bluuebunny/crossref_metadata_2025 huggingface dataset:
A Global, Continental, and Regional Analysis of Changes in Extreme Precipitation
Authors: Sun Qiaohong , Zhang Xuebin , Zwiers Francis , Westra Seth , Alexander Lisa V.
Published: September 2020

This paper provides an updated analysis of observed changes in extreme precipitation using high-quality station data up to 2018. We examine changes in extreme precipitation represented by annual maxima of 1-day (Rx1day) and 5-day (Rx5day) precipitation accumulations at different spatial scales and attempt to address whether the signal in extreme precipitation has strengthened with several years of additional observations. Extreme precipitation has increased at about two-thirds of stations and the percentage of stations with significantly increasing trends is significantly larger than that can be expected by chance for the globe, continents including Asia, Europe, and North America, and regions including central North America, eastern North America, northern Central America, northern Europe, the Russian Far East, eastern central Asia, and East Asia. The percentage of stations with significantly decreasing trends is not different from that expected by chance. Fitting extreme precipitation to generalized extreme value distributions with global mean surface temperature (GMST) as a covariate reaffirms the statistically significant connections between extreme precipitation and temperature. The global median sensitivity, percentage change in extreme precipitation per 1 K increase in GMST is 6.6% (5.1% to 8.2%; 5%–95% confidence interval) for Rx1day and is slightly smaller at 5.7% (5.0% to 8.0%) for Rx5day. The comparison of results based on observations ending in 2018 with those from data ending in 2000–09 shows a consistent median rate of increase, but a larger percentage of stations with statistically significant increasing trends, indicating an increase in the detectability of extreme precipitation intensification, likely due to the use of longer records.
Depth Structure of Ningaloo Niño/Niña Events and Associated Drivers
Authors: Ryan Svenja , Ummenhofer Caroline C. , Gawarkiewicz Glen , Wagner Patrick , Scheinert Markus , Biastoch Arne , Böning Claus W.
Published: September 2020

Marine heatwaves along the coast of Western Australia, referred to as Ningaloo Niño, have had dramatic impacts on the ecosystem in the recent decade. A number of local and remote forcing mechanisms have been put forward; however, little is known about the depth structure of such temperature extremes. Utilizing an eddy-active global ocean general circulation model, Ningaloo Niño and the corresponding cold Ningaloo Niña events are investigated between 1958 and 2016, with a focus on their depth structure. The relative roles of buoyancy and wind forcing are inferred from sensitivity experiments. Composites reveal a strong symmetry between cold and warm events in their vertical structure and associated large-scale spatial patterns. Temperature anomalies are largest at the surface, where buoyancy forcing is dominant, and extend down to 300-m depth (or deeper), with wind forcing being the main driver. Large-scale subsurface anomalies arise from a vertical modulation of the thermocline, extending from the western Pacific into the tropical eastern Indian Ocean. The strongest Ningaloo Niños in 2000 and 2011 are unprecedented compound events, where long-lasting high temperatures are accompanied by extreme freshening, which emerges in association with La Niñas, that is more common and persistent during the negative phase of the interdecadal Pacific oscillation. It is shown that Ningaloo Niños during La Niña phases have a distinctively deeper reach and are associated with a strengthening of the Leeuwin Current, while events during El Niño are limited to the surface layer temperatures, likely driven by local atmosphere–ocean feedbacks, without a clear imprint on salinity and velocity.
Weather Radar Network Benefit Model for Nontornadic Thunderstorm Wind Casualty Cost Reduction
Authors: Cho John Y. N. , Kurdzo James M.
Published: September 2020

An econometric geospatial benefit model for nontornadic thunderstorm wind casualty reduction is developed for meteorological radar network planning. Regression analyses on 22 years (1998–2019) of storm event and warning data show, likely for the first time, a clear dependence of nontornadic severe thunderstorm warning performance on radar coverage. Furthermore, nontornadic thunderstorm wind casualty rates are observed to be negatively correlated with better warning performance. In combination, these statistical relationships form the basis of a cost model that can be differenced between radar network configurations to generate geospatial benefit density maps. This model, applied to the current contiguous U.S. weather radar network, yields a benefit estimate of $207 million (M) yr−1 relative to no radar coverage at all. The remaining benefit pool with respect to enhanced radar coverage and scan update rate is about $36M yr−1. Aggregating these nontornadic thunderstorm wind results with estimates from earlier tornado and flash flood cost reduction models yields a total benefit of $1.12 billion yr−1 for the present-day radars and a remaining radar-based benefit pool of $778M yr−1.
A Successful Organized Effort to Improve Operating Room First-Case Starts in a Tertiary Academic Medical Center
Authors: Chua Melissa M. J. , Lewis Keith , Huang Yi-An , Fingliss Mary , Farber Alik
Published: September 2020

Background

Operating room (OR) inefficiency drives up cost, decreases revenue, and leads to surgeon, staff, and patient dissatisfaction. Given a low mean first-case start rate in our tertiary academic medical center, we developed a process to improve first-case start rates in an effort to increase OR efficiency.

