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Personal names are an important part of people's social identity, and they function socially as labels that both identify and distinguish an individual from others (Watzlawik et al., 2012). Cheang (2008) suggests that personal names can be a vehicle of self-presentation/self-promotion (cf. Goffman, 1980), not just a passive label, if the names are selected by the name bearers themselves. Although self-naming is also observed with a small minority of people who have changed their names given by their parents or close relations, the most common cases of self-presentation/self-promotion seem to be entertainers’ adopted stage names.
To evaluate oral antibiotic prescribing for common infections at hospital discharge before and after implementation of a pharmacist-driven transitions-of-care (TOC) program.
Single-center before-and-after study.
Acute-care, academic, community hospital in Santa Barbara, California.
Eligible adult patients prescribed oral antibiotics at hospital discharge for community-acquired pneumonia, skin and soft-tissue infections, and urinary tract infections between September 2019 and December 2019 (preimplementation period) and between March 2021 and May 2021 (postimplementation period).
Antimicrobial stewardship–initiated, department-wide, TOC program requiring all clinical pharmacists to review discharge antibiotic prescriptions in real time.
In total, 260 antibiotic prescriptions were assessed for appropriateness: 140 before implementation and 120 after implementation. After implementation, the number of prescriptions considered inappropriate significantly decreased by 18% (52% vs 34%; P = .005). Inappropriate rates decreased in all assessment categories: dosing (15% vs 2%; P < .001), treatment duration (42% vs 31%; P = .08), antibiotic selection based on infection type or microbiology (8% vs 4%; P = .33), and antibiotics not indicated (16% vs 10%; P = .18). Median total antibiotic days decreased by 1 day after implementation (10 days vs 9 days; P = .67), and 30-day readmission rates were similar between both phases.
A real-time, pharmacist-driven, TOC program for oral antibiotic prescriptions had a significant impact in reducing inappropriate prescribing of antibiotics at hospital discharge for common infections. Incorporating discharge antibiotic prescription review into pharmacist daily workflow may be a sustainable approach to outpatient antimicrobial stewardship in a setting with limited resources.
The purpose of this study was to analyze the cost-effectiveness of helicopter emergency medical services (HEMS) for its economic operations in South Korea.
This study targeted trauma patients that were transported by either HEMS or ground emergency medical services (GEMS) from the scene of an accident to a regional emergency medical center. From this patient population, severe trauma patients (injury severity score ISS ≥ 16 points) with a distance travelled from the scene of the injury to the hospital that was 30 km or longer and with analyzable outcome data were extracted and included in this study. Cost-effectiveness was analyzed from survival and efficiency based on medical costs incurred from the pre-hospital setting to hospital discharge. This study included a total of 34 HEMS and 105 GEMS patients with an Injury Severity Score (ISS) ≥ 16 points from a pool of 357 potential patients.
The survival-to-discharge rate of HEMS was 29 of 34 patients (85.3%) and was significantly higher than that of GEMS, where only 66 of 105 patients (62.8%) survived to discharge (P = 0.024). The expected and the actual mortality was higher in HEMS than it was in GEMS. Statistical significant difference in cost was found between the 2 groups (P = 0.002).
The results of the present study indicate the increased discharge rate, survival rate and reduced in hospital mortality of HEMS with reduced admission time. This result association leads to reasonable cost effectiveness and efficient estimates overall.
This paper analyzes the higher-order approximation of instrumental variable (IV) estimators in a linear homoskedastic IV regression model when a large set of instruments with potential invalidity is present. We establish theoretical results on the higher-order mean-squared error (MSE) approximation of the two-stage least-squares (2SLS), the limited information maximum likelihood (LIML), the Fuller (FULL), the bias-adjusted 2SLS, and jackknife version of the LIML and FULL estimators by allowing for local violations of the instrument exogeneity conditions. Based on the approximation to the higher-order MSE, we consider the instrument selection criteria that can be used to choose among the set of available instruments. We demonstrate the asymptotic optimality of the instrument selection procedure proposed by Donald and Newey (2001, Econometrica 69, 1161–1191) in the presence of locally (faster than
) invalid instruments in the sense that the dominant term in the MSE with the chosen instrument is asymptotically equivalent to the infeasible optimum. Furthermore, we propose instrument selection procedures to choose instruments among the sets of conservative (known) valid instruments and potentially locally (
) invalid instruments based on the higher-order MSE of the IV estimators by considering the bias-variance trade-off.
