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The 7600 14C-year-old Kurile Lake caldera-forming eruption (KO) in southern Kamchatka, Russia, produced a 7-km-wide caldera now mostly filled by the Kurile Lake. The KO eruption has a conservatively estimated tephra volume of 140–170 km3 making it the largest Holocene eruption in the Kurile–Kamchatka volcanic arc and ranking it among the Earth''s largest Holocene explosive eruptions. The eruptive sequence consists of three main units: (I) initial phreatoplinian deposits; (II) plinian fall deposits, and (III) a voluminous and extensive ignimbrite sheet and accompanying surge beds and co-ignimbrite fallout. The KO fall tephra was dispersed over an area of >3 million km2, mostly in a northwest direction. It is a valuable stratigraphic marker for southern Kamchatka, the Sea of Okhotsk, and a large part of the Asia mainland, where it has been identified as a ∼6 to 0.1 cm thick layer in terrestrial and lake sediments, 1000–1700 km from source. The ignimbrite, which constitutes a significant volume of the KO deposits, extends to the Sea of Okhotsk and the Pacific Ocean on either side of the peninsula, a distance of over 50 km from source. Fine co-ignimbrite ash was likely formed when the ignimbrite entered the sea and could account for the wide dispersal of the KO fall unit. Individual pumice clasts from the fall and surge deposits range from dacite to rhyolite, whereas pumice and scoria clasts in the ignimbrite range from basaltic andesite to rhyolite. Ignimbrite exposed west and south of the caldera is dominantly rhyolite, whereas north, east and southeast of the caldera it has a strong vertical compositional zonation from rhyolite at the base to basaltic andesite in the middle, and back to rhyolite at the top. Following the KO eruption, Iliinsky volcano formed within the northeastern part of the caldera producing basalt to dacite lavas and pyroclastic rocks compositionally related to the KO erupted products. Other post-caldera features include several extrusive domes, which form islands in Kurile Lake, submerged cinder cones and the huge silicic extrusive massif of Dikii Greben'' volcano. [Copyright &y& Elsevier]

Background: The bedside head impulse test (bHIT) is a clinical method of assessing the vestibulo-ocular reflex. It is a critical component of the bedside assessment of dizzy patients and helps differentiate acute stroke from vestibular neuritis. A previous study on senior Otolaryngology residents showed poor competence in performing and interpreting the bHIT and called for specific evaluations in the Competency By Design (CBD) curriculum to remedy this. This study aimed to assess whether those competencies have improved after full implementation of CBD in residency programs., Methods: Thirty post-graduate year 4 Otolaryngology residents in Canada were evaluated on the use of the bHIT using a written multiple-choice question (MCQ) examination, interpretation of bHIT videos, and performance of a bHIT. Ratings of bHIT performance were completed by 2 expert examiners (DT, DL) using the Ottawa Clinic Assessment Tool., Results: Only 6.7% (rater DT) and 20% (rater DL) of residents were found able to perform the bHIT independently. Inter-rater reliability was moderate (0.55, intraclass correlation). Mean scores were 70% (13.4% standard deviation) for video interpretation and 59% (20.6% standard deviation) for multiple-choice questions. Video interpretation scores did not correlate with bHIT ratings (Pearson r  = 0.11), but MCQs and bHIT ratings did correlate moderately (Pearson r = 0.52).Comparing to the prior study, residents performed worse on the bHIT (3.14 average score vs 3.64, P  < .01) and fewer residents performed the bHIT independently (6.7% vs 22%-rater DT, 20% vs 39%-rater DL). Residents also performed worse on MCQs (58.7% vs 70.9%, P = 0.038), though similarly on video interpretation (70% vs 65%, P  = .198)., Conclusion: Fourth year OTL-HNS residents in Canada are not competent in performing the bHIT. These findings have implications for refining competency-based curricula in the evaluation of critical physical exam skills., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