Methods

A working group of the OR Executive Committee was constituted to develop and implement a multistep operational plan. This plan was predicated on a sensible staggered start framework, coordination of stakeholder responsibilities, a visual preoperative Stop/Go checklist tool, real-time measurement, and feedback.

Results

Within 11 days of implementation, 95% of first-start OR cases were tracked to start on time. Throughout the observation period (May 2015-July 2016), the goal of a daily mean 80% on-time start rate was either met or exceeded.

Conclusions

Implementation of an organized collaborative effort led to dramatic improvements in first OR case on-time rates. Such improvement in OR utilization may lead to an increase in staff and patient satisfaction and cost reduction.
Association between mode of delivery and postpartum depression: A systematic review and network meta-analysis
Authors: Sun Lei , Wang Su , Li Xi-Qian
Published: September 2020

Background:

Postpartum depression is one of the most common postpartum diseases, which has an important impact on the interaction between mother, infant, partner and family, as well as the long-term emotional and cognitive development of infants. However, there are still great disagreements on whether the delivery mode will affect the risk of postpartum depression. The purpose of this study is to explore whether the mode of delivery will affect the risk of postpartum depression through the comprehensive network meta-analysis of elective cesarean section, emergency cesarean section, instrumental vaginal delivery and spontaneous vaginal delivery.

Methods:

We searched in three electronic databases: PubMed, EMBASE and Cochrane Library.

Results:

This paper included 43 studies with a total sample size of 1,827,456 participants. Direct meta-analysis showed that the odds ratio of postpartum depression risk was 1.33 (95% confidence interval = [1.21, 1.46]) between cesarean section and vaginal delivery. The odds ratios of high Edinburgh Postpartum Depression Scale score between cesarean section and vaginal delivery in the three postpartum periods (within 2 weeks, within half a year and over half a year) were basically the same. There was no difference between cesarean section and vaginal delivery in the risk of severe postpartum depression at the Edinburgh Postpartum Depression Scale cut-off point ⩾13 (odds ratio = 1.07; 95% confidence interval = [0.99, 1.16]). Network meta-analysis showed that the risk of postpartum depression in the pairwise comparisons emergency cesarean section vs spontaneous vaginal delivery and elective cesarean section vs spontaneous vaginal delivery was odds ratio = 1.53 (95% confidence interval = [1.22, 1.91]) and 1.47 (95% confidence interval = [1.16, 1.86]).

Conclusion:

The mode of delivery has a significant effect on the occurrence of mild postpartum depression. Women who give birth by cesarean section, especially who give birth by emergency cesarean section, are at a higher risk of mild postpartum depression. We should carefully monitor the progress of postpartum mental disorders in women who delivered by cesarean section and make it possible for women to have a quick access to mental healthcare.
When “Fake News” Becomes Real: The Consequences of False Government Denials in an Authoritarian Country
Authors: Wang Chengli , Huang Haifeng
Published: September 2020

Governments around the world, particularly authoritarian ones, often deny inconvenient or unfavorable information, calling it fake news or false rumor, and yet what was denied often turns out to be true eventually. How will citizens react when the initial “fake news” is verified to be real? What are the consequences of false government denials on government credibility and citizen satisfaction? Using a survey experiment in China and a follow-up survey, we find that citizens can be persuaded by the authorities’ denials and reduce their belief in a piece of news that has been declared “fake.” But when the denied news turns out to be real, citizens will reduce their belief not only in the denial at hand but also in a similar denial in the future and reduce their satisfaction with the government. Thus, false denials have both immediate and lasting effects on government credibility and can erode citizen satisfaction with the government.
The Effect of Wave Motion Intensities on Performance in a Simulated Search and Rescue Task and the Concurrent Demands of Maintaining Balance
Authors: Duncan Carolyn A. , Bishop Nicole , Komisar Vicki , MacKinnon Scott N. , Byrne Jeannette M.
Published: September 2020

Objective

The purpose of this study was to examine how intensity of wave motions affects the performance of a simulated maritime search and rescue (SAR) task.

Background

Maritime SAR is a critical maritime occupation; however, the effect of wave motion intensity on worker performance is unknown.

Methods

Twenty-four participants (12 male, 12 female) performed a simulated search and rescue task on a six-degree-of-freedom motion platform in two conditions that differed in motion intensity (low and high). Task performance, electromyography (EMG), and number of compensatory steps taken by the individual were examined.

Results

As magnitude of simulated motion increased, performance in the SAR task decreased, and was accompanied by increases in lower limb muscle activation and number of steps taken.

Conclusions

Performance of an SAR task and balance control may be impeded by high-magnitude vessel motions.

