of underlying cerebral small vessel diseases. Therefore, we investigated the incidence, characteristics, and outcome of lobar and nonlobar ICH. Methods— In a population-based, prospective inception cohort study of ICH, we used multiple overlapping sources of case ascertainment and follow-up to identify and validate ICH diagnoses in 2010 to 2011 in an adult population of 695 335. Results— There were 128 participants with first-ever primary ICH. The overall incidence of lobar ICH was similar to nonlobar ICH (9.8 [95% confidence interval, 7.7–12.4] versus 8.6 [95% confidence interval, 6.7–11.1] per 100 000 adults/y). At baseline, adults with lobar ICH were more likely to have preceding dementia (21% versus 5%; P =0.01), lower Glasgow Coma Scale scores (median, 13 versus 14; P =0.03), larger ICHs (median, 38 versus 11 mL; P P P =0.02) than those with nonlobar ICH. One-year case fatality was lower after lobar ICH than after nonlobar ICH (adjusted odds ratio for death at 1 year: lobar versus nonlobar ICH 0.21; 95% confidence interval, 0.07–0.63; P =0.006, after adjustment for known predictors of outcome). There were 4 recurrent ICHs, which occurred exclusively in survivors of lobar ICH (annual risk of recurrent ICH after lobar ICH, 11.8%; 95% confidence interval, 4.6%–28.5% versus 0% after nonlobar ICH; log-rank P =0.04). Conclusions— The baseline characteristics and outcome of lobar ICH differ from other locations.

Sporadic Creutzfeldt–Jacob disease (CJD) is a rare untreatable neurodegenerative disease which every neurologist will occasionally encounter during their career. However, it is likely to appear on their differential diagnosis list significantly more frequently. Numerous conditions can present with subacute encephalopathy which might be sporadic CJD and this article explores these diagnoses. It includes the commonest sporadic CJD mimics which are neurodegenerative, and highlights the relatively rare treatable mimics which must not be missed. It discusses relevant investigations, including serum antibodies, CSF, electroencephalography and MR brain imaging, and strategies when preliminary investigations fail to support sporadic CJD but no alternative diagnosis is readily apparent.

Objective To characterize the effects of severe hypoglycemia on the developing brain in children with early-onset type 1 diabetes mellitus (T1DM). Study design Children diagnosed with T1DM before age 6 years were studied. Those with prospectively monitored severe hypoglycemia (coma/seizure; n = 32) were compared with age-matched peers (n = 30) with no history of such events using magnetic resonance imaging. Glycemic control (evaluated based on glycated hemoglobin [HbA lc ] level), episodes of diabetic ketoacidosis (DKA), and clinical variables were monitored continuously since diagnosis in all subjects. Results Mean HbA lc from diagnosis and the duration of T1DM were similar in those with and without a history of severe hypoglycemia (9.0% ± 0.9% vs 8.8% ± 0.9%; 7.2 ± 2.7 years vs 6.7 ± 2.3 years). A high prevalence of central nervous system (CNS) structural abnormalities was detected (29%), and mesial temporal sclerosis (MTS) was detected in 16% of the total sample (n = 62). The presence of MTS was not associated with a history of severe hypoglycemia or DKA. Analysis of brain matter volumes suggested relatively less gray matter density in those subjects with a history of severe hypoglycemia. Conclusions Early age of onset of T1DM per se is associated with a high incidence of CNS abnormalities, particularly MTS, suggesting hippocampal damage. Early-onset severe hypoglycemia may have an effect on gray matter volume.

The ‘Precautionary Principle’ provides a somewhat ill-defined guide, often of uncertain normative status, for those exercising administrative decision-making power in circumstances where that may create potential risks to human health or the environment. This paper seeks to explore to what extent the precautionary principle should have been and was in fact utilised by the Australian Therapeutic Goods Administration (TGA) in its decision to approve the marketing of sunscreens containing titanium dioxide (TiO2) and zinc oxide (ZnO) in nanoparticulate form. In particular, this article assesses to what extent better application of that principle might have altered the TGA’s decision that TiO2 and ZnO ENPs in sunscreens do not require new safety testing, because they are considered to be functionally equivalent to their bulk counterparts.

