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Schmidt-hammer exposure-age dating (SHD) of boulders on cryoplanation terrace treads and associated bedrock cliff faces revealed Holocene ages ranging from 0 ± 825 to 8890 ± 1185 yr. The cliffs were significantly younger than the inner treads, which tended to be younger than the outer treads. Radiocarbon dates from the regolith of 3854 to 4821 cal yr BP (2σ range) indicated maximum rates of cliff recession of ~0.1 mm/yr, which suggests the onset of terrace formation before the last glacial maximum. Age, angularity, and size of clasts, together with planation across bedrock structures and the seepage of groundwater from the cliff foot, all support a process-based conceptual model of cryoplanation terrace development in which frost weathering leads to parallel cliff recession and, hence, terrace extension. The availability of groundwater during autumn freezeback is viewed as critical for frost wedging and/or the growth of segregation ice during prolonged winter frost penetration. Permafrost promotes cryoplanation by providing an impermeable frost table beneath the active layer, focusing groundwater flow, and supplying water for sediment transport by solifluction across the tread. Snow beds are considered an effect rather than a cause of cryoplanation terraces, and cryoplanation is seen as distinct from nivation.
The current study examined whether self-reported memory problems among cognitively intact older adults changed concurrently with, preceded, or followed depressive symptoms over time.
Data were collected annually via in-person comprehensive medical and neuropsychological examinations as part of the Einstein Aging Study.
Community-dwelling older adults in an urban, multi-ethnic area of New York City were interviewed.
The current study included a total of 1,162 older adults (Mage = 77.65, SD = 5.03, 63.39% female; 74.12% White). Data were utilized from up to 11 annual waves per participant.
Multilevel modeling tested concurrent and lagged associations between three types of memory self-report (frequency of memory problems, perceived one-year decline, and perceived ten-year decline) and depressive symptoms.
Results showed that self-reported frequency of memory problems covaried with depressive symptoms only in participants who were older at baseline. Changes in perceived one-year and ten-year memory decline were related to changes in depressive symptoms across all ages. Depressive symptoms increased the likelihood of perceived ten-year memory decline the next year; however, perceived ten-year memory decline did not predict future depressive symptoms. Additionally, no significant temporal relationship was observed between depressive symptoms and self-reported frequency of memory problems or perceived one-year memory decline.
Our findings highlight the importance of testing the unique associations of different types of self-reported memory problems with depressive symptoms.
This study identified underlying career orientation types of clinical research coordinators (CRCs) using cluster analysis. Select career (satisfaction, engagement, and planning) and competency-related (perceived competence) information was used to identify four distinct career orientation types.
A web-based survey was administered to CRCs employed in one of four research institutions affiliated with a National Institutes of Health-funded Clinical and Translational Research Award (CTSA) in the southeastern USA. Each respondent completed a survey containing questions about personal background, individual attributes, perceived professional competence, and career orientation.
The first CRC type (35.2%) possessed a positive, knowledge-seeking orientation, characterized by high career-related scores but a conservative assessment of perceived competence. The second CRC type (18.6%) represented an optimistic and confident career orientation reflected in moderate to high scores on each of the four identifying factors. The third CRC type (27.6%) reflected an inconsistent career orientation highlighted by lowered perceived competence. The final CRC type (18.6%) reflected a disengaged orientation characterized by negative responses to all career and competence factors.
Understanding the career orientation of CRCs can be helpful to institutional administrators and clinical investigators as they seek to support the professional development of CRCs through tailored training efforts or work-related supports. Knowledge of career orientation may also inform individual CRCs as they manage their personal career paths by assessing current levels of functioning, career-related strengths or weaknesses, and training needs.