Application

This research has the potential to be used by maritime engineers, occupational health and safety professionals, and ergonomists to improve worker safety and performance for SAR operators.
Entrepreneurs in diplomacy: Maratha expansion in the age of the vakil
Authors: O’Hanlon Rosalind
Published: September 2020

In eighteenth-century South Asia, ‘political’ vakils are familiar to us principally as diplomats, active in the inter-state negotiations of the period. They were unlike their predecessors, the īlchī and hejib of earlier centuries, who were associated with the service of courts and states. Maratha political vakils, like others, worked rather more as the mobile agents of individual rulers. Their activities extended far beyond the diplomatic arena. Since revenue rights were central to many inter-state negotiations, vakils often oversaw arrangements for local-level revenue collection. Frequently acting on behalf of several employers, they also had key roles in the remittance of cash, to meet the costs of their own establishments, to participate in the gift economy of the court, to pay the costs of local mercenaries, and to make down-payments for revenue farms on behalf of their employers. Drawing on support of their own extended families, for whom vakil service was often a profession that extended over several generations and regions, many political vakils combined mobility with deep connections to local economies and societies, sharing some characteristics of the ‘portfolio capitalism’ of the eighteenth century. What distinguished them, though, was their access to subcontinent-wide networks of political intelligence, and their expertise in the ‘soft skills’ of negotiation and persuasion, which further enabled them to exploit local social networks and political institutions. Colonial reforms of the late eighteenth century broke this flexible and entrepreneurial service role apart, dissipating it within the lower levels of colonial bureaucracy. The old figure of the political vakil disappeared, to be replaced by the semi-professional ‘native pleader’ in courts of law, and by ‘munshi’ assistants and translators to the Residents of the princely states within the uncovenanted civil service.
Exploring factors influencing social workers’ attitudes toward evidence-based practice: A Chinese study
Authors: Kim Minseop
Published: September 2020

Despite the growing emphasis on evidence-based practice (EBP), Chinese social workers’ adoption of EBP has been slow and limited, due partly to the fact that they often hold negative attitudes toward EBP. This study examined factors that account for these negative attitudes, using data collected from social workers in Hong Kong. Regression revealed that females, those less experienced, and social workers in non-governmental organizations endorsed more positive attitudes toward EBP, while those providing youth services had less favorable attitudes. Recent initiatives to promote Chinese social workers’ adoption of EBP will be more successful if they target those groups having less favorable attitudes.
Navigating the territories of transition: An exploration of the experiences of transnational social workers in Aotearoa New Zealand
Authors: Peter Shajimon , Beddoe Liz , Bartley Allen
Published: September 2020

This qualitative study conducted three focus groups with transnational social workers (TSWs) in three cities of Aotearoa New Zealand. The aim of the study was to examine the transitional experience of TSWs, particularly in relation to any strategies and mechanisms existing in the host country to facilitate their personal and professional transition. A significant finding is that a coherent profession-wide programme for facilitating the transition is absent as the existing practices are mostly within the employer–employee relationships. Transitional experiences of TSWs are explained using the metaphor of ‘territory’ and some strategies for effective transition are suggested.
Analysis of crush-damaged carbon-fiber-reinforced-polymer (CFRP) composites with optimization-assisted post-peak-stress modeling
Authors: Dong Sheng , Gräning Lars , Carney Kelly , Sheldon Allen
Published: September 2020

In the presented effort, layered CFRP composites samples with differing thicknesses and cross-sections are manufactured and crushed under quasi-static loading conditions. Simulation of the crushes are conducted using traditional continuum mechanics damage models. Parameters are proposed to represent the post peak-stress material behavior including the residual strengths of the fiber and matrix, as well the ultimate strain for deletion of composite elements. This paper presents a systematic approach to identify optimal values for these post peak-stress parameters based on a methodology incorporating CAE models and numerical optimization. An adaptive meta-model based global optimization strategy, with the objective of matching the force-time characteristics of multiple crush experiments simultaneously, has been established to quantify the values of the CFRP’s post peak-stress degradation and erosion material model parameters through calibration. Using two separate test configurations for optimization, a set of values for those parameters are determined. This parameter set is shown to successfully predict the response of additional test cases, including matching of force-displacement curves and crushing modes. The resulting composite crush simulations show a good quantitative as well as qualitative agreement between simulations and experiments to a degree that is difficult to be achieved solely with previous engineering practice.
Optical measurement of voids in situ during infusion of carbon reinforcements
Authors: Lystrup C , George A , Zobell B , Boster K , Childs C , Girod H , Fullwood D
Published: September 2020

Liquid composite molding (LCM) is growing in importance as an alternative to traditional prepreg-autoclave methods for manufacture high-performance composites. The most significant roadblock to industry’s implementation of LCM is the usually higher void content compared with prepreg processing. One tool for reducing void levels in LCM involves optimization of flow velocity, which requires models to be developed to describe void formation at a given velocity. To help solve this problem, the following research illustrates the first known method for optical void measurement in situ during infusion in a carbon fiber reinforcement. Similar to previous studies on glass fiber, this work utilizes fluorescent dye and a digital camera to produce sufficient contrast and resolution for image analysis. Visible bubbles are photographed against the opaque carbon fiber background. An automated method of image analysis is outlined, which was used to analyze 230 images for three different flow orientations of a single fabric, producing the highest amount of experimental data seen so far on in situ void measurement. The resulting data identifies a minimum velocity threshold for minimal macro-void formation. The resultant void characterization framework will better enable optimization of LCM processing for high-performance composites based on carbon reinforcements.
Why No Justice for Past Repression? Militaries and Human Rights Organizations in Post-Authoritarian States
Authors: Edwards Pearce
Published: September 2020

