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Echinoderms have evolved diverse and disparate morphologies throughout the Phanerozoic. Among them, blastozoans, an extinct group of echinoderms that were an important component of Paleozoic marine ecosystems, are primarily subdivided into groups based on the morphology of respiratory structures. However, systematic and phylogenetic research from the past few decades have shown that respiratory structures in blastozoans are not group-defining and they have re-evolved throughout echinoderm evolution. This Element provides a review of the research involving blastozoan respiratory structures, along with research concerning the morphology, paleoecology, and ontogeny of each of the major groupings of blastozoans as it relates to their corresponding respiratory structures. Areas of future research in these groups are also highlighted.
Pain following surgery for cardiac disease is ubiquitous, and optimal management is important. Despite this, there is large practice variation. To address this, the Paediatric Acute Care Cardiology Collaborative undertook the effort to create this clinical practice guideline.
A panel of experts consisting of paediatric cardiologists, advanced practice practitioners, pharmacists, a paediatric cardiothoracic surgeon, and a paediatric cardiac anaesthesiologist was convened. The literature was searched for relevant articles and Collaborative sites submitted centre-specific protocols for postoperative pain management. Using the modified Delphi technique, recommendations were generated and put through iterative Delphi rounds to achieve consensus
60 recommendations achieved consensus and are included in this guideline. They address guideline use, pain assessment, general considerations, preoperative considerations, intraoperative considerations, regional anaesthesia, opioids, opioid-sparing, non-opioid medications, non-pharmaceutical pain management, and discharge considerations.
Postoperative pain among children following cardiac surgery is currently an area of significant practice variability despite a large body of literature and the presence of centre-specific protocols. Central to the recommendations included in this guideline is the concept that ideal pain management begins with preoperative counselling and continues through to patient discharge. Overall, the quality of evidence supporting recommendations is low. There is ongoing need for research in this area, particularly in paediatric populations.
The growth of shareholder stewardship codes around the globe reflects a belief that greater engagement by institutional shareholders improves corporate decision-making and protects against excessive risk-taking. In theory, there is considerable sense in shareholders undertaking their stewardship activities collectively, to leverage their power, pool resources and share costs, making stewardship more feasible and less speculative. This chapter examines collective action in Australia, which constitutes a nuanced corporate governance practice. Evidence indicates that investors do not routinely engage in direct forms of collective action, preferring to leverage their collective influence through intermediary organizations that undertake behind-the-scenes engagement activities for investors. The nuanced image emerging from the Australian experience highlights that collective action by institutional shareholders is by no means a simple governance phenomenon. This chapter explores the implications of this insight for how securities and takeover laws apply to collective action, and how the issuers of stewardship codes frame their codes’ expectations regarding collective action.
This chapter focuses on current psychological approaches to drug and alcohol dependence, most notably learning theory and cognitive behavioural approaches. The role of motivation and readiness to change is discussed in some depth, due to its central place in initiating change, although it may be less important in sustaining change. The role of mental health factors both in instigating and sustaining addiction are explored and the question of how to tackle such comorbidity is discussed. Neuropsychological impediments most commonly evident in alcohol addiction are often either entirely neglected or mentioned only in passing when discussing psychological approaches. This is an important omission as the impact of mild-moderate impediments of executive functioning and memory clearly affect both initial learning, retention, recall and judgement. These areas are of crucial importance in terms of establishing self-regulation and monitoring and in terms of remembering to enact change. The critical role of relapse prevention in sustaining long-term change are then explored, before the chapter closes with some key pointers for those working in the field.
Business history and theory reflect a tension between public and private conceptions of the corporation. This is embodied in the famous Berle-Dodd debate, which provides the basis for contemporary clashes between “different visions of corporatism,” such as the conflict between shareholder primacy and stakeholder-centered versions of the corporation. This chapter examines a number of recent developments suggesting that the pendulum, which swung so clearly in favour of a private conception of the corporation from the 1980s onwards, is in the process of changing direction. The chapter provides two central insights. The first is that there is not one problem, but multiple problems in corporate law, and that different problems may come to the forefront at different times. The second insight is that corporate governance techniques (such as performance-based pay), which are designed to ameliorate one problem in corporate law, such as corporate performance, can at the same time exacerbate other problems involving the social impact of corporations.