Introduction: Variation in image ordering exists across Alberta emergency departments (EDs). Evidence-based, pocket-sized knowledge dissemination tools were developed for two conditions (acute asthma [AA] and benign headache [BHA]) for which imaging (chest x-ray [CXR] and computed tomography [CT], respectively) has limited utility. This study explored tool acceptability among ED patients and emergency physicians (EPs). Methods: Tool feedback was provided by EPs, via online survey, and adult patients with AA and BHA via in-person survey. EPs qualitative interviews further explored communication tools. Preliminary descriptive analyses of survey responses and content analysis of interview data were conducted. Results: Overall, 55 EPs (55/192; 29%) and 38 consecutive patients participated in the AA study; 73 EPs (73/192; 38%) and 160 patients participated in the BHA study. In both studies, approximately 50% of EPs felt comfortable using the tool; however, they suggested including radiation risk details and imaging indications and removing references to imaging variation and health system cost. In the BHA study, EPs opposed the four Choosing Wisely® campaign questions fearing they would increase imaging expectations. In both conditions, most patients ( >90%) understood the content and 68% felt the information applied to them. Less than half (AA:45%; BHA: 38%) agreed that they now knew more about when a patient should have imaging workup done. Following tool review, 71% of AA and 50% of BHA patients stated they would discuss their imaging needs with their ED care provider today or during a future presentation. Both patient groups suggested including: additional imaging details (i.e., indications, risk, clinical utility), removing imaging overuse references, and including instructions that encourage patients to ask their EP questions. EP interviews (n = 12) identified preferences for personalized and interactive tools. Tensions were perceived around ED time pressure as well as remuneration schemes that fail to prioritize patient conversation. Tool centralization, easy access, and connection with outpatient support were also key themes. Conclusion: Both patients and EPs provided valuable information on how to improve ED knowledge dissemination tools, using two chronic conditions to demonstrate how these changes would improve tool utility. Implementing these recommendations, and considering preferences of EPs and patients, may improve future tool uptake and impact.
The second year of life is a period of nutritional vulnerability. We aimed to investigate the dietary patterns and nutrient intakes from 1 to 2 years of age during the 12-month follow-up period of the Growing Up Milk – Lite (GUMLi) trial. The GUMLi trial was a multi-centre, double-blinded, randomised controlled trial of 160 healthy 1-year-old children in Auckland, New Zealand and Brisbane, Australia. Dietary intakes were collected at baseline, 3, 6, 9 and 12 months post-randomisation, using a validated FFQ. Dietary patterns were identified using principal component analysis of the frequency of food item consumption per d. The effect of the intervention on dietary patterns and intake of eleven nutrients over the duration of the trial were investigated using random effects mixed models. A total of three dietary patterns were identified at baseline: ‘junk/snack foods’, ‘healthy/guideline foods’ and ‘breast milk/formula’. A significant group difference was observed in ‘breast milk/formula’ dietary pattern z scores at 12 months post-randomisation, where those in the GUMLi group loaded more positively on this pattern, suggesting more frequent consumption of breast milk. No difference was seen in the other two dietary patterns. Significant intervention effects were seen on nutrient intake between the GUMLi (intervention) and cows’ milk (control) groups, with lower protein and vitamin B12, and higher Fe, vitamin D, vitamin C and Zn intake in the GUMLi (intervention) group. The consumption of GUMLi did not affect dietary patterns, however, GUMLi participants had lower protein intake and higher Fe, vitamins D and C and Zn intake at 2 years of age.
Soldier operational performance is determined by their fitness, nutritional status, quality of rest/recovery, and remaining injury/illness free. Understanding large fluctuations in nutritional status during operations is critical to safeguarding health and well-being. There are limited data world-wide describing the effect of extreme climate change on nutrient profiles. This study investigated the effect of hot-dry deployments on vitamin D status (assessed from 25-hydroxyvitamin D (25(OH)D) concentration) of young, male, military volunteers. Two data sets are presented (pilot study, n 37; main study, n 98), examining serum 25(OH)D concentrations before and during 6-month summer operational deployments to Afghanistan (March to October/November). Body mass, percentage of body fat, dietary intake and serum 25(OH)D concentrations were measured. In addition, parathyroid hormone (PTH), adjusted Ca and albumin concentrations were measured in the main study to better understand 25(OH)D fluctuations. Body mass and fat mass (FM) losses were greater for early (pre- to mid-) deployment compared with late (mid- to post-) deployment (P<0·05). Dietary intake was well-maintained despite high rates of energy expenditure. A pronounced increase in 25(OH)D was observed between pre- (March) and mid-deployment (June) (pilot study: 51 (sd 20) v. 212 (sd 85) nmol/l, P<0·05; main study: 55 (sd 22) v. 167 (sd 71) nmol/l, P<0·05) and remained elevated post-deployment (October/November). In contrast, PTH was highest pre-deployment, decreasing thereafter (main study: 4·45 (sd 2·20) v. 3·79 (sd 1·50) pmol/l, P<0·05). The typical seasonal cycling of vitamin D appeared exaggerated in this active male population undertaking an arduous summer deployment. Further research is warranted, where such large seasonal vitamin D fluctuations may be detrimental to bone health in the longer-term.