Do human rights organizations (HROs) aid the consolidation of democracy in post-authoritarian states? It is often argued that these groups contribute to accountability for past repression. Yet HROs can have unintended consequences if they threaten the interests of powerful domestic institutions. This paper develops a simple model of human rights activism in post-authoritarian states. Civilian governments in these states trade off support from the military and human rights activists which seek to punish the military. Counterintuitively, the model predicts human rights activists make amnesty for the military more likely, as activists tempt the government to punish the military and the military becomes more likely to intervene in politics. The model’s implications are tested using a sample of post-authoritarian states from 1970-2010. Results show that more HRO influence increases the likelihood of amnesty laws and military involvement in government, though HROs may achieve justice through pathways such as truth commissions.
A Grounded Theory on the Comprehension Processing of Teachers as ESL Readers of Multimodal Still Visuals
Authors: Bautista Judy Cañero , Gutierrez Merry Ruth Morauda
Published: September 2020

Contemporary society demands from individuals new and relevant literacies that go beyond the basics of reading and writing. Furthermore, texts now appear less confined to a single semiotic resource. The proliferation of different forms of communication like visuals, among others, encourages people to use literacy in multiple modalities. Nevertheless, not all individuals are capable of understanding and producing information in modalities other than the usual linguistic texts, and teachers are not exempt in this phenomenon. Ironically, school curricula burden teachers with the demand to develop visually literate learners even though most teachers themselves were not formally trained for visual literacy and visual grammar. Consequently, this study sought to identify and describe the processing strategies and the sources of information that teachers, as ESL readers, deliberately use when they make sense from multimodal still visuals. The think-aloud method, as an introspective procedure, was used to collect, analyze, and code 42 sets of verbal protocols from 14 teacher-respondents who read three different multimodal still visuals in three sectional rounds. Results reveal four integrated categories or themes of comprehension processes that teachers used when making sense of the visual stimuli. These are (a) anticipation or preparation; (b) sampling; (c) deepening; and (d) regulation. As regards to the sources of information they use in building meaning, a dismal number of verbal protocols manifest that the majority of the teachers do not use all the elements of the visual grammar and they lack the ability to integrate reader-based, text-based, and context-based sources of information in order to establish a closer match between their meaning and the intended meaning of the multimodal still visuals. Ultimately, the paper provides a theoretical model which can serve as basis for teacher development with regard to visual literacy in an ESL context and offers future directions in multimodal language learning and teaching.
Characterization of the airflow field in the rotor spinning unit based on a novel experimental approach and numerical simulation
Authors: Shi Qianqian , Akankwasa Nicholus Tayari , Zhang Yuze , Wang Jiang , Wang Jun , Lin Huiting
Published: September 2020

It is very challenging to experimentally characterize and verify the airflow in the rotor spinning machine because the process takes place in an enclosure. In an attempt to portray the process, we present a methodology that combines a novel experimental approach and numerical techniques. We developed a model unit and used colored smoke to mimic the airflow behavior practically, measured the air pressure, and compared the results to the simulation data. Three state conditions, namely suction and rotation (the regular rotor spinning operation, (Case 1)), without rotation (Case 2), and without suction (Case 3), were adopted to investigate the formation mechanism of the airflow field in the rotor spinning unit based on two operating conditions. Results show that, in a regular state, the airstream accelerates rapidly in the transfer channel under the dominant action of air suction at the rotor outlet and crashes clockwise to the rotor wall with the joint action of two operating conditions. In the rotor, the airflow flows clockwise with the velocity distribution of a multi-ring gradient due to the dominant action of high-speed rotor rotation. Analytics from the air pressure indicate that while the air pressure in the rotor is mainly controlled by the action of the air suction mechanism, it is also affected by the superposition action of the rotation mechanism. This approach is groundbreaking for rotor spinning machine optimization and is anticipated to trigger more insights that will lead to fundamental research in the spinning industry and beyond.
Career Assistance From Psychology Programs and Career Services: Who Is Preparing Psychology Students?
Authors: Conroy Jessica C. , Stamm Karen E. , Pfund Rory A. , Christidis Peggy , Hailstorks Robin , Norcross John C.
Published: September 2020

Background:

Despite the popularity of the undergraduate psychology major, little is known about career support and preparation available to psychology students.

Objective:

This study examined the prevalence, types, and methods of career assistance available to undergraduate psychology students both through their psychology programs and through their institutional career services.

Method:

A total of 240 programs from a stratified random sample of institutions offering undergraduate psychology programs responded to an online survey, yielding a response rate of 42.5%.

Results:

Undergraduate psychology programs most often provided assistance in applying to graduate school, while career services provided a wider range of resources. Baccalaureate institutions offer career assistance, via the psychology program or the institutional career center, more frequently than associate institutions. Most common forms of assistance consisted of instruction on how to apply for a job, how to find information about career possibilities in psychology subfields, resumé or curriculum vitae preparation, and individual advising.

