Each year the Ernest Hemingway Foundation and PEN award the PEN/Hemingway prize for the year's best debut novel. The award is presented at a gala reception at the John F. Kennedy Library in Boston, ...Massachusetts. The 2023 PEN/Hemingway prize was awarded to Oscar Hokeah for his book, Calling for a Blanket Dance. We are pleased to present the keynote address of Jennifer Haigh, a New York Times Best Selling author who has been called a "gifted chronicler of the human condition" (Washington Post Book World).
BackgroundResearchers and healthcare providers have paid little attention to morbidity and unplanned healthcare encounters for children following hospital discharge in low- and middle-income ...countries. Our objective was to compare symptoms and unplanned healthcare encounters among children aged <5 years who survived with those who died within 60 days of hospital discharge through follow-up phone calls.MethodsWe conducted a secondary analysis of a prospective observational cohort of children aged <5 years discharged from neonatal and paediatric wards of two national referral hospitals in Dar es Salaam, Tanzania and Monrovia, Liberia. Caregivers of enrolled participants received phone calls 7, 14, 30, 45, and 60 days after hospital discharge to record symptoms, unplanned healthcare encounters, and vital status. We used logistic regression to determine the association between reported symptoms and unplanned healthcare encounters with 60-day post-discharge mortality.ResultsA total of 4243 participants were enrolled and had 60-day vital status available; 138 (3.3%) died. For every additional symptom ever reported following discharge, there was a 35% greater likelihood of post-discharge mortality (adjusted odds ratio aOR 1.35, 95% confidence interval CI 1.10 to 1.66; p=0.004). The greatest survival difference was noted for children who had difficulty breathing (2.1% among those who survived vs 36.0% among those who died, p<0.001). Caregivers who took their child home from the hospital against medical advice during the initial hospitalisation had over eight times greater odds of post-discharge mortality (aOR 8.06, 95% CI 3.87 to 16.3; p<0.001) and those who were readmitted to a hospital had 3.42 greater odds (95% CI 1.55 to 8.47; p=0.004) of post-discharge mortality than those who did not seek care when adjusting for site, sociodemographic factors, and clinical variables.ConclusionSurveillance for symptoms and repeated admissions following hospital discharge by healthcare providers is crucial to identify children at risk for post-discharge mortality.
Rose is recognized as an important ornamental plant worldwide, and it is also one of the most widely used flowers in gardens. At present, the improvement of rose traits is still difficult and ...uncertain, and molecular breeding can provide new ideas for the improvement of modern rose varieties. Somatic embryos are quite good receptors for genetic transformation. However, little is known about the molecular mechanisms underlying during the regeneration process of rose somatic embryos. To elucidate the molecular regulation mechanism of somatic embryo plantlet regeneration, the relationship between the differences in traits of the two different regenerated materials and the significantly differentially expressed genes (DEGs) related to phytohormone pathways in the process of regeneration were be investigated.
These representative two regenerated samples from single-piece cotyledonary somatic embryo (SPC) culture of Rosa hybrida 'John F. Kennedy', were harvested for transcriptome analysis, with the SPC explants at the initial culture (Day 0) as the control. The differentially expressed genes (DEGs) in the materials from two different types for regeneration approach (SBF type: the regeneration approach type of single bud formed from SPC explants; MBF type: the regeneration approach type of multiple buds formed from SPC explants) were be screened by means of the transcriptome sequencing technology. In this study, a total of about 396.24 million clean reads were obtained, of which 78.95-82.92% were localized to the reference genome, compared with the initial material (CK sample), there were 5594 specific genes in the material of SBF type and 6142 specific genes in the MBF type. The DEGs from the SBF type material were mainly concentrated in the biological processes of GO terms such as phytohormones, substance transport, cell differentiation, and redox reaction. The KEGG enrichment analysis revealed these DEGs were more active in ubiquinone and other terpenoid-quinone biosynthesis, fatty acid elongation, steroid biosynthesis, and glycosphingolipid biosynthesis-globo and isoglobo series. In contrast, the DEGs induced by the MBF type material were mainly associated with the biological processes such as phytohormones, phosphorylation, photosynthesis and signal transduction. According to KEGG analysis, these DEGs of MBF type were significantly enriched in the porphyrin and chlorophyll metabolism, brassinosteroid biosynthesis, carotenoid biosynthesis, and peroxisome. Furthermore, the results from the phytohormone pathways analysis showed that the auxin-responsive factor SAUR and the cell wall modifying enzyme gene XTH were upregulated for expression but the protein phosphatase gene PP2C was downregulated for expression in SBF type; the higher expression of the ethylene receptor ETR, the ethylene transduction genes EBF1/2, the transcription factor EIN3, and the ethylene-responsive transcription factor ERF1/2 were induced by MBF type.
