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We study when CEOs with legal expertise are valuable for firms. In general, lawyer CEOs are negatively associated with frequency and severity in employment civil rights, contract, labor, personal injury, and securities litigation. This effect is partly induced by the CEO’s management of litigation risk and reduction in other risky policies. Lawyer CEOs are further associated with an increase in gatekeepers providing additional legal oversight and a decrease in innovative activities with high litigation risk. Lawyer CEOs are more valuable during periods of enhanced compliance requirements and regulatory pressure and in industries with high litigation risk or better growth opportunities.
Despite extensive paleoenvironmental research on the postglacial history of the Kenai Peninsula, Alaska, uncertainties remain regarding the region's deglaciation, vegetation development, and past hydroclimate. To elucidate this complex environmental history, we present new proxy datasets from Hidden and Kelly lakes, located in the eastern Kenai lowlands at the foot of the Kenai Mountains, including sedimentological properties (magnetic susceptibility, organic matter, grain size, and biogenic silica), pollen and macrofossils, diatom assemblages, and diatom oxygen isotopes. We use a simple hydrologic and isotope mass balance model to constrain interpretations of the diatom oxygen isotope data. Results reveal that glacier ice retreated from Hidden Lake's headwaters by ca. 13.1 cal ka BP, and that groundwater was an important component of Kelly Lake's hydrologic budget in the Early Holocene. As the forest developed and the climate became wetter in the Middle to Late Holocene, Kelly Lake reached or exceeded its modern level. In the last ca. 75 years, rising temperature caused rapid changes in biogenic silica content and diatom oxygen isotope values. Our findings demonstrate the utility of mass balance modeling to constrain interpretations of paleolimnologic oxygen isotope data, and that groundwater can exert a strong influence on lake water isotopes, potentially confounding interpretations of regional climate.
Parkinson's disease (PD) is the second most common neurodegenerative disease after Alzheimer's disease and affects about 1% of the population over the age of 60 years in industrialised countries. The aim of this review is to examine nutrition in PD across three domains: dietary intake and the development of PD; whole body metabolism in PD and the effects of PD symptoms and treatment on nutritional status. In most cases, PD is believed to be caused by a combination of genetic and environmental factors and although there has been much research in the area, evidence suggests that poor dietary intake is not a risk factor for the development of PD. The evidence about body weight changes in both the prodromal and symptomatic phases of PD is inconclusive and is confounded by many factors. Malnutrition in PD has been documented as has sarcopaenia, although the prevalence of the latter remains uncertain due to a lack of consensus in the definition of sarcopaenia. PD symptoms, including those which are gastrointestinal and non-gastrointestinal, are known to adversely affect nutritional status. Similarly, PD treatments can cause nausea, vomiting and constipation, all of which can adversely affect nutritional status. Given that the prevalence of PD will increase as the population ages, it is important to understand the interplay between PD, comorbidities and nutritional status. Further research may contribute to the development of interventional strategies to improve symptoms, augment care and importantly, enhance the quality of life for patients living with this complex neurodegenerative disease.
Given a large number of community-based older adults with mild cognitive impairment, it is essential to better understand the relationship between unmet palliative care (PC) needs and mild cognitive impairment in community-based samples.
Method
Participants consisted of adults ages 60+ receiving services at senior centers located in New York City. The Montreal Cognitive Assessment (MoCA) and the Unmet Palliative Care Needs screening tool were used to assess participants’ cognitive status and PC needs.
Results
Our results revealed a quadratic relationship between unmet PC needs and mild cognitive impairment, controlling for gender, living status, and age. Participants with either low or high MoCA scores reported lower PC needs than participants with average MoCA scores, mean difference of the contrast (low and high vs. middle) = 2.15, P = 0.08.
Significance of results
This study is a first step toward elucidating the relationship between cognitive impairment and PC needs in a diverse community sample of older adults. More research is needed to better understand the unique PC needs of older adults with cognitive impairment living in the community.
The US Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Center (EPC) program sponsors the development of systematic reviews to inform clinical policy and practice. The EPC program sought to better understand how health systems identify and use this evidence.