Background: Tracheal aspirate bacterial cultures are routinely collected in mechanically ventilated children for the evaluation of ventilator-associated infections (VAIs). However, frequent bacterial colonization of endotracheal and tracheostomy tubes contribute to the marginal performance characteristics of the test for diagnosing VAI. Published literature characterizing drivers of culture collection and the predictive value of positive cultures are limited. Methods: This single-center, retrospective cohort study included children admitted to the pediatric intensive care unit who were receiving mechanical ventilation for at least 48 hours and had 1 or more semiquantitative tracheal aspirate cultures collected between September 1, 2019, and August 31, 2020. Indications for culture collection were determined through medical record review and included fever, hypothermia, tracheal secretion changes, radiographic pneumonia, increased oxygen requirement, and/or increased positive end-expiratory pressure (PEEP). A positive culture was defined as moderate or heavy growth of a noncommensal bacterial organism. A purulent Gram stain was defined as detection of moderate or many white blood cells. Diagnosis of VAI was based on treating-clinician documentation and was ascertained through medical record review. Logistic regression accounting for clustering by patient was performed to estimate the association between indications for culture collection and (1) culture positivity, (2) purulent Gram stain, and (3) diagnosis of VAI. Results: In total, 625 tracheal aspirate cultures were performed in 261 unique patients. Common indications for culture collection included isolated fever or hypothermia (n = 124, 20%), fever with an increase in oxygen requirement or PEEP (n = 71, 11%), isolated increase in oxygen requirement or PEEP (n = 67, 11%), or isolated secretion change (n = 54, 9%) (Figure 1). Overall, 230 cultures (37%) were positive and 218 (35%) Gram stains were purulent. There were no associations between culture indications and a positive culture. Presence of isolated fever was negatively associated with a purulent Gram stain (odds ratio [OR], 0.49; 95% CI, 0.30–0.81; P = .005); otherwise, there were no associations between indication and purulent Gram stain. Finally, in a multivariable model, odds of VAI diagnosis increased with both the number of indications for culture collection and purulent Gram stain, but not with positive culture (Figure 2). Conclusions: Number and type of clinical signs were not associated with tracheal aspirate culture positivity or purulence on Gram stain, but they were associated with a clinical diagnosis of VAI. These findings suggest that positive tracheal aspirate cultures may not aid clinicians in the diagnosis of VAI, and they highlight the opportunity for improved diagnostic stewardship.
Antisaccade tasks can be used to index cognitive control processes, e.g. attention, behavioral inhibition, working memory, and goal maintenance in people with brain disorders. Though diagnoses of schizophrenia (SZ), schizoaffective (SAD), and bipolar I with psychosis (BDP) are typically considered to be distinct entities, previous work shows patterns of cognitive deficits differing in degree, rather than in kind, across these syndromes.
Large samples of individuals with psychotic disorders were recruited through the Bipolar-Schizophrenia Network on Intermediate Phenotypes 2 (B-SNIP2) study. Anti- and pro-saccade task performances were evaluated in 189 people with SZ, 185 people with SAD, 96 people with BDP, and 279 healthy comparison participants. Logistic functions were fitted to each group's antisaccade speed-performance tradeoff patterns.
Psychosis groups had higher antisaccade error rates than the healthy group, with SZ and SAD participants committing 2 times as many errors, and BDP participants committing 1.5 times as many errors. Latencies on correctly performed antisaccade trials in SZ and SAD were longer than in healthy participants, although error trial latencies were preserved. Parameters of speed-performance tradeoff functions indicated that compared to the healthy group, SZ and SAD groups had optimal performance characterized by more errors, as well as less benefit from prolonged response latencies. Prosaccade metrics did not differ between groups.
With basic prosaccade mechanisms intact, the higher speed-performance tradeoff cost for antisaccade performance in psychosis cases indicates a deficit that is specific to the higher-order cognitive aspects of saccade generation.
Clinical trials are a fundamental tool in evaluating the safety and efficacy of new drugs, medical devices, and health system interventions. Clinical trial visits generally involve eligibility assessment, enrollment, intervention administration, data collection, and follow-up, with many of these steps performed during face-to-face visits between participants and the investigative team. Social distancing, which emerged as one of the mainstay strategies for reducing the spread of SARS-CoV-2, has presented a challenge to the traditional model of clinical trial conduct, causing many research teams to halt all in-person contacts except for life-saving research. Nonetheless, clinical research has continued during the pandemic because study teams adapted quickly, turning to virtual visits and other similar methods to complete critical research activities. The purpose of this special communication is to document this rapid transition to virtual methodologies at Clinical and Translational Science Awards hubs and highlight important considerations for future development. Looking beyond the pandemic, we envision that a hybrid approach, which implements remote activities when feasible but also maintains in-person activities as necessary, will be adopted more widely for clinical trials. There will always be a need for in-person aspects of clinical research, but future study designs will need to incorporate remote capabilities.