According to the GO and KEGG analysis, it indicated the DEGs between two different regenerated materials from somatic embryos were significantly different which might be causing morphological differences. That was somatic embryos from Rosa hybrida 'John F. Kennedy' could regenerate plantlet via both classic somatic embryogenesis (seed-like germination) and organogenesis, cotyledonary somatic embryos should be considered as one kind of intermediate materials similiar to callus, rather than the indicator materials for somatic embryogenesis.
Almost 60 years after the assassination of President John F. Kennedy in 1963, the majority of Americans are still reluctant to believe official reports presented by the commissions gathered in 1964 ...and again in 1976 that determined the direction of the shot resulting in the fatal head injury. Long-withheld, confidential government files released in 2017 reignited the controversy. The present investigation computationally simulated projectile-skull-impacts from the direction specified in official reports and from three other directions. Detailed geometric models of the human head and ammunition, as well as known parameters from the assassination site served as the supportive base for analysis. Constitutive mathematical models for the impact of projectile material with skull tissues at supersonic speed were employed to analyze bone and bullet fragmentation mechanics. Simulated fracture characteristics of bone and bullet were compared with photographic and X-ray evidence. The most likely origin of the fatal shot was determined based on the degree of corresponding deformation and fragmentation between simulation and documented evidence. Computational corroboration could be established as physically consistent with high-speed impact from the rear, as established by the official commissions. Simulations of three other speculative shot origins did not correspond with the documented evidence.
•Finite element simulation applied to fatal cranial gunshot to president Kennedy.•Simulation compares speculative shot origins to skull fracture and bullet evidence.•Match to evidence achieved by simulated shot from Texas School Book Depository.•Due to mismatch with evidence other speculative shot origins are excluded.
To report the initial outcomes and associated risk factors for poor outcome of cataract surgery performed in Liberia.
LV Prasad Eye Institute (LVPEI), Hyderabad, started providing eye care in Liberia ...since July 2017. Electronic Medical Records of 573 patients operated for age-related cataract from July 2017 to January 2019 were reviewed. One eye per patient was included for analysis. All patients underwent either phacoemulsification or manual small incision cataract surgery (MSICS). Pre and postoperative uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA) were recorded at one day, 1-3 weeks and 4-11 weeks. Main outcome measure was BCVA at 4-11 weeks; Intraoperative complications and preoperative ocular comorbidities (POC) were noted. BCVA less than 6/12 was classified as visual impairment (VI). Risk factor for VI was analysed using the logistic regression model.
Of the 573 patients, 288 were males and 285 were females (49.7%). Mean age was 65.9±10.9 years; 14.3% had POC. The surgical technique was mainly MSICS (94.59%, n = 542). At 4-11 weeks, good outcome of 6/12 or better was noted in 38.55% (UCVA) and 82.54% (BCVA). Visual acuity (VA) of 6/18 or better as UCVA and BCVA was noted in 63.5% and 88% eyes respectively. Poor outcome of less than 6/60 was noted as UCVA (11.11%) and BCVA (5.22%). Multivariable analysis showed poor visual outcomes significantly higher in patients with POC (odds ratio 3.28; 95% CI: 1.70, 6.34).
The cataract surgical outcomes in Liberia were good; with ocular comorbidities as the only risk factor.