Conclusion:

Although career assistance was widely available, there are several ways in which the type and scope of assistance can be improved upon to better support students and increase access.

Teaching implications:

Undergraduate psychology students could benefit from more career assistance content throughout psychology curricula.
Communicative Participation and Quality of Life in Pretreatment Oral and Oropharyngeal Head and Neck Cancer
Authors: Sauder Cara , Kapsner‐Smith Mara , Baylor Carolyn , Yorkston Kathryn , Futran Neal , Eadie Tanya
Published: September 2020

Objective

To determine how communicative participation is affected in patients with oral and oropharyngeal head and neck cancers (HNCs) pretreatment and whether communication function predicts HNC‐specific quality of life (QOL) before treatment, beyond known demographic, medical, psychosocial, and swallowing predictors.

Study Design

Cross‐sectional study.

Setting

Tertiary care academic medical center.

Methods

Eighty‐seven patients with primary oral (40.2%) or oropharyngeal (59.8%) HNC were recruited prior to treatment. T stage, tumor site, and p16 status were extracted from medical records. Demographic and patient‐reported measures were obtained. Communicative participation was measured using the Communicative Participation Item Bank (CPIB) General short form. A hierarchical regression analysis included demographic, medical, psychosocial, and functional measures of swallowing and communication as predictors; the University of Washington Quality of Life (UW‐QOL v4) composite score was the predicted variable.

Results

Median (SD) baseline CPIB scores were 71.0 (11.83); patients with oral cancers reported worse scores. A final sequential hierarchical regression model that included all variables explained 71% of variance in QOL scores. Tumor site, T stage, and p16 status accounted for 28% of variance (P <. 001). Perceived depression predicted an additional 28% of the variance (P <. 001). Swallowing and communicative participation together predicted an additional 12% of variance (P =. 005). Tumor site, perceived depression, swallowing, and communication measures were unique predictors in the final model. Finally, communicative participation uniquely predicted QOL, above and beyond other predictors.

Conclusion

Pretreatment communication predicted QOL and was negatively affected in some oral and oropharyngeal patients with HNC.
The Gender Gap: Looking at the Entire Distribution
Authors: Farja Yanay , Tillman Avi , Zax Ori
Published: September 2020

We propose a new method of estimating wage differences among individuals from different populations, which is based on looking at the distribution of fixed effects from a wage regression. We use this method to compare males’ and females’ wage distribution at different levels of education and at different ages. In most cases, unobserved, time-constant factors increase the wage of males, compared to that of females, by a constant share. But this is not true when looking at the tails of the distribution. We also discuss the advantages of our method.

JEL: J71, J31
L2 transfer of L1 island-insensitivity: The case of Norwegian
Authors: Kush Dave , Dahl Anne
Published: September 2020

Norwegian allows filler-gap dependencies into embedded questions, which are islands for filler-gap dependency formation in English. We ask whether there is evidence that Norwegian learners of English transfer the functional structure that permits island violations from their first language (L1) to their second language (L2). In two acceptability judgment studies, we find that Norwegians are more likely to accept ‘island-violating’ filler-gap dependencies in L2 English if the corresponding filler-gap dependency is acceptable in Norwegian: Norwegian learners variably accept English sentences with dependencies into embedded questions, but not into subject phrases. These results are consistent with models that permit transfer of abstract functional structure. Norwegians are still less likely to accept filler-gap dependencies into English embedded questions than Norwegian embedded questions. We interpret the latter finding as evidence that, despite transfer, Norwegian speakers may partially restructure their L2 English analysis. We discuss how indirect positive evidence may play a role in helping learners restructure.
A therapeutic concept to resolve a possible coronary desaturation under Ecpella support and maximize the potential for myocardial recovery: combination of veno-arteriovenous extracorporeal membrane oxygenation and Impella (VAVEcpella)
Authors: Ushijima Tomoki , Sonoda Hiromichi , Tanoue Yoshihisa , Shiose Akira
Published: September 2020

Introduction:

Ecpella, a combination of veno-arterial (V-A) extracorporeal membrane oxygenation (ECMO) and Impella, may result in the differential hypoxia in patients with cardiogenic shock and severe lung dysfunction. Here, we report a solution of this Ecpella-induced unfavorable phenomenon.

Case report:

A 70-year-old man developed cardiogenic shock from fulminant myocarditis. As we established Ecpella but immediately significant differential hypoxia became apparent, the ECMO configuration was switched from V-A to veno-arteriovenous (V-AV): a combination of V-AV ECMO and Impella, newly termed VAVEcpella, was instituted. The differential hypoxia resolved, and he was successfully weaned from mechanical circulatory support.

Discussion and conclusion:

VAVEcpella is an effective configuration to resolve Ecpella-induced differential hypoxia and may contribute to restoration of normal cardiac function.
A randomized clinical trial of the effects of saphenous and perforating veins radiofrequency ablation on venous ulcer healing (VUERT trial)
Authors: Puggina Juliana , Sincos Igor Rafael , Campos Walter , Porta Rina Maria P , dos Santos Jorgete Barreto , De Luccia Nelson , Puech-Leão Pedro , Collares Felipe Birchal , da Silva Erasmo Simão
Published: September 2020

Objectives

To investigate whether radiofrequency endovenous ablation (RFA) of saphenous and perforating veins increases venous leg ulcer (VLU) healing rates and prevents ulcer recurrence.