An estimated 17.6% of blue-collar, manufacturing jobs were lost in the United States between 1970 and 2016. These jobs, often union-represented, provided relatively generous pay and benefits, creating a path to the middle class for individuals without a four-year college degree. Evidence suggests the closure of manufacturing facilities and resulting decline in economic opportunity increased demand for disability insurance (SSDI) among blue-collar workers. In recent years, the opening of Amazon Fulfillment Centers (FCs) has accelerated around the country, driving a wave of blue-collar job creation. We estimated the extent to which the opening of FCs affected SSDI application rates, including rates of approvals and denials, using a synthetic control group approach. We found that FC openings were associated with a 1.4% reduction in the SSDI application rate over the subsequent three years, translating to 5,528 fewer applications per year across commuting zones with an FC opening. Our findings are consistent with FC openings improving economic opportunities in local labor markets, though our confidence intervals were wide and included the null., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Rudolph et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Although machine learning (ML) has shown promise across disciplines, out-of-sample generalizability is concerning. This is currently addressed by sharing multi-site data, but such centralization is challenging/infeasible to scale due to various limitations. Federated ML (FL) provides an alternative paradigm for accurate and generalizable ML, by only sharing numerical model updates. Here we present the largest FL study to-date, involving data from 71 sites across 6 continents, to generate an automatic tumor boundary detector for the rare disease of glioblastoma, reporting the largest such dataset in the literature (n = 6, 314). We demonstrate a 33% delineation improvement for the surgically targetable tumor, and 23% for the complete tumor extent, over a publicly trained model. We anticipate our study to: 1) enable more healthcare studies informed by large diverse data, ensuring meaningful results for rare diseases and underrepresented populations, 2) facilitate further analyses for glioblastoma by releasing our consensus model, and 3) demonstrate the FL effectiveness at such scale and task-complexity as a paradigm shift for multi-site collaborations, alleviating the need for data-sharing., (© 2022. The Author(s).)

The decline of manufacturing employment is frequently invoked as a key cause of worsening U.S. population health trends, including rising mortality due to "deaths of despair." Increasing automation-the use of industrial robots to perform tasks previously done by human workers-is one structural force driving the decline of manufacturing jobs and wages. In this study, we examine the impact of automation on age- and sex-specific mortality. Using exogenous variation in automation to support causal inference, we find that increases in automation over the period 1993-2007 led to substantive increases in all-cause mortality for both men and women aged 45-54. Disaggregating by cause, we find evidence that automation is associated with increases in drug overdose deaths, suicide, homicide, and cardiovascular mortality, although patterns differ by age and sex. We further examine heterogeneity in effects by safety net program generosity, labor market policies, and the supply of prescription opioids., (Copyright © 2022 The Authors.)

Background: Persistent Postural Perceptual Dizziness (PPPD) is a newly defined condition which was added to the International Classification of Vestibular Disorders in 2017. Little is known about its impact on patients., Objective: The goal of this study was to analyze the symptomology, epidemiology and impact of PPPD on patients., Methods: A retrospective chart review was done to identify patients who attended the Multidisciplinary Dizziness Clinic (MDC) and were diagnosed with PPPD. Responses to demographic questions, health-related quality of life surveys and several well-validated questionnaires commonly used to assess dizziness severity were analyzed., Results: One hundred patients were diagnosed with PPPD between March 2017 and January 2019, of which 80%(80/100) were females. The average Dizziness Handicap Index score was 60.3±19.0. Responses to the Patient Health Questionnaire classified 53 patients (53/99;53.5%) as moderately to severely depressed. Sixty-four patients (64/100;64.0%) were minimally or mildly anxious according to the Generalized Anxiety Disorder scale. The average Vertigo Symptom Scale score was 24.1/60. The average Situational Vertigo Questionnaire score was 2.00. Forty-nine (49/100;49.0%) patients had migraine symptoms according to the Migraine Screen Questionnaire., Conclusions: In conclusion, patients with PPPD display important handicap and an elevated risk of depression, anxiety and migraines.