The national objectives of general welfare, economic growth and stability, and security of the United States require the development of transportation policies and programs that contribute to ...providing fast, safe, efficient, and convenient transportation at the lowest cost consistent with those and other national objectives, including the efficient use and conservation of the resources of the United States.1 The above statement encapsulates the purpose and complexity of the federal government's transportation policy. Impediments to Ryan A. Payne, ryan@nkbattorneys.com, is a senior associate attorney with the law firm ofNetzer, Krautter & Brown P.C. He holds aBA in political science from the University of South Carolina, aJDfrom the University of Montana School of Law, and an MBA from the University of Montana. the successful deployment of a new generation of civil supersonic aircraft, therefore, include not only the regulations in 14 C.F.R. part 91 (applicable to all civil aircraft operations in US airspace), but also an outdated and mismatched intellectual property rights structure that rewards second, third, or fourth movers instead of protecting the trailblazer's investment in this technology. The sonic boom test program at Oklahoma City was designed to determine the public acceptability and the effect on ground structures on booms anticipated from future supersonic transport flights, inasmuch as the projected supersonic transport would travel at faster-than-sound speeds, carrying paying passengers, and fly over people and population centers.9 The results did not bode well for the possibility of overland supersonic travel and resulted in several rounds of lawsuits against the federal government, though they were ultimately unsuccessful.10 Concorde's Derivative Technology Due to the unique operational environment and mission objectives, Concorde was forced to be lighter, more powerful, more advanced, more luxurious, and faster than any civil aircraft of its time. For The law as it has developed is in tension with clearly stated federal policy goals, as well as commonsense and commercial goals. example, during an address to graduates of the US Air Force Academy delivered early on in the Jet Age, President John F. Kennedy remarked as follows: I am announcing today that the United States will commit itself to an important new program in civilian aviation.
Informed consent and SUPPORT Drazen, Jeffrey M; Solomon, Caren G; Greene, Michael F
The New England journal of medicine,
2013-May-16, Letnik:
368, Številka:
20
Journal Article
BackgroundThere are no validated clinical decision aids to identify neonates and young children at risk of hospital readmission or postdischarge mortality in sub-Saharan Africa, leaving the decision ...to discharge a child to a clinician’s impression. Our objective was to determine the precision of clinician impression to identify neonates and young children at risk for readmission and postdischarge mortality.MethodsWe conducted a survey study nested in a prospective observational cohort of neonates and children aged 1–59 months followed 60 days after hospital discharge from Muhimbili National Hospital in Dar es Salaam, Tanzania or John F. Kennedy Medical Center in Monrovia, Liberia. Clinicians who discharged each enrolled patient were surveyed to determine their perceived probability of the patient’s risk of 60-day hospital readmission or postdischarge mortality. We calculated the area under the precision-recall curve (AUPRC) to determine the precision of clinician impression for both outcomes.ResultsOf 4247 discharged patients, 3896 (91.7%) had available clinician surveys and 3847 (98.7%) had 60-day outcomes available: 187 (4.8%) were readmitted and 120 (3.1%) died within 60 days of hospital discharge. Clinician impression had poor precision in identifying neonates and young children at risk of hospital readmission (AUPRC: 0.06, 95% CI: 0.04 to 0.08) and postdischarge mortality (AUPRC: 0.05, 95% CI: 0.03 to 0.08). Patients for whom clinicians attributed inability to pay for future medical treatment as the reason for risk for unplanned hospital readmission had 4.76 times the odds hospital readmission (95% CI: 1.31 to 17.25, p=0.02).ConclusionsGiven the poor precision of clinician impression alone to identify neonates and young children at risk of hospital readmission and postdischarge mortality, validated clinical decision aids are needed to aid in the identification of young children at risk for these outcomes.
Accepting the Democratic nomination for president in July 1960, John F. Kennedy exhorted his fellow Americans to join him in a mission of national sacrifice on the 'New Frontier'. This article will ...explore the influence of frontier mythology on the foreign policy rhetoric of the Kennedy administration. It will show how the prevalence of the Western in U.S. popular culture led Kennedy and his advisers to carefully construct a meaningful Cold War discourse, one which attempted to situate the administration's foreign policy within a heroic narrative of westward expansion. Yet this rhetorical strategy proved something of a double-edged sword; at key moments during his presidency, Kennedy found his 'New Frontier' rhetoric being turned against him by critics of his foreign policy. Led by Arizona Senator Barry Goldwater, these opponents accused the president of deviating from the mythic narratives he appealed to in his speeches, charging that the 'New Frontier' was but a pale imitation of the old. By exploring this contest over frontier mythology and its interaction with U.S. foreign policy, this article seeks to add a new dimension to the recent 'narrative turn' in international history.
PDF