Method

This prospective, open-label, randomized, controlled, single-center trial recruited 56 patients with VLU divided into: compression alone (CR, N = 29) and RFA plus compression (RF, N = 27). Primary endpoints were ulcer recurrence rate at 12 months; and ulcer healing rates at 6, 12, and 24 weeks. Secondary endpoints were ulcer healing velocity; and Venous Clinical Severity Score (VCSS).

Results

Recurrence was lower in the RF group (p < .001), as well as mean VCSS after treatment (p = .001). There were no significant between-group differences in healing rates. Healing velocity was faster in the RF group (p = 0.049). In the RF group, 2 participants had type 1 endovenous heat-induced thrombosis (EHIT).

Conclusions

RFA plus compression is an excellent treatment for VLU because of its safety, effectiveness, and impact on ulcer recurrence reduction and clinical outcome. Registration: Clinicaltrials.gov, NCT03293836, clinicaltrials.gov.
The diagnostic value of multi-detector CT angiography for catheter-related central venous stenosis in hemodialysis patients
Authors: Zhao Yuliang , Yang Letian , Wang Yating , Zhang Huawei , Cui Tianlei , Fu Ping
Published: September 2020

The objective is to compare Multi-detector CT angiography (MDCTA) and digital subtraction angiography (DSA) in diagnosing hemodialysis catheter related-central venous stenosis (CVS). During a period of 6 years, hemodialysis patients with suspected catheter related-CVS who received both MDCTA and DSA were retrospectively enrolled. We analyzed the sensitivity, specificity, accuracy, Cohen’s kappa coefficient (κ) and other diagnostic parameters for MDCTA compared to DSA. A total of 1533 vascular segments in 219 patients were analyzed. Among the 280 lesions identified by DSA, 156 were correctly identified by MDCTA. There were 124 false negative and 41 false positive diagnoses. MDCTA had a high specificity (96.73%) but a low sensitivity (55.71%), with a moderate inter-test agreement (κ = 0.5930). In stratified analyses of vascular segments, the specificities of MDCTA were 89.93% (superior vena cava), 98.95% (left brachiocephalic vein), 95.33% (right brachiocephalic vein), 99.53% (left subclavian vein), 97.61% (right subclavian vein), 97.13% (left internal jugular vein), and 95.86% (right internal jugular vein), while the sensitivities were 90.00%, 65.52%, 66.67%, 87.50%, 40.00%, 20.00% and 8.11%, respectively. Good to excellent inter-test agreement was observed for the superior vena cava (κ = 0.7870), left brachiocephalic vein (κ = 0.7300), right brachiocephalic vein (κ = 0.6610), and left subclavian vein (κ = 0.8700) compared with poor to low agreement for the right subclavian vein (κ = 0.3950), left internal jugular vein (κ = 0.1890), and right internal jugular vein (κ = 0.0500). MDCTA had a high specificity in diagnosing hemodialysis catheter related-CVS. Its sensitivity varied by central venous segments, with better performance in superior vena cava and brachiocephalic veins.
Education needed to improve antimicrobial use during end-of-life care of older adults with advanced cancer: A cross-sectional survey
Authors: Datta Rupak , Topal Jeffrey , McManus Dayna , Sanft Tara , Dembry Louise Marie , Morrison Laura J , Quagliarello Vincent , Juthani-Mehta Manisha
Published: September 2020

Background:

Antimicrobial use during end-of-life care of older adults with advanced cancer is prevalent. Factors influencing the decision to prescribe antimicrobials during end-of-life care are not well defined.

Aim:

To evaluate factors influencing medicine subspecialists to prescribe intravenous and oral antimicrobials during end-of-life care of older adults with advanced cancer to guide an educational intervention.

Design:

18-item single-center cross-sectional survey.

Setting/participants:

Inpatient medicine subspecialists in 2018.

Results:

Of 186 subspecialists surveyed, 67 (36%) responded. Most considered withholding antimicrobials at the time of clinical deterioration during hospitalization ( n = 54/67, 81%), viewed the initiation of additional intravenous antimicrobials as escalation of care ( n = 44/67, 66%), and believed decision-making should involve patients or surrogates and providers ( n = 64/67, 96%). Fifty-one percent ( n = 30/59) of respondents who conducted advance care planning did not discuss antimicrobials. Barriers to discussing end-of-life antimicrobials included the potential to overwhelm patients or families, challenges of withdrawing antimicrobials, and insufficient training.