The objective of this study was to investigate the impact of the most commonly cited factors that may have influenced infants’ gut microbiota profiles at one year of age: mode of delivery, breastfeeding duration and antibiotic exposure. Barcoded V3/V4 amplicons of bacterial 16S-rRNA gene were prepared from the stool samples of 52 healthy 1-year-old Australian children and sequenced using the Illumina MiSeq platform. Following the quality checks, the data were processed using the Quantitative Insights Into Microbial Ecology pipeline and analysed using the Calypso package for microbiome data analysis. The stool microbiota profiles of children still breastfed were significantly different from that of children weaned earlier (P<0.05), independent of the age of solid food introduction. Among children still breastfed, Veillonella spp. abundance was higher. Children no longer breastfed possessed a more ‘mature’ microbiota, with notable increases of Firmicutes. The microbiota profiles of the children could not be differentiated by delivery mode or antibiotic exposure. Further analysis based on children’s feeding patterns found children who were breastfed alongside solid food had significantly different microbiota profiles compared to that of children who were receiving both breastmilk and formula milk alongside solid food. This study provided evidence that breastfeeding continues to influence gut microbial community even at late infancy when these children are also consuming table foods. At this age, any impacts from mode of delivery or antibiotic exposure did not appear to be discernible imprints on the microbial community profiles of these healthy children.
It gives me great pleasure and honour to provide the introductory message for this rather impressive volume on the Philippine economy. Authored by renowned Filipino scholars and serious observers of the Philippine economy, the volume is arguably the most comprehensive reference work on the economy since at least the global financial crisis in 2008–9 and will likely shape the thinking and practice of Philippine development policy in the years ahead.
This volume had its beginning, albeit accidental, during my stint as Socioeconomic Planning Secretary and, concurrently, Director- General of the National Economic and Development Authority under the administration of President Benigno S. Aquino III. At that time, in early 2014, I got hold of the ADB Report entitled Asia 2050: Realizing the Asian Century, and it caught my interest. The report talked about how Asia is in the middle of a historic transformation. To quote the report: “If it continues to follow its recent trajectory, by 2050 its per capita income could rise six-fold in purchasing power parity (PPP) terms to reach Europe's levels today. It would make some 3 billion additional Asians affluent by current standards. By nearly doubling its share of global gross domestic product (GDP) to 52 percent by 2050, Asia would regain the dominant economic position it held some 300 years ago, before the industrial revolution.”
It was an exciting prospect for Asia, except for the Philippines. In the Report, the Philippines was a slow- or modest-growth aspiring country, lumped in the same group as Afghanistan, Bangladesh, North Korea, Laos, Myanmar, Nepal, Pakistan, and many of the Pacific Island countries. Even the Report's epic video-production did not make any reference to or show any significant Philippine landmark. That was, of course, understandable, given the country's poor-growth record in the three decades before 2010, which was the report's database for its extrapolation of the future. In contrast, since at least 2010, the country's economic performance has been quite stellar, impressively even earning the title 'the rising tiger of Asia', among other accolades bestowed upon the Philippine economy by various global development observers, e.g., the World Bank and HSBC.