Complex Dynamic Systems Theory (CDST), an instantiation in applied linguistics of complexity epistemology that transcends disciplinary boundaries, has gained much traction and momentum over the last decade, finding expressions in a fast-growing number of empirical second language developmental studies. However, the literature, while rapidly expanding, has displayed much confusion, notably oscillating between invoking CDST as a metatheory and as an object theory. Then, too, the metaphorical genesis of CDST—the metaphorical adoption of complexity epistemology from physical sciences—has seemed to invite miscellaneous interpretations, rendering CDST an ostensibly all-in-one conceptual prism. This article explores the epistemology of CDST, tracing its ontology and examining its role in second language developmental research. This enables a more nuanced understanding of CDST, while at once surfacing critical issues and directions for future research, as it moves toward a pluralistic approach to investigating CDST as a potentially unique lens on second language development.
We investigated the change in limbic structure volumes and intrinsic limbic network in patients with obstructive sleep apnea (OSA) compared to healthy controls.
We enrolled 26 patients with OSA and 30 healthy controls. They underwent three-dimensional T1-weighted magnetic resonance imaging (MRI) on a 3 T MRI scanner. The limbic structures were analyzed volumetrically using the FreeSurfer program. We examined the intrinsic limbic network using the Brain Analysis with Graph Theory program and compared the groups' limbic structure volumes and intrinsic limbic network.
There were significant differences in specific limbic structure volumes between the groups. The volumes in the right amygdala, right hippocampus, right hypothalamus, right nucleus accumbens, left amygdala, left basal forebrain, left hippocampus, left hypothalamus, and left nucleus accumbens in patients with OSA were lower than those in healthy controls (right amygdala, 0.102 vs. 0.113%, p = 0.004; right hippocampus, 0.253 vs. 0.281%, p = 0.002; right hypothalamus, 0.028 vs. 0.032%, p = 0.002; right nucleus accumbens, 0.021 vs. 0.024%, p = 0.019; left amygdala, 0.089 vs. 0.098%, p = 0.007; left basal forebrain, 0.020 vs. 0.022%, p = 0.027; left hippocampus, 0.245 vs. 0.265%, p = 0.021; left hypothalamus, 0.028 vs. 0.031%, p = 0.016; left nucleus accumbens, 0.023 vs. 0.027%, p = 0.002). However, there were no significant differences in network measures between the groups.
We demonstrate that the volumes of several limbic structures in patients with OSA are significantly lower than those in healthy controls. However, there are no alterations to the intrinsic limbic network. These findings suggest that OSA is one of the risk factors for cognitive impairments.
This study was conducted to provide basic data for preparing a disaster nursing education program. It examined the degree of nursing students’ disaster awareness, disaster preparedness, willingness to participate in disaster response, and disaster nursing competency, aiming to determine the relationship between these attributes.
This was a descriptive research study. The participants were 163 nursing students. The data collected from the participants were analyzed via descriptive statistics and Pearson’s correlation coefficients.
Disaster awareness showed a positive correlation with a willingness to participate in a disaster response. Further, disaster preparedness and willingness to participate in a disaster response showed a positive correlation with disaster nursing capacity. Disaster awareness did not show a significant correlation with disaster preparedness and disaster nursing competency. Last, disaster preparedness did not show a significant correlation with willingness to participate in a disaster response.
It is necessary to improve nursing students’ disaster awareness, disaster preparation, disaster response participation willingness, and disaster nursing competency. It is imperative to develop disaster nursing education programs to strengthen students’ capabilities in a comprehensive manner.
