This article analyzes Myanmar’s transition from authoritarianism and asks if it represents a transition towards democracy or a hybrid form of rule. Starting from theoretical debates about modes of ...transition, the article examines competing discourses on Myanmar’s opening and argues that it resembles an imposed more than a negotiated transition. Next, the article analyzes the links between this mode of transition and its outcomes, and finds that contemporary Myanmar is characterized by a combination of formal institutions for democratic representation, civilian government, and power-sharing, and problems of weak popular representation, limited civilian control of the military, and continued centralization of state authority. The article concludes that Myanmar’s political trajectory remains open-ended, but also that Myanmar, at least for the time being, seems more accurately described as a relatively stable hybrid regime than as a country that is in transition to democracy.
In 2022, Myanmar reported the second-highest number of aid workers killed globally.15 In addition, the MMC introduced new registration requirements and procedures for NGOs that affected their zones ...of operation and the delivery of life-saving humanitarian assistance (mainly affecting the national and international NGOs who are main contributors to the humanitarian aid programme).14 Even before the coup Myanmar was already facing several challenges in the health sector. The parliamentary government in Myanmar that came to power in 2011 increased spending on health, but it was still only 3·7% of the total government budget in 2016.16 Out-of-pocket spending accounted for 75% of all health spending in 2016.16 The economic recession in 2022, which saw inflation reach 18%, affected health care as people continue to have less disposable income for medical expenses. ...the prevalence of depression and anxiety has increased from 18% before the coup19 to 61% in 2021.20 The deterioration of health services and the high prevalence of mental distress are most likely attributed to the polycrisis of war and conflict, forced migration, the COVID-19 pandemic, and a weakened health-care system post-coup.21 Those affected directly by the coup's trauma, or indirectly by displacement or loss of protective factors (eg, family, financial protection, and socioeconomic factors) are at risk of developing post-traumatic stress disorder (PTSD), anxiety, depression, and other psychiatric disorders.22 Community mental health programmes, reaching displaced people in the border area and hard-to-reach areas, should be given priority. For children and adolescents, focused psychosocial interventions can help reduce symptoms of depression, anxiety, and PTSD and enhance hope, coping, and social support.23 For adults, WHO has developed the Self-Help Plus intervention to manage psychological distress and mental health problems in vulnerable populations, shown to have effects on symptoms up to 3 months after delivery.24 To help resolve the conflict and put the democratisation process back on track, we suggest using health as a bridge for peace through strengthening of health services and humanitarian aid delivery reaching displaced people in the border areas and hard-to-reach areas inside Myanmar.
...a cost-effectiveness analysis of repellent distribution in the context of a large-scale malaria control and elimination programme was conducted in order to inform policy. Methods Ethics This trial ...is registered in the Australian New Zealand Clinical Trials Registry (ACTRN12616001434482; approved retrospectively 14 October 2016) and was approved by the Ethics Review Committee on Medical Research involving Human Subjects, Department of Medical Research, Ministry of Health and Sports, Myanmar Government (#21/Ethics/2015; extended approval #Ethics/DMR/2016/020), and the Alfred Hospital, Melbourne, Australia (95/15). ...the repellent was provided in plain unbranded tubes, and the investigators registered the trial after completion of fieldwork (but prior to the commencement of data analysis) to minimise public disclosure. In order to determine the number of repellent tubes required to supply a village across the study, the respective village authority provided the village population size, and the number of tubes needed to be stocked was estimated by the in-country study team (2 tubes per person initially and an additional 20%–30% of this total allocation for the VHV-led repellent replacement).
▸ A novel and exciting vision for future lab-on-a-chip platforms for neuroscience. ▸ Discuss limitations of current bench-top instrumentations for neuroscience research. ▸ State recent progress in ...microfabrication technologies for neurobiology and electrophysiology. ▸ Covers LOCs which will be of interest for cellular and molecular neuroscience researchers.