In Chapters 18 and 19, we introduced a statistical formalization of causal effects using potential outcomes, focusing on the estimation of average causal effects and interactions using data from controlled experiments. In practice, logistic, ethical, or financial constraints can make it difficult or impossible to externally assign treatments, and simple estimates of the treatment effect based on differences or regressions can be biased when selection into treatment and control group is not random. To estimate effects when there is imbalance and lack of overlap between treatment and control groups, you should include as regression predictors all the confounders that explain this selection. The present chapter discusses methods for causal inference in the presence of systematic pre-treatment differences between treatment and control groups. A key difficulty is that there can be many pre-treatment variables with mismatch, hence the need for adjustment on many variables.
Most textbooks on regression focus on theory and the simplest of examples. Real statistical problems, however, are complex and subtle. This is not a book about the theory of regression. It is about using regression to solve real problems of comparison, estimation, prediction, and causal inference. Unlike other books, it focuses on practical issues such as sample size and missing data and a wide range of goals and techniques. It jumps right in to methods and computer code you can use immediately. Real examples, real stories from the authors' experience demonstrate what regression can do and its limitations, with practical advice for understanding assumptions and implementing methods for experiments and observational studies. They make a smooth transition to logistic regression and GLM. The emphasis is on computation in R and Stan rather than derivations, with code available online. Graphics and presentation aid understanding of the models and model fitting.
Statistical inference can be formulated as a set of operations on data that yield estimates and uncertainty statements about predictions and parameters of some underlying process or population. From a mathematical standpoint, these probabilistic uncertainty statements are derived based on some assumed probability model for observed data. In this chapter, we sketch the basics of probability modeling, estimation, bias and variance, and the interpretation of statistical inferences and statistical errors in applied work. We introduce the theme of uncertainty in statistical inference and discuss how it is a mistake to use hypothesis tests or statistical significance to attribute certainty from noisy data.
This introductory chapter lays out the key challenges of statistical inference in general and regression modeling in particular. We present a series of applied examples to show how complex and subtle regression can be, and why a book-length treatment is needed, not just on the mathematics of regression modeling but on how to apply and understand these methods.
This chapter is a departure from the rest of the book, which focuses on data analysis: building, fitting, understanding, and evaluating models fit to existing data. In the present chapter, we consider the design of studies, in particular asking the question of what sample size is required to estimate a quantity of interest to some desired precision. We focus on the paradigmatic inferential tasks of estimating population averages, proportions, and comparisons in sample surveys, or estimating treatment effects in experiments and observational studies. However, the general principles apply for other inferential goals such as prediction and data reduction. We present the relevant algebra and formulas for sample size decisions and demonstrating with a range of examples, but we also criticize the standard design framework of “statistical power,” which when studied naively yields unrealistic expectations of success and can lead to the design of ineffective, noisy studies. As we frame it, the goal of design is not to attain statistical significance with some high probability, but rather to have a sense–before and after data have been collected–about what can realistically be learned from statistical analysis of an empirical study.
So far, we have been interpreting regressions predictively: given the values of several inputs, the fitted model allows us to predict y, typically considering the n data points as a simple random sample from a hypothetical infinite “superpopulation” or probability distribution. Then we can make comparisons across different combinations of values for these inputs. This section of the book considers causal inference, which concerns what would happen to an outcome y as a result of a treatment, intervention, or exposure. This chapter introduces the notation and ideas of causal inference in the context of randomized experiments, which allow clean inference for average causal effects and serve as a starting point for understanding the tools and challenges of causal estimation.
With logistic as with linear regression, fitting is only part of the story. In this chapter we develop more advanced graphics to visualize data and fitted logistic regressions with one or more predictors. We discuss the challenges of interpreting coefficients in the presence of interactions and the use of linear transformations to aid understanding. We show how to make probabilistic predictions and how to average these predictions to obtain summaries–average predictive comparisons–that can be more interpretable than logistic regression coefficients. We discuss the evaluation of fitted models using binned residual plots and predictive errors, and we present all these tools in the context of a worked example. The chapter concludes with a discussion of the use of Bayesian inference and prior distributions to resolve a challenge of inference that arises with sparse discrete data, which again we illustrate with an applied example.