Environmental violation by enterprises is a common problem in environmental management worldwide. To restrict enterprises' environmental pollution behaviors, China has implemented a public supervision system based on environmental information publicity, which guides the public to participate in environmental governance and supervises enterprises' environmental pollution behaviors. This study exploits a quasi-natural experiment based on the disclosure policy of the Pollution Information Transparency Index in China from 2008 and the difference-in-differences method to evaluate the disclosure effect of public supervision on enterprises' environmental violations, and to examine its environmental benefits and their realization path. We find that the public supervision system is conducive to the disclosure of enterprises' environmental violations. At the same time, public supervision has achieved the expected environmental benefits, mainly realized by reducing enterprises' output to reduce polluting emissions, and this mechanism is more obvious for high-polluting enterprises.
The optimal timing of surgical repair for infants with complete atrioventricular canal defect remains controversial, as there are risks to both early and late repair. We address this debate by investigating the association of various risk factors, including age and weight at surgery, markers of failure to thrive, and pulmonary vascular disease, with postoperative length of stay following complete atrioventricular canal repair.
Infants who underwent repair of complete atrioventricular canal were identified from our institutional Society of Thoracic Surgeons Congenital Heart Surgery Database. Additional clinical data were collected from the electronic medical record. Descriptive statistics were computed. Associations between postoperative length of stay and covariates of interest were evaluated using linear regression with bootstrap aggregation.
From 2001 to 2020, 150 infants underwent isolated complete atrioventricular canal repair at our institution. Pre-operative failure to thrive and evidence of pulmonary disease were common. Surgical mortality was 2%. In univariable analysis, neither weight nor age at surgery were associated with mortality, postoperative length of stay, duration of mechanical ventilation, or post-operative severe valvular regurgitation. In multivariable analysis of demographic and preoperative clinical factors using bootstrap aggregation, increased postoperative length of stay was only significantly associated with previous pulmonary artery banding (33.9 day increase, p = 0.03) and preoperative use of supplemental oxygen (19.9 day increase, p = 0.03).
Our analysis shows that previous pulmonary artery banding and preoperative use of supplemental oxygen were associated with increased postoperative length of stay after complete atrioventricular canal repair, whereas age and weight were not. These findings suggest operation prior to the onset of pulmonary involvement may be more important than reaching age or weight thresholds.
Oblique breakdown in a Mach 2.0 supersonic boundary layer controlled by a local cooling strip with a temperature jump is investigated using direct numerical simulations and linear stability theory. The effect of temperature on the stability of the fundamental oblique waves is first studied by linear stability theory. It is shown that the growth rate of fundamental oblique waves will decrease monotonically as the temperature decreases. However, the results of the direct numerical simulations indicate that transition reversal will occur as the growth rate of the fundamental oblique waves of cooled case becomes faster compared with that of baseline case downstream of the cooling strip. When the cooling strip is in the linear region, the transition is delayed due to the suppression effect of the cooling strip on the fundamental oblique waves. When the cooling strip is located in the early nonlinear region, the fundamental oblique waves will be suppressed by higher spanwise wavenumber steady modes generated by the mutual and self-interaction between the fundamental oblique waves and harmonic modes, which is first called the self-suppression effect (SSE) in the present study. Further research indicated that the meanflow distortion generated by steady modes plays an important role in the SSE. Compared with the stabilization effect of the cooling strip, the SSE is more effective. Moreover, the SSE might provide a new idea on the instability control, as it is observed that the SSE works three times leading to the growth rate of fundamental oblique waves slowing down at three different regions, respectively.
Mood disorders require consistent management of symptoms to prevent recurrences of mood episodes. Circadian rhythm (CR) disruption is a key symptom of mood disorders to be proactively managed to prevent mood episode recurrences. This study aims to predict impending mood episodes recurrences using digital phenotypes related to CR obtained from wearable devices and smartphones.
The study is a multicenter, nationwide, prospective, observational study with major depressive disorder, bipolar disorder I, and bipolar II disorder. A total of 495 patients were recruited from eight hospitals in South Korea. Patients were followed up for an average of 279.7 days (a total sample of 75 506 days) with wearable devices and smartphones and with clinical interviews conducted every 3 months. Algorithms predicting impending mood episodes were developed with machine learning. Algorithm-predicted mood episodes were then compared to those identified through face-to-face clinical interviews incorporating ecological momentary assessments of daily mood and energy.