The Philippines has long been viewed as the “East Asian exception”. Although suffering massive wartime destruction, in the 1950s and 1960s its economic prospects were considered to be favourable. While very poor, its per capita income was somewhat higher than most of its neighbours. In the post-colonial era it neither closed off from the global economy — as China, Indonesia and Myanmar did — nor was it overwhelmed by the conflict that engulfed Indochina. Its civil society and polity appeared to be among the most robust in developing East Asia. And it retained close commercial and political ties with the undisputed global super power of that era, the United States. As a vote of confidence, Manila was selected to be the headquarters of the Asia Pacific's premier development finance institution, the Asian Development Bank, in 1966.
However, these early high expectations were not realized. From the late 1960s the Philippines increasingly parted company with its neighbours, as first the four Asian NIEs, then the ASEAN four (i.e., Indonesia, Malaysia, Thailand, together with Singapore) and, most important of all, China began to register exceptionally high rates of economic growth. By contrast, Philippine economic growth began to falter, especially from the late 1970s, and particularly during the country's deep economic and political crisis in the mid-1980s. The collapse of the two-decade Marcos rule in early 1986 was accompanied by the sharpest economic contraction in the country's economic history as an independent nation state. The economy was in free fall, with GDP declining by about 15 per cent in the years 1984'86 and poverty incidence rising sharply. Thereafter, a fragile political system was gradually constructed, punctuated by periodic political instability and extended debt negotiations. This was the country's lost decade, as most of East Asia boomed, fuelled by a newly dynamic China and the relocation of labour-intensive manufacturing from Northeast to Southeast Asia. At the turn of the century, Philippine per capita income (PCI) had not progressed beyond that achieved in 1980.
Comparative surveys of Asian economic development have highlighted, and puzzled over, the country's divergent economic path. A leading contributor to the literature on growth empirics speculated that the country was “a democratic dud” (Pritchett 2003).
In this volume, a leading group of scholars pose the question, has the Philippine economy rejoined the dynamic East Asian mainstream and, if so, what set of policies and priorities are required to maintain the strong economic momentum of recent years? Successive chapters address issues related to growth and poverty, infrastructure and urbanization, education, health, the environment, energy, development finance, and governance and institutions. This volume has been written with a broad audience in mind. First and foremost it is for readers in, and interested in, this fascinating and important country with a population that now exceeds 100 million people. Second, it will appeal to those in the broader development community with an interest in the analytical and policy challenges that democratic, middle-income countries face as they struggle to lift their citizens out of poverty and to achieve broad-based and environmentally sustainable growth.
Introduction: Unnecessary care is an increasingly commonly used term in medicine. Previous survey research suggests that definitions of unnecessary care vary within and among professional and patient groups. This research explores how emergency physicians and administrators understand the term unnecessary care. Methods: Site chiefs and emergency physicians in an Alberta region were recruited through email and online surveys respectively for a qualitative study. One hour one-on-one in-depth interviews explored understandings of unnecessary care within the emergency department (ED) context. Interview transcripts underwent thematic analysis. Results: Five physicians and seven site chiefs completed interviews. Two key themes emerged. First, interviewees conceptualized unnecessary care as inappropriate or non-urgent presentations. This patient-centric view raised non-urgent ED presentations as a health system problem with complex components, including: lack of public knowledge of healthcare resources, shrinking comfort and scope of community providers and patient willingness to utilize other resources. Despite concerns over non-urgent visits, interviewees expressed that these patients still need to be seen, assessed and managed. The second conceptualization focused on over-investigation (and to lesser extent, treatment). This physician-centric conceptualization identified issues around: variation in physician risk tolerance, established decision rules with the allowable miss rates, patient expectation for testing or physician feeling that the patient was owed something or that patient would not accept their diagnosis/treatment without testing. Additionally, interviewees described patient characteristics that may initiate more aggressive investigation (e.g., patient reliability, follow-up care access, etc.). An overarching concern about the connection between unnecessary care and wasted resources was identified. Additionally, interviewees emphasized that patient conversations are outside the scope of unnecessary care despite their possible implications for limited time resources. Conclusion: A range of concepts surrounding unnecessary care in the ED were identified. Further exploring nuances of these conceptualizations may inform and improve the effectiveness of campaigns seeking to improve efficiency in practice and reduce inappropriate care. Additionally, this work provides an impetus for developing clearer concepts of care within the ED.