Objective: Hearing loss is an important health concern in Canada's Arctic. The objective of this research was to provide information on the prevalence of childhood hearing loss in Nunavut., Design: This cross-sectional study involved comprehensive audiologic assessments of school-aged children in six communities to determine overall and community-specific prevalence of hearing loss. Data were collected about hearing aid use and factors affecting use through a parent questionnaire., Study Sample: Assessments were completed for 644 children in kindergarten to grade 6., Results: 124 (19.3%) children had hearing loss of ≥ 30 dB HL at one or more frequencies in at least one ear (93.5% conductive loss). Applying a Canadian prevalence study definition, 148 (23.5%) children had hearing loss. Tympanic membrane perforations were present in 36.8% ( n  = 28) of children with unilateral and 45.8% ( n  = 22) with bilateral loss., Conclusions: The prevalence of hearing loss in Canada's North was almost three times that reported for non-indigenous children. One in five school-aged children was found to have hearing loss that is likely to affect classroom learning and social/emotional development. A hearing health strategy tailored to this population is critically needed.

This pilot study evaluated a high-energy, high-protein, peptide-based, (medium-chain triglycerides) MCT-containing enteral tube feed (Nutrison Peptisorb Plus HEHP ® , Nutricia Ltd., Trowbridge, BA14 0XQ, UK.) containing 1.5 kcal/mL and 7.5 g protein/100 mL. Fifteen community-based, enterally tube-fed adults (42 (SD 16.3) years) received the intervention feed daily for 28 days, with gastrointestinal tolerance, compliance and nutrient intake assessed at baseline and after the intervention period. Incidence and intensity of constipation ( p = 0.496), nausea ( p = 1.000), abdominal pain ( p = 0.366) and bloating ( p = 0.250) remained statistically unchanged, yet the incidence and intensity of diarrhoea improved significantly after receiving the intervention feed (Z = -2.271, p = 0.023). Compliance with the intervention feed was significantly greater compared to the patient's baseline regimens (99% vs. 87%, p = 0.038). Compared to baseline, use of the intervention feed enabled patients to significantly increase total energy (1676 kcal/day (SD 449) to 1884 kcal/day (SD 537), p = 0.039) and protein intake (73 g/day (SD 17) to 89 g/day (SD 23), p = 0.001), allowing patients to better achieve energy (from 88% to 99%, p = 0.038) and protein (from 101% to 121%, p < 0.001) requirements. This pilot study demonstrates that a high-energy, high-protein, peptide-based, MCT-containing enteral tube feed maintains gastrointestinal tolerance and improves compliance, energy and protein intake in complex, enterally tube-fed, community-based adult patients, though more work is recommended to confirm this.

Positive affect is linked to greater mental and physiological well-being. Conversely, negative affect is linked to depressive symptoms such as anhedonia. Relative biases in attention to positive or negative emotional information are thought to underlie individual difference in positive and negative affective traits, respectively. Attention bias modification (ABM) increases positive affect by training attention away from negative, or toward positive, stimuli. ABM training to reduce bias to negative information modulates electrocortical activity (i.e., P2, N2, & P3 ERP amplitudes), and this effect is moderated by participant sex. The extent to which ABM training to positive stimuli alters electrocortical activity and the extent to which such changes are moderated by participant sex is unknown. Here, participants completed attend positive ABM (or control) training followed by assessments of attentional bias, mood, and reward-related electrocortical activity. The results provide evidence of greater attentional bias to positive information following ABM. Transfer of these training effects to electrocortical measures was found for the P2 ERP component and moderated by participant sex. Females displayed a larger P2 amplitude for positive outcomes following ABM training. The reward positivity (RewP) and P3 ERPs were not directly affected by training, but the relationship between ERPs was linked to training such that following ABM training, the P2 and RewP components were strongly correlated, while following control training, the P3 and RewP were moderately correlated. Thus, ABM training to positive information enhanced electrocortical measures of reward processing in females and increased the relationship between reward-related ERPs., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Atheendar S. Venkataramani and colleagues discuss economic factors and population health in the United States., Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interest: ACT receives a stipend as a Specialty Consulting Editor for PLOS Medicine and serves on the journal's Editorial Board.