Two hundred seventy mood episodes recurred in 135 subjects during the follow-up period. The prediction accuracies for impending major depressive episodes, manic episodes, and hypomanic episodes for the next 3 days were 90.1, 92.6, and 93.0%, with the area under the curve values of 0.937, 0.957, and 0.963, respectively.
We predicted the onset of mood episode recurrences exclusively using digital phenotypes. Specifically, phenotypes indicating CR misalignment contributed the most to the prediction of episodes recurrences. Our findings suggest that monitoring of CR using digital devices can be useful in preventing and treating mood disorders.
We study the two-dimensional Rayleigh–Bénard instability subject to the combined effects of a solid–liquid phase boundary and shear using linear stability theory and energy analysis. We consider two thermal states of the solid (isothermal and conducting), and two types of shear that can arise in different contexts. When the melting temperature is equal to that held at the top boundary, three instability modes can arise with the increase of Reynolds number Re that characterizes the shear intensity: a boundary mode, a mixed boundary–bulk mode and a bulk flow mode. When the melting temperature lies between the top and the bottom boundaries, the introduction of Couette flow, independent of its intensity, always leads to the mixed mode, whereas the instability with Poiseuille flow is dominated by the bulk flow mode once Re exceeds a critical value, below which the mixed mode dominates. The energy analysis suggests that there exist two mechanisms by which the shear flow affects the system: one is by inhibiting the upward heat flux and another is by absorbing energy from the perturbed hydrodynamic field. These two mechanisms can play totally different roles in different cases. Results in the high-Re regime indicate that, when Re exceeds its classical threshold, i.e. Re = 5772.2 for Poiseuille flow, the Tollmien–Schlichting instability will be dominant in the present system.
Power spectral analysis is the most common method of quantitative electroencephalogram (qEEG) techniques and enables investigation of the microstructure of insomnia. Previous spectral analysis studies on insomnia have shown inconsistent results due to their heterogeneity and small sample sizes.
We compared the difference of electroencephalogram (EEG) spectral power during sleep among participants without insomnia, insomniacs with no hypnotic use, hypnotic users with no insomnia complaints, and hypnotic users with insomnia complaints.
We used the Sleep Heart Health Study data, which is large sample size and has good quality control. The fast Fourier transformation was used to calculate the EEG power spectrum for total sleep duration within contiguous 30-second epochs of sleep. For 1,985 participants, EEG spectral power was compared among the groups while adjusting for potential confounding factors that could affect sleep EEG.
The power spectra during total sleep differed significantly among the groups in all frequency bands (p corr < 0.001). We found that quantitative EEG spectral power in the beta and sigma bands of total sleep differed (p corr < 0.001) between participants without insomnia and hypnotic users with insomnia complaints after controlling for potential confounders. The higher beta and sigma power were found in the hypnotic users with insomnia complaints than in the non-insomnia participants.
This study suggests differences in the microstructures of polysomnography-derived sleep EEG between the insomnia groups.
The purpose of this chapter is to explore Bentham’s observation of the tendency of representative democracy towards corruption. In his constitutional theory, Bentham’s chief concern is to prevent corruption, and he consistently maintains that the antidote for that political evil is representative democracy. However, Bentham indicates that representative democracy is not immune from corruption, and I suggest that this insight is derived from his observation of the dynamic processes of politics. For that reason, Bentham’s constitutional theory can be interpreted as an analysis of political processes and an offering of normative guidance on them and their development as influenced by the political psychology of members of political society.
This study aimed to explore perceptions of the meaning of life among Korean patients living with advanced cancer.
The study employed a mixed-methods design, and 16 participants were included in the analysis. Qualitative data gathered from in-depth interviews were analyzed using Colaizzi's phenomenological method. Quantitative survey data were analyzed using descriptive statistics, the Mann–Whitney U test, the Kruskal–Wallis test, and Spearman's ρ correlation.