Advances in microelectronics, microfluidics, polymers and microfabrication have enabled the creation of disposable lab-on-a-chips (LOCs) as the new tools for neuroscience research. The LOCs have been applied for a wide range of neurobiology studies, including cellular and molecular biochemical experimentations, morphological observations and electrophysiological investigations. The integration of miniaturised components leads to analytical instrumentations with unprecedented automation, speed of analysis, and flexibility. These features make LOCs capable enough to replace their bulky and expensive bench-top counterparts. LOCs can be useful for genomic, proteomic, epigenomic, peptidomic, connectomic and electrophysiological studies and also as effective tools for reductionist neuroscientists. Moreover, they can be applied at higher level studies such as developmental neurobiology and behavioural investigations. This work provides an in-depth review of LOC platforms for neuroscience research. First, we review the essential bench-top neuroscience instrumentation as per their functions and features. Next, we present LOC counterparts for those bench-top instrumentations. Finally, we offer perspectives on persistent challenges and our perception of opportunities based on LOC instrumentations in neuroscience research.
To determine the incidence of and risk factors for neonatal unit admission, intrapartum stillbirth or neonatal death without admission, and describe outcomes, in babies born in an alongside midwifery ...unit (AMU).
National population-based case-control study.
We used the UK Midwifery Study System to identify and collect data about 1041 women who gave birth in AMUs, March 2017 to February 2018, whose babies were admitted to a neonatal unit or died (cases) and 1984 controls from the same AMUs. We used multivariable logistic regression, generating adjusted OR (aOR) with 95% CIs, to investigate maternal and intrapartum factors associated with neonatal admission or mortality.
The incidence of neonatal admission or mortality following birth in an AMU was 1.2%, comprising neonatal admission (1.2%) and mortality (0.01%). White 'other' ethnicity (aOR=1.28; 95% CI=1.01 to 1.63); nulliparity (aOR=2.09; 95% CI=1.78 to 2.45); ≥2 previous pregnancies ≥24 weeks' gestation (aOR=1.38; 95% CI=1.10 to 1.74); male sex (aOR=1.46; 95% CI=1.23 to 1.75); maternal pregnancy problem (aOR=1.40; 95% CI=1.03 to 1.90); prolonged (aOR=1.42; 95% CI=1.01 to 2.01) or unrecorded (aOR=1.38; 95% CI=1.05 to 1.81) second stage duration; opiate use (aOR=1.31; 95% CI=1.02 to 1.68); shoulder dystocia (aOR=5.06; 95% CI=3.00 to 8.52); birth weight <2500 g (aOR=4.12; 95% CI=1.97 to 8.60), 4000-4999 g (aOR=1.64; 95% CI=1.25 to 2.14) and ≥4500 g (aOR=2.10; 95% CI=1.17 to 3.76), were independently associated with neonatal admission or mortality. Among babies admitted (n=1038), 18% received intensive care. Nine babies died, six following neonatal admission. Sepsis (52%) and respiratory distress (42%) were the most common discharge diagnoses.
The results of this study are in line with other evidence on risk factors for neonatal admission, and reassuring in terms of the quality and safety of care in AMUs.
The strong present-day Asian monsoons are thought to have originated between 25 and 22 million years (Myr) ago, driven by Tibetan-Himalayan uplift. However, the existence of older Asian monsoons and ...their response to enhanced greenhouse conditions such as those in the Eocene period (55-34 Myr ago) are unknown because of the paucity of well-dated records. Here we show late Eocene climate records revealing marked monsoon-like patterns in rainfall and wind south and north of the Tibetan-Himalayan orogen. This is indicated by low oxygen isotope values with strong seasonality in gastropod shells and mammal teeth from Myanmar, and by aeolian dust deposition in northwest China. Our climate simulations support modern-like Eocene monsoonal rainfall and show that a reinforced hydrological cycle responding to enhanced greenhouse conditions counterbalanced the negative effect of lower Tibetan relief on precipitation. These strong monsoons later weakened with the global shift to icehouse conditions 34 Myr ago.