Methods:
Representatives from eleven EPCs, the EPC Scientific Resource Center, and AHRQ developed a semi-structured interview script to query a diverse group of nine Key Informants (KIs) involved in health system quality, safety and process improvement about how they identify and use evidence. Interviews were transcribed and qualitatively summarized into key themes.
Results:
All KIs reported that their organizations have either centralized quality, safety, and process improvement functions within their system, or they have partnerships with other organizations to conduct this work. There was variation in how evidence was identified, with larger health systems having medical librarians and central bureaus to gather and disseminate information and smaller systems having local chief medical officers or individual clinicians do this work. KIs generally prefer guidelines, especially those with treatment algorithms, because they are actionable. They like systematic reviews because they efficiently condense study results and reconcile conflicting data. They prefer information from systematic reviews to be presented as short digestible summaries with the full report available on demand. KIs preferred systematic reviews from reputable entities and those without commercial bias. Some of the challenges KIs reported include how to resolve conflicting evidence, the generalizability of evidence to local needs, determining whether the evidence is up-to-date, and the length of time required to generate reviews. The topics of greatest interest included predictive analytics, high-value care, advance care planning, and care coordination. To increase awareness of AHRQ EPC reviews, KIs suggest alerting people at multiple levels in a health-system when new evidence reports are available and making reports easier to find in common search engines.
Conclusions:
Systematic reviews are valued by health system leaders. To be most useful they should be easy to locate and available in different formats targeted to the needs of different audiences.
The Greenland ice sheet (GrIS) subglacial hydrological system may undergo a seasonal evolution, with significant geophysical and biogeochemical implications. We present results from a new isotope-mixing model to quantify the relative contributions of surface snow, glacial ice and delayed flow to the bulk meltwater discharge from a small (∼5 km2) land-terminating GrIS outlet glacier during melt onset (May) and at peak melt (July). We use radioactive (222Rn) and stable isotopes (18O, deuterium) to differentiate the water source contributions. Atmospherically derived 7Be further constrains meltwater transit time from the glacier surface to the ice margin. We show that (1) 222Rn is a promising tracer for glacial waters stored at the bed and (2) a quantitative chemical mixing model can be constructed by combining 222Rn and the stable water isotopes. Applying this model to the bulk subglacial outflow from our study area, we find a constant delayed-flow (stored) component from melt onset through peak melt. This component is diluted first by snowmelt and then by increasing glacial ice melt as the season progresses. Results from this pilot study are consistent with the hypothesis that subglacial drainage beneath land-terminating sections of the GrIS undergoes a seasonal evolution from a distributed to a channelized system.
Whispering gallery modes (WGMs) have been widely studied over the past 20 years for various applications, including biological sensing. While the WGM-based sensing approaches reported in the literature have shown tremendous performance down to single molecule detection, at present such sensing technologies are not yet mature and still have significant practical constraints that limit their use in real-world applications. Our work has focused on developing a practical, yet effective, WGM-based sensing platform capable of being used as a dip sensor for in-vivo biosensing by combining WGM fluorescent microresonators with silica Microstructured Optical Fibers (MOFs).
We recently demonstrated that a suspended core MOF with a dye-doped polymer microresonator supporting WGMs positioned onto the tip of the fiber, can be used as a dip sensor. In this architecture the resonator is anchored to one of the MOF air holes, in contact with the fiber core, enabling a significant portion of the evanescent field from the fiber to overlap with the sphere and hence excite the fluorescent WGMs. This architecture allows for remote excitation and collection of the WGMs. The fiber also permits easy manipulation of the microresonator for dip sensing applications, and hence alleviates the need for a complex microfluidic interface. More importantly, it allows for an increase in both the excitation and collection efficiency compared to free space coupling, and also improves the Q factor.
In this paper we present our recent results on microstructured fiber tip WGM-based sensors and show that this sensing platform can be used in clinical diagnostics, for detecting various clinically relevant biomarkers in complex clinical samples.
Little is known as to whether childhood temperament is associated with
long-term sickness absence in adult life.