Participants experienced both the existence of meaning and the will to find meaning in terms of four categories: “interpersonal relationships based on attachment and cohesion” (three themes — family as the core meaning of one's life, supportive and dependent interconnectedness with significant others, and existential responsibility embedded in familism), “therapeutic relationships based on trust” (one theme — communication and trust between the patient and medical staff), “optimism” (two themes — positivity embodied through past experiences and a positive attitude toward the current situation), and “a sense of purpose with advanced cancer” (two themes — the will to survive and expectations for the near future). The meaning in life questionnaire (MLQ) and the purpose in life scale (PIL) showed a significant positive correlation tendency with the functional assessment of chronic illness therapy-spiritual well-being scale (FACIT-Sp). The patient health questionnaire (PHQ-9) showed significant negative correlation tendency with both the MLQ-presence of meaning (MLQ-PM) and PIL-Initiative (PIL-I) questionnaires.
Significance of results
Finding meaning in life helps advanced cancer patients realize their will to live. It also acts as a coping mechanism that palliates negative experiences in the fight against the disease. In particular, among advanced cancer patients in the Korean culture, the dynamics of relationships with family and medical staff was a key axis that instilled optimism and will to live. These results suggest that considering the meaning of life in advanced cancer patients by reflecting Korean culture in the treatment process improves the quality of care.
Chapter 27 stresses the importance of connecting assessment with learning and of assessment prior to implementation of instructional design based on the backward design principle (Wiggins & McTighe, 2005). Backward design contrasts sharply with the traditional approach of planning instructional activities first and designing assessment later in the general instructional process. It also urges teachers to set clear learning objectives as the first step of curriculum design. After offering a short overview of key assessment types for different purposes, it presents Integrated Performance Assessment (IPA: Adair-Hauck, Glisan & Troyan, 2013) model by discussing how language proficiency and skills in real use of grammar and vocabulary can be measured in actual performance assessment. Actual students’ outcomes after implementation of IPA in an Advanced Korean class are collected and analyzed based on rubrics that can be used as standards for scoring. The chapter also analyzes whether there are correlations between IPA results and Proficiency outcomes.
Chapter 8 examines the typologically rare three-way laryngeal contrast found in Korean. As also noted in Chapter 2, the manner contrasts in the Korean obstruent inventory have been the point of departure for many descriptive and theoretical contributions to the typology of laryngeal contrasts and related issues, such as feature theory. More recently, a diachronic change characterized by the redistribution of cue weights from the consonantal to the vocalic portion of the signal, mirroring the common historical process of tonogenesis, has sparked renewed interest in the Korean laryngeal contrasts. The opportunity to observe such a change in vivo, and to compare its progression across different dialects, provides an ideal testing ground for theories of sound change. This chapter provides a review of the literature on the phonetic and phonological characterizations of the stop-laryngeal contrast, as well as a survey of dialectal and diachronic variation in its phonetic realization. The chapter closes with an apparent-time study documenting dialectal variation and change in the use of three acoustic cues to the contrast (VOT, f0, and H1-H2) in three dialects of Korean.
What explains variation in the inclusion of women in authoritarian cabinets? We theorize that leaders of electoral autocracies are affected by changing international norms of democracy and women's rights to appoint women ministers. We propose two hypotheses. First, increasing dependence on aid from democratic donors encourages leaders of electoral autocracies to appoint more women ministers. Second, electoral autocrats uprooting democratic traits appoint more women ministers to minimize the reputational costs of their autocratization. Using data from authoritarian regimes in 38 African countries between 1973 and 2013, we find that increases in aid from democracies are associated with modest increases in women's share of cabinet seats. As our theory suggests, this relationship holds only in electoral autocracies in more recent years when norms of gender equality have been strongest. Conversely, we find no evidence that autocratization periods are associated with increases in women's cabinet share. Additionally, we show that supply-side factors and the politics of multi-ethnic coalition building appear to explain differences in women's cabinet seat share in autocracies.