Middlebury College

Ehlers Danlos and related hypermobility syndromes underly chronic, recurrent, and multiple-site pain in a small number of persons. By making the diagnosis, clinicians can better guide the treatment of the presenting problem. The diagnosis can help a patient make sense of their recurrent challenges as well. By inquiring about numerous associated conditions, ranging from postural orthostatic tachycardia syndrome to autism spectrum and attention deficit issues, the clinician may help the patient deal with other challenges. Detection can be easy-primarily observation of flexibility in the thumb, finger, elbow, and knee. The diagnosis is missed commonly, so we recommend clinicians take 1 month to perform these maneuvers on all chronic pain patients as one way of ensuring that clinicians have awareness.

Abstract This chapter introduces the ancient Maya and an attempt by the Kaan (Snake) dynasty to forge an empire in the southern lowlands. It describes how the Kaan League, a coalition of client kingdoms led by the Snakes, briefly dominates the Maya lowlands but ultimately falls apart due structural weaknesses, a brutal war, and the actions of a few extraordinary people. The chapter contrasts this decentralized League with successful empires like the Inca and Aztec, arguing that Maya kings fail to formalize authority or unify diverse lineages under lasting control. At the heart of the conflict lies the rivalry between the Kaan and Mut families, culminating in a decisive battle in 695 ce, as Jasaw Chan K’awiil defeats the League against the odds. Finally, the chapter explores the evidence left behind—from inscriptions to archaeology—and sets the stage for a historical narrative of ambition, war, and the elusive dream of empire.

ABSTRACT The global COVID‐19 pandemic dramatically altered virtually all aspects of social and political life. In particular, stay‐at‐home orders and social distancing mandates reduced the desirability of densely populated urban centers and sparked urban out‐migration. Migration responses to such exogenous shocks, however, vary across socioeconomically differentiated communities and are shaped by established migration channels. This paper builds a case study of out‐migration from New York City drawing on home locations recorded for individual mobile devices to examine two research questions. (1) How do out‐migration patterns from New York City during the COVID‐19 pandemic vary between class‐differentiated neighborhoods? (2) To what extent do previously established migration routes shape migration patterns during the pandemic? The results demonstrate that those leaving affluent neighborhoods moved further distances and were more likely to be directed toward high amenity recreation destinations. In addition, the analysis reveals that past migration behavior greatly increases the likelihood of outmigration during the pandemic, and those leaving affluent origins followed previously established outmigration pathways. In contrast, those leaving low‐income neighborhoods are more likely to return to origins with established histories of sending migrants to New York City. Combined, these results demonstrate the ways class context shaped migration responses to the COVID‐19 pandemic and how past migration behavior at both individual and aggregate scales influences both the likelihood of moving and choice of destination.

Heat exposure impairs decision making and increases injury and death risk among outdoor workers. Since 2022, five US states have adopted outdoor heat standards, but these recent policies cannot yet be evaluated with the available data. We examined California's 2005 outdoor heat standard, which is the only standard that was in place before 2022. Using negative binomial regression with wild cluster bootstrapped standard errors, we compared heat-related deaths among outdoor workers in California with those in neighboring states during the period 1999-20. California's policy showed increasingly strong associations with reduced deaths over time, with no decline during initial implementation (2005-09) but estimated reductions of 33percent after enforcement increased (2010-14) and 51percent after policy revisions (2015-20). Although these period-specific reductions were not individually statistically significant, a Wald test indicated that the combined effect during the period 2010-20 was statistically significant. These findings suggest that when properly designed and enforced, comprehensive heat standards can protect vulnerable workers as temperatures rise.

Abstract The Nuclear Spectroscopic Telescope Array (NuSTAR) enables detailed high-energy X-ray observations from 3–79 keV, but its performance can be constrained by telemetry saturation when observing bright sources, leading to reduced effective exposure times. In this study, we investigate the use of serendipitous stray light (SL) observations to infer properties of an X-ray bright source in comparison to focused data. Our case study is performed on the neutron star low-mass X-ray binary GX 340+0, a prominent Z source, where we execute a spectral analysis comparing 25 SL and 7 focused NuSTAR observations. Our findings demonstrate that SL observations can significantly enhance long-term temporal coverage detecting variations in the thermal components of the system across the baseline of the mission, which could not be inferred from focused observations alone.