In this study, we introduce the 'racial opportunity gap' as a place-based measure of structural racism for use in population health research. We first detail constructing the opportunity gap using race-sex specific estimates of intergenerational economic mobility outcomes for a recent cohort. We then illustrate its utility in examining spatial variation in the racial mortality gap. First we demonstrate a correlation between the racial opportunity gap and the racial mortality gap across U.S. counties; where the gap in the adult earnings of black and white children born to families at the same income level is greater so, too, is the gap in mortality. Second, we show in a multivariable framework that the racial opportunity gap is associated with the racial mortality gap net of differences in the socioeconomic composition of the two groups. In so doing, we aim to provide population health researchers with a new empirical tool and analytic framework for examining the role of structural racism in generating racial health disparities., Competing Interests: None., (© 2020 The Authors.)

The reward-related positivity (RewP) is an event-related potential (ERP) with a positive amplitude occurring approximately 250-350 ms post-feedback at frontocentral electroencephalogram (EEG) electrode sites. The RewP is typically elicited in monetary gambling tasks and has a relatively larger amplitude for positive vs. negative outcomes. However, the extent to which RewP amplitude is modulated by non-monetary feedback is less clear. To address this issue, EEG was used to record reward-related electrocortical activity during a simple non-monetary gambling task. We hypothesized that the RewP would be enhanced for non-monetary wins relative to losses, which was supported by the results. In our supplementary material, we provide additional analyses suggesting that this effect was not observed for the P3. In sum, RewP amplitudes were larger for positive (nonmonetary) feedback relative to negative feedback at frontocentral electrode sites-suggesting that monetary reward is not necessary to elicit the RewP.

Following publication of the original article [1], the authors reported an error in one of the author names. In this Correction the incorrect and correct author names are listed.

New estimates of intergenerational economic mobility reveal substantial variation in the spatial distribution of opportunity in the United States. Efforts to explain this variation in economic mobility have conspicuously omitted health despite it being a key pathway for the transmission of economic position across generations. We begin to fill this gap in the literature by examining the relationship between health endowment at birth and intergenerational economic mobility across county birth cohorts in the United States, drawing on estimates from two population-level data sets. Exploiting variation across counties and over time, we find a negative relationship between the incidence of low-weight births and the level of economic mobility as measured in adulthood for the county birth cohorts in our sample. Our results build on a large and growing literature detailing the role of early childhood health in the transmission of economic status across generations and suggest that the incidence of low-weight births is negatively associated with intergenerational economic mobility.