Conclusions:

Although the initiation of additional intravenous antimicrobials was viewed as escalation of care, antimicrobials were not routinely discussed during advance care planning. Educational interventions that promote recognition of antimicrobial-associated adverse events, incorporate antimicrobial use into advance care plans, and offer communication simulation training around the role of antimicrobials during end-of-life care are warranted.
Systematic Review and Meta-Analysis of Classroom-Wide Social–Emotional Interventions for Preschool Children
Authors: Luo Li , Reichow Brian , Snyder Patricia , Harrington Jennifer , Polignano Joy
Published: September 2020

All children benefit from intentional interactions and instruction to become socially and emotionally competent. Over the past 30 years, evidence-based intervention tactics and strategies have been integrated to establish comprehensive, multitiered, or hierarchical systems of support frameworks to guide social–emotional interventions for young children. In this study, the authors reviewed systematically the efficacy of classroom-wide social–emotional interventions for improving the social, emotional, and behavioral outcomes of preschool children and used meta-analytic techniques to identify critical study characteristics associated with obtained effect sizes. Four electronic databases (i.e., Academic Search Premier, Educational Resource Information Center, PsycINFO, and Education Full Text) were systematically searched in December 2015 and updated in January 2018. “Snowball methods” were used to locate additional relevant studies. Effect size estimates were pooled using random-effects meta-analyses for three child outcomes, and moderator analyses were conducted. Thirty-nine studies involving 10,646 child participants met the inclusion criteria and were included in this systematic review, with 33 studies included in the meta-analyses. Random-effects meta-analyses showed (a) improvements in social competence and emotional competence, and (b) decreases in challenging behavior. For social competence and challenging behavior, moderator analyses suggested interventions with a family component had statistically significant and larger effect sizes than those without a family component. Studies in which classroom teachers served as the intervention agent produced statistically significant but smaller effect sizes than when researchers or others implemented the intervention for challenging behavior. This systematic review and meta-analysis support using comprehensive social–emotional interventions for all children in a preschool classroom to improve their social–emotional competence and reduce challenging behavior.
Regression to the tail: Why the Olympics blow up
Authors: Flyvbjerg Bent , Budzier Alexander , Lunn Daniel
Published: September 2020

The Olympic Games are the largest, highest-profile, and most expensive megaevent hosted by cities and nations. Average sports-related costs of hosting are $12.0 billion. Non-sports-related costs are typically several times that. Every Olympics since 1960 has run over budget, at an average of 172 percent in real terms, the highest overrun on record for any type of megaproject. The paper tests theoretical statistical distributions against empirical data for the costs of the Games, in order to explain the cost risks faced by host cities and nations. It is documented, for the first time, that cost and cost overrun for the Games follow a power-law distribution. Olympic costs are subject to infinite mean and variance, with dire consequences for predictability and planning. We name this phenomenon "regression to the tail": it is only a matter of time until a new extreme event occurs, with an overrun larger than the largest so far, and thus more disruptive and less plannable. The generative mechanism for the Olympic power law is identified as strong convexity prompted by six causal drivers: irreversibility, fixed deadlines, the Blank Check Syndrome, tight coupling, long planning horizons, and an Eternal Beginner Syndrome. The power law explains why the Games are so difficult to plan and manage successfully, and why cities and nations should think twice before hosting. Based on the power law, two heuristics are identified for better decision making on hosting. Finally, the paper develops measures for good practice in planning and managing the Games, including how to mitigate the extreme risks of the Olympic power law.
Fast Starters and Slow Starters After Hip Arthroscopy for Femoroacetabular Impingement: Correlation of Early Postoperative Pain and 2-Year Outcomes
Authors: Nguyen Thu Quynh , Friedman James M. , Flores Sergio E. , Zhang Alan L.
Published: September 2020

Background:

Patients experience varying degrees of pain and symptoms during the early recovery period after hip arthroscopy for femoroacetabular impingement (FAI). Some “fast starters” report minimal discomfort and are eager to advance activities, while “slow starters” describe severe pain and limitations. The relationship between these early postoperative symptoms and 2-year outcomes after hip arthroscopy is unknown.

Purpose:

To analyze the relationship between early postoperative pain and 2-year patient-reported outcomes (PROs) after hip arthroscopy for FAI.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

Patients without arthritis or dysplasia who were undergoing primary hip arthroscopy for FAI were prospectively enrolled and completed validated PROs. Scores for visual analog scale (VAS) for pain were collected preoperatively and at 1 week, 6 weeks, and 2 years postoperatively. Scores for the modified Harris Hip Score (mHHS), Hip disability and Osteoarthritis Outcome Score (HOOS), and 12-Item Short Form Health Survey (SF-12) were collected preoperatively and 2 years postoperatively. Paired t tests were used to evaluate PRO score changes, and correlation analyses were used to assess relationships between early postoperative pain and 2-year postoperative outcomes.

Results:

A total of 166 patients were included (55% female; mean ± SD age, 35.29 ± 9.6 years; mean body mass index, 25.07 ± 3.98 kg/m2). Patients demonstrated significant improvements in PRO scores (VAS, SF-12 Physical Component Score, mHHS, and all HOOS subscales) at 2 years after hip arthroscopy for FAI ( P < .001). There was a significant correlation between lower 1-week VAS pain level (fast starters) and lower 2-year VAS pain level ( R = 0.31; P < .001) as well as higher 2-year PRO scores (SF-12 Physical Component Score, mHHS, and all HOOS subscales: R = −0.21 to −0.3; P < .001). There was no correlation between 1-week VAS pain and 2-year SF-12 Mental Component Score ( P = .17). Preoperative VAS pain levels showed positive correlations with 1-week postoperative pain scores ( R = 0.39; P < .001) and negative correlations with 2-year patient outcomes ( R = −0.15 to −0.33, P < .01). There was no correlation between 6-week postoperative pain scores and 2-year PRO scores.