Aims
To explore the associations between childhood temperament and long-term
sickness absence in middle age.
Method
The Aberdeen Children of the 1950s study is comprised of 12 150 children
born in Aberdeen 1950–55. Teachers completed the Aberdeen–London Child
Behaviour Scale (Rutter B) for all participants in 1964. Current
employment status was ascertained for 7183 (63.7%) in 2001.
Results
Five and a half per cent of responders classified themselves as
‘permanently sick or disabled’ at follow-up. ‘Often complains of aches
and pains’ (OR=6.75, 95% CI 1.28–35.5) and ‘Often appears miserable or
unhappy’ (OR=3.81, 95% CI 1.01–14.4) were strongly associated with being
permanently sick or disabled following adjustment for year of birth,
gender, IQ and father's social class.
Conclusions
Childhood temperament is strongly associated with sickness absence in
middle age.
Mental illness is now the leading cause of both sickness absence and
incapacity benefits in most high-income countries. The rising economic and
social costs make health and work an increasing priority for policy makers.
We discuss the findings from Dame Carol Black's recent review of the health
of Britain's working-age population and examine how her recommendations may
impact and challenge mental health services.
Palliative care arose as a discipline with the birth of the modern hospice movement. From its earliest origins, palliative care championed what has come to be known as a patient-centred approach to delivering care. This chapter discusses the clinical assessment of patients with advanced disease, followed by a description of a number of common clinical problems that may be referred to psychiatrists working in palliative care. It reviews first models of coping in advanced disease. As in any other groups of patients with established physical disease, comorbid depression is a familiar problem. In palliative care, depression may have dramatic consequences. Compared to depression, anxiety has received much less attention in the literature. There are a large number of reasons why patients with advanced disease, particularly those in hospices, might present with confusion or disturbed behaviour.
Recent experiments by Hammack et al. (J. Fluid Mech., vol. 532, 2005, p. 1) on deep-water waves with two-dimensional, periodic surface patterns showed several features, some of which were unsteady. Fuhrman & Madsen (J. Fluid Mech., vol. 559, 2006, p. 391) explained three of these as being the consequence of sinusoidal forcing by the wavemaker array that did not include forced harmonics, either in time or in the direction parallel to the wavemaker. They predicted that neglected third-harmonic terms cause more serious consequences than neglected second-harmonic terms when the generated wavefields have two-dimensional surface patterns. This paper presents experiments that provide strong evidence that their explanation is correct: including the third-harmonic terms in the wavemaker forcing results in wave patterns that propagate with nearly permanent form.
Endogenous vitamin D deficiency (low serum 25(OH)D3) is a necessary but insufficient requirement for the genesis of vitamin D-deficiency rickets and osteomalacia. The magnitude of the independent contributions of dietary factors to rachitic and osteomalacic risk remains uncertain. We reanalysed two weighed dietary surveys of sixty-two cases of rickets and osteomalacia and 113 normal women and children. The independent associations of four dietary variables (vitamin D, Ca, fibre and meat intakes) and daylight outdoor exposure with rachitic and osteomalacic relative risk were estimated by multivariate logistic regression. Meat and fibre intakes showed significant negative and positive associations respectively with rachitic and osteomalacic relative risk (RR; zero meat intake: RR 29·8 (95 % CI 4·96, 181), P<0·001; fibre intake: RR 1·53 (95 % CI 1·01, 2·32), P+0·043). The negative association of meat intakes with rachitic and osteomalacic relative risk was curvilinear; relative risk did not fall further at meat intakes above 60 g daily. Daylight outdoor exposure showed a significant negative association with combined relative risk (RR 0·33 (95 % CI 0·17, 0·66), P<0·001). Operation of the meat and fibre risk factors was related to sex, age and dietary pattern (omnivore/lactovegetarian), mainly determined by religious affiliation. The mechanism by which meat reduces rachitic and osteomalacic risk is uncertain and appears independent of revised estimates of meat vitamin D content. The meat content of the omnivore Western diet may explain its high degree of protection against nutritional rickets and osteomalacia from infancy to old age in the presence of endogenous vitamin D deficiency.