In neonatal encephalopathy, the clinical manifestations of injury can only be reliably assessed several years after an intervention, complicating early prognostication and rendering trials of ...promising neuroprotectants slow and expensive. We aimed to determine the accuracy of thalamic proton magnetic resonance (MR) spectroscopy (MRS) biomarkers as early predictors of the neurodevelopmental abnormalities observed years after neonatal encephalopathy.
We did a prospective multicentre cohort study across eight neonatal intensive care units in the UK and USA, recruiting term and near-term neonates who received therapeutic hypothermia for neonatal encephalopathy. We excluded infants with life-threatening congenital malformations, syndromic disorders, neurometabolic diseases, or any alternative diagnoses for encephalopathy that were apparent within 6 h of birth. We obtained T1-weighted, T2-weighted, and diffusion-weighted MRI and thalamic proton MRS 4–14 days after birth. Clinical neurodevelopmental tests were done 18–24 months later. The primary outcome was the association between MR biomarkers and an adverse neurodevelopmental outcome, defined as death or moderate or severe disability, measured using a multivariable prognostic model. We used receiver operating characteristic (ROC) curves to examine the prognostic accuracy of the individual biomarkers. This trial is registered with ClinicalTrials.gov, number NCT01309711.
Between Jan 29, 2013, and June 25, 2016, we recruited 223 infants who all underwent MRI and MRS at a median age of 7 days (IQR 5–10), with 190 (85%) followed up for neurological examination at a median age of 23 months (20–25). Of those followed up, 31 (16%) had moderate or severe disability, including one death. Multiple logistic regression analysis could not be done because thalamic N-acetylaspartate (NAA) concentration alone accurately predicted an adverse neurodevelopmental outcome (area under the curve AUC of 0·99 95% CI 0·94–1·00; sensitivity 100% 74–100; specificity 97% 90–100; n=82); the models would not converge when any additional variable was examined. The AUC (95% CI) of clinical examination at 6 h (n=190) and at discharge (n=167) were 0·72 (0·65–0·78) and 0·60 (0·53–0·68), respectively, and the AUC of abnormal amplitude integrated EEG at 6 h (n=169) was 0·73 (0·65–0·79). On conventional MRI (n=190), cortical injury had an AUC of 0·67 (0·60–0·73), basal ganglia or thalamic injury had an AUC of 0·81 (0·75–0·87), and abnormal signal in the posterior limb of internal capsule (PLIC) had an AUC of 0·82 (0·76–0·87). Fractional anisotropy of PLIC (n=65) had an AUC of 0·82 (0·76–0·87). MRS metabolite peak-area ratios (n=160) of NAA–creatine (<1·29) had an AUC of 0·79 (0·72–0·85), of NAA–choline had an AUC of 0·74 (0·66–0·80), and of lactate–NAA (>0·22) had an AUC of 0·94 (0·89–0·97).
Thalamic proton MRS measures acquired soon after birth in neonatal encephalopathy had the highest accuracy to predict neurdevelopment 2 years later. These methods could be applied to increase the power of neuroprotection trials while reducing their duration.
National Institute for Health Research UK.
•The present study explored the effect of the scan lengths from 0.25 to 2 mm on thermal, microstructural, and mechanical responses.•Shorter scan lengths resulted in a noticeable increase in yield ...stress, but a reduction in strain at failure.•The increase in void fraction was found to be highly localized at the interface between hatch regions, especially at a small scan length.•The microstructure was mostly alpha prime martensite, but the lath size became smaller with shorter scan lengths.•Finite element analysis showed that shorter scan lengths led to higher cooling rates, which could explain the smaller lath size.•The study suggests that varying the scan length can be used to modify mechanical properties, but further research is needed for defect minimization.