Introduction: Submucous cleft palate (SMCP) classically involves bifid uvula, zona pellucida, and notched hard palate. However, patients may present with more subtle anatomic abnormalities. The ability to detect these abnormalities is important for surgeons managing velopharyngeal dysfunction (VPD) or considering adenoidectomy., Objectives: Validate an assessment protocol for diagnosis of occult submucous cleft palate (OSMCP) and identify physical examination features present in patients with OSMCP in the relaxed and activated palate positions., Methods: Study participants included patients referred to a pediatric VPD clinic with concern for hypernasality or SMCP. Using an appropriately encrypted iPod touch, transoral video was obtained for each patient with the palate in the relaxed and activated positions. The videos were reviewed by two otolaryngologists in normal speed and slow-motion, as needed, and a questionnaire was completed by each reviewer pertaining to the anatomy and function of the palate., Results: 47 patients, with an average age of 4.6 years, were included in the study over a one-year period. Four videos were unusable due to incomplete view of the palate. The most common palatal abnormality noted was OSMCP, diagnosed by each reviewer in 26/43 and 30/43 patients respectively. Using the assessment protocol, agreement on palatal diagnosis was 83.7% (kappa = 0.68), indicating substantial agreement, with the most prevalent anatomic features being vaulted palate elevation (96%) and visible notching of hard palate (75%)., Conclusion: The diagnosis of subtle palatal anomalies is difficult and can be subjective. Using the proposed video-analysis method and assessment protocol may improve reliability of diagnosis of OSMCP., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: The effects of changes in immigration policy on health outcomes among undocumented immigrants are not well known. We aimed to examine the physical and mental health effects of the Deferred Action for Childhood Arrivals (DACA) programme, a 2012 US immigration policy that provided renewable work permits and freedom from deportation for a large number of undocumented immigrants., Methods: We did a retrospective, quasi-experimental study using nationally representative, repeated cross-sectional data from the US National Health Interview Survey (NHIS) for the period January, 2008, to December, 2015. We included non-citizen, Hispanic adults aged 19-50 years in our analyses. We used a difference-in-differences strategy to compare changes in health outcomes among individuals who met key DACA eligibility criteria (based on age at immigration and at the time of policy implementation) before and after programme implementation versus changes in outcomes for individuals who did not meet these criteria. We additionally restricted the sample to individuals who had lived in the USA for at least 5 years and had completed high school or its equivalent, in order to hold fixed two other DACA eligibility criteria. Our primary outcomes were self-reported overall health (measured on a 5 point Likert scale) and psychological distress (Kessler 6 [K6] scale), the latter was administered to a random subset of NHIS respondents., Findings: Our final sample contained 14 973 respondents for the self-reported health outcome and 5035 respondents for the K6 outcome. Of these individuals, 3972 in the self-reported health analysis and 1138 in the K6 analysis met the DACA eligibility criteria. Compared with people ineligible for DACA, the introduction of DACA was associated with no significant change among DACA-eligible individuals in terms of self-reported overall health (b=0·056, 95% CI -0·024 to 0·14, p=0·17) or the likelihood of reporting poor or fair health (adjusted odds ratio [aOR] 0·98, 95% CI 0·66-1·44, p=0·91). However, DACA-eligible individuals experienced a reduction in K6 score compared with DACA-ineligible individuals (adjusted incident risk ratio 0·78, 95% CI 0·56-0·95, p=0·020) and were less likely to meet screening criteria for moderate or worse psychological distress (aOR 0·62, 95% CI 0·41-0·93, p=0·022)., Interpretation: Economic opportunities and protection from deportation for undocumented immigrants, as offered by DACA, could confer large mental health benefits to such individuals. Health consequences should be considered by researchers and policy makers in evaluations of the broader welfare effects of immigration policy., Funding: None., (Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.)

Background: Human papillomavirus (HPV) is an important cause of head and neck squamous cell carcinoma (HNSCC), especially in young people. These tumours overexpress p16 and respond well to treatment. The rapid detection of HPV in patients with HNSCC may expedite treatment when p16 status is not immediately available., Methods: Saliva-based DNA collection kits and nested polymerase chain reaction (PCR) were used to determine the HPV status of 62 individuals with biopsy-proven HNSCC. Immunohistochemistry was used to determine tumour p16 status., Results: A total of 62 patients were included in the study. Twenty-nine samples (47%) were positive for HPV DNA, the majority of which were high risk (HR) subtypes (79%). Patients who tested positive for HR HPV were more likely to have a tumour arising in the oropharynx compared to a non-oropharyngeal site (74 vs 26%; p = 0.003). A positive HR HPV saliva assay was 100% specific (95% CI 59-100%) and had a 100% positive predictive value (95% CI 75-100%) for a p16 positive tumour arising in the oropharynx. In contrast, a negative HR HPV assay had a 96% negative predictive value (95% CI 80-100%) for tumours arising in a non-oropharyngeal site. Independent of site, the saliva assay had a sensitivity of 77% (95% CI 54-91%) and a specificity of 94% (95% CI 77-99%), respectively, for a p16 positive tumour., Conclusion: We show that a saliva based assay is an effective method for detecting HPV in patients with HNSCC and that a positive HR HPV test is highly specific for p16 positive tumours arising in the oropharynx. This simple and rapid test could be used in cases where a biopsy of the primary tumour is not readily available.