Driven by the unprecedented wealth of high quality data that is accumulating for the Frontier Fields, they are becoming some of the best-studied strong lensing clusters to date, and probably the next few years. As will be discussed intensively in this focus meeting, the FF prove transformative for many fields: from studies of the high redshift Universe, to the assembly and structure of the clusters themselves. The FF data and the extensive collaborative effort around this program will also allow us to examine and improve upon current lens modeling techniques. Strong lensing is a powerful tool for mass reconstruction of the cores of galaxy clusters of all scales, providing an estimate of the total (dark and seen) projected mass density distribution out to 0.5 Mpc. Though SL mass may be biased by contribution from structures along the line of sight, its strength is that it is relatively insensitive to assumptions on cluster baryon astrophysics and dynamical state. Like the Frontier Fields clusters, the most “famous” strong lensing clusters are at the high mass end; they lens dozens of background sources into multiple images, providing ample lensing constraints. In this talk, I will focus on how we can leverage what we learn from modeling the FF clusters in strong lensing studies of the hundreds of clusters that will be discovered in upcoming surveys. In typical clusters, unlike the Frontier Fields, the Bullet Cluster and A1689, we observe only one to a handful of background sources, and have limited lensing constraints. I will describe the limitations that such a configuration imposes on strong lens modeling, highlight measurements that are robust to the richness of lensing evidence, and address the sources of uncertainty and what sort of information can help reduce those uncertainties. This category of lensing clusters is most relevant to the wide cluster surveys of the future.

A 43-year-old right-handed woman presented with a two month history of drooling and difficulty eating due to food falling out of her mouth, particularly on the right, initially diagnosed as a Bell’s palsy. She then noted progressive limb weakness, beginning with difficulty lifting heavy objects above her head, climbing stairs and running. Her power rapidly deteriorated over six weeks. There was no fatigability. She lost 1 kg in weight and complained of painful spontaneous muscle cramps of all limbs. There were no sensory, autonomic, ocular or cognitive symptoms. Several weeks before her symptom onset, she had suffered from brief diarrhoea and vomiting (as had several other family members) but there was no other past medical history. She was on no medication, did not smoke and rarely drank alcohol. Her mother was said to have died of suspected motor neuron disease at the age of 53, but the details were unclear. On initial examination she had bilateral lower motor neuron facial weakness, more marked on the right, with associated dysarthria. There were sparse tongue fasciculations but no wasting. Her jaw jerk was normal, as were her ocular movements, and she did not have ptosis. She was generally thin but had possible wasting of deltoids and quadriceps with occasional fasciculations in these muscles. She was weak (MRC grade 3–4/5) in all four limbs, particularly proximally, with normal tone, easily elicited reflexes and flexor plantar responses. Sensation and coordination were normal. #### Question 1 What is the differential diagnosis and what investigations would you do? The signs suggested a lower motor neuron disorder, although she had retained her reflexes. There were no sensory features, so one must consider the following possible sites of pathology and conditions

Our mum was diagnosed, declined and died over a period of two months and one week. My siblings gathered from around the globe. We cared for her in her home on a small island off the west coast of British Columbia (Canada). She described this as the richest period of her life. We shared the care. And her friends, “the walkie-talkies” came to support us and to check in on her. We took time for fresh air. We walked the beaches. A piece of driftwood inspired my brothers to build a coffin. Silk in her studio inspired my sister to create a beautiful shroud. We snuggled with her, talked, sang, reminisced. We listened to her stories. And then in the quiet of the night, she died. We kept her body at home for a full day. Her friends gathered. Then early the next morning, with government permit to transport her body, we went via ferry, and drove her down Vancouver Island, past the green burial ground that my brother designed to the crematorium. The next day the bereavement counsellor greeted us, and with warmth and sensitivity introduced us to the staff and the cremator. After a bit of time, we lifted her body into the cremator and pushed the button. In Canada, the majority of after death care is provided by funeral professionals, but there is a growing interest in the concept of do it yourself care for the body and funerals. The purpose of this presentation is to share a photo journal of this experience, and depending on time allotted, open time for discussion regarding “do it yourself” care.