Although a laser powder bed fusion (LPBF) process involves a complex laser-material interaction, it allows the possibility of designing the process conditions to achieve a distinct thermal history. Thus, in-situ control of microstructures and mechanical properties is feasible. Among many process parameters, the scan length has been regarded as an important variable, which can have a strong effect on thermal responses. Therefore, the present study performed a numerical and experimental assessment of the effect of scan lengths on thermal, microstructural, and mechanical behaviors on the LPBF of Ti-6Al-4V. Four scan lengths of 0.25, 0.5, 1, and 2 mm were used. Overall, it was found that shortening scan lengths can result in a more rapid cooling. As a result, even though the phase fraction was indifferent in each sample, a lath size refinement was observed for the sample with a short scan length. By changing the scan length from 2 to 0.25 mm, the lath size changed from 1.05 to 0.76 µm, and the yield stress increased from 1031 MPa to 1125 MPa. Nonetheless, the ductility reduction was also observed, which was mainly driven by a significant void escalation at 0.25 mm scan length. In addition, not only was the void fraction higher with shorter scan lengths, but it also become more highly localized at the hatch interface, especially at a scan length of 0.25 mm. Therefore, the gain of yield stress with the loss of ductility at the short scan length was noted. Ultimately, the present work revealed comprehensively the interaction between thermal, microstructural, and mechanical responses under different built conditions. These understandings could be used further toward process optimization in the LPBF technology.
Abstract
Background
Staphylococcal cassette chromosome mec (SCCmec) elements are highly diverse and have been classified into 13 types. The arginine catabolic mobile element (ACME) is an SCC-like ...element harbouring an arginine deiminase pathway gene cluster (ACME-arc). ACME type I (ACME I), additionally including a spermidine/spermine-N1-acetyltransferase gene (speG), is considered to have contributed to the rapid spread of the most successful MRSA clone, USA300.
Objectives
To characterize the SCC composite islands (SCC-CIs) in ST5 MRSA positive for both ACME-arc and speG.
Methods
Three ST5 MRSA strains (SC640, SC792 and SC955) collected in Hokkaido, Japan were subjected to WGS and the SCC-CIs were determined.
Results
The SCC-CIs consisted of four (SC640 and SC792) or three (SC955) SCC/SCC-like elements and commonly harboured both an ACME type II′ and an SCC encoding speG. These SCC-CIs appear to mimic ACME I in USA300, in that they are equipped with ACME-arc and speG. The SCC-CIs of SC640 and SC792 contained novel SCCmec/SCCmec-like elements at the 3′ end, whereas SC955 contained SCCmec type V. The SCCmec of SC792 carried mec complex A and ccrC1, which was determined to be novel and designated as SCCmec type XIV (5A). SC640 harboured an SCCmec-like element derived from SCCmec type XIV. It lacked most of the downstream region of the mec complex, including the left chromosomal attachment site (SCCmec XIV Δkdp/DR-L), and lost its capability for chromosomal excision, suggesting that the mecA gene is immobilized on the chromosome.
Conclusions
These findings provide evidence for increasing complexity of SCC-CIs.
To examine if therapeutic hypothermia reduces the composite outcome of death, moderate or severe disability at 18 months or more after mild neonatal encephalopathy (NE).
MEDLINE, Cochrane database, ...Scopus and ISI Web of Knowledge databases, using 'hypoxic ischaemic encephalopathy', 'newborn' and 'hypothermia', and 'clinical trials' as medical subject headings and terms. Manual search of the reference lists of all eligible articles and major review articles and additional data from the corresponding authors of selected articles.
Randomised and quasirandomised controlled trials comparing therapeutic hypothermia with usual care.
Safety and efficacy data extracted independently by two reviewers and analysed.
We included the data on 117 babies with mild NE inadvertently recruited to five cooling trials (two whole-body cooling and three selective head cooling) of moderate and severe NE, in the meta-analysis. Adverse outcomes occurred in 11/56 (19.6%) of the cooled babies and 12/61 (19.7%) of the usual care babies (risk ratio 1.11 (95% CIs 0.55 to 2.25)).
Current evidence is insufficient to recommend routine therapeutic hypothermia for babies with mild encephalopathy and significant benefits or harm cannot be excluded.
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