Conclusion:

Fast starters after hip arthroscopy for FAI experience sustained improvements in outcomes at 2 years after surgery. Patient pain levels before surgery may delineate potential fast starters and slow starters.
Psychiatric Disability in Ontario
Authors: Goering Paula , Lin Elizabeth , Campbell Dugal , Boyle Michael H , Offord David R
Published: September 2020

Objective

To describe the disability associated with psychiatric disorder in a community sample in order to refine estimates of service need and identify subgroups with greater priority for intervention.

Method

Disability is conceptualized broadly as performance difficulties, troubled relationships, and dissatisfaction in various life domains. Data from the Mental Health Supplement are used to compare disability between those with and without disorder and among various subtypes of disorder.

Results

Although the majority of those with disorder do not report disability, their difficulties with functioning are far greater than for the rest of the population. Those with comorbid or affective disorders typically have more disability than those with anxiety or substance abuse disorders.

Conclusions

Society needs to recognize the high human and economic costs associated with the prevalence of psychiatric disorder. Assessments of service need and decisions about priorities should take both disorder and disability into consideration.
Review of material test standardization status for the material qualification of laminated thermosetting composite structures
Authors: Yoon Park Sang , Jong Choi Won
Published: September 2020

This paper presents a review of recent literature related to the static mechanical testing of thermoset-based carbon fiber reinforced composites and introduces a material qualification methodology to generate statistically-based allowable design values for aerospace application. Although most test methods have been found to be effective in determining the specific material properties by incorporating them into the material qualification and quality control provisions, a full validation to clarify the behavior of thermoset-based laminated composite materials is currently lacking, particularly with regard to the characterization of compressive, in-plane, interlaminar shear, and damage tolerance properties. The present study obtains information on the different types of test method that can be employed within the same material properties, and makes an in-depth experimental comparison based on the past literatures. A discussion on the scope of theoretical analysis involves a description of how the proposed test method can be adequate for obtaining more accurate material properties. This discussion is directly applicable to the assessment of material nonlinearity and the geometrical effect of specimens. Finally, the resulting failure modes and the effect of each material property are studied to aid the understanding of the load distribution and behavior of laminated composite materials.
Boricua Founder Variant in FRRS1L Causes Epileptic Encephalopathy With Hyperkinetic Movements
Authors: Abdelmoumen Imane , Jimenez Sandra , Valencia Ignacio , Melvin Joseph , Legido Agustin , Diaz-Diaz Mayela M. , Griffith Christopher , Massingham Lauren J. , Yelton Melissa , Rodríguez-Hernández Janice , Schnur Rhonda E. , Walsh Laurence E. , Cristancho Ana G. , Bergqvist Christina A. , McWalter Kirsty , Mathieson Iain , Belbin Gillian M. , Kenny Eimear E. , Ortiz-Gonzalez Xilma R. , Schneider Michael C.
Published: September 2020

Objective:

To describe a founder mutation effect and the clinical phenotype of homozygous FRRS1L c.737_739delGAG (p.Gly246del) variant in 15 children of Puerto Rican (Boricua) ancestry presenting with early infantile epileptic encephalopathy (EIEE-37) with prominent movement disorder.

Background:

EIEE-37 is caused by biallelic loss of function variants in the FRRS1L gene, which is critical for AMPA-receptor function, resulting in intractable epilepsy and dyskinesia.

Methods:

A retrospective, multicenter chart review of patients sharing the same homozygous FRRS1L (p.Gly246del) pathogenic variant identified by clinical genetic testing. Clinical information was collected regarding neurodevelopmental outcomes, neuroimaging, electrographic features and clinical response to antiseizure medications.

Results:

Fifteen patients from 12 different families of Puerto Rican ancestry were homozygous for the FRRS1L (p.Gly246del) pathogenic variant, with ages ranging from 1 to 25 years. The onset of seizures was from 6 to 24 months. All had hypotonia, severe global developmental delay, and most had hyperkinetic involuntary movements. Developmental regression during the first year of life was common (86%). Electroencephalogram showed hypsarrhythmia in 66% (10/15), with many older children evolving into Lennox-Gastaut syndrome. Six patients demonstrated progressive volume loss and/or cerebellar atrophy on brain magnetic resonance imaging (MRI).

Conclusions:

We describe the largest cohort to date of patients with epileptic encephalopathy. We estimate that 0.76% of unaffected individuals of Puerto Rican ancestry carry this pathogenic variant due to a founder effect. Children homozygous for the FRRS1L (p.Gly246del) Boricua variant exhibit a very homogenous phenotype of early developmental regression and epilepsy, starting with infantile spasms and evolving into Lennox-Gastaut syndrome with hyperkinetic movement disorder.