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Previous research has shown that positive outcomes are associated with receiving a neuropsychological evaluation (NPE). The current project examined hospitalization outcomes following an NPE in a sample of patients who had sustained a traumatic brain injury (TBI). Hospitalization rates were compared between the two years pre- and two years post-evaluation. The role that insurance status plays on these health outcomes was also examined. This project is part of a growing effort to evaluate outcomes of clinical neuropsychological services in order to better characterize the broad health impacts of NPEs.
Participants and Methods:
Participants for the current study come from the Optum® de-identified Electronic Health Record dataset. The final sample included 245 patients who completed at least one NPE and were diagnosed with a TBI, according to ICD codes associated with their healthcare records. Patients were aged 21-87 (M = 51.55, SD = 16.74) with an average Charleston Comorbidity Index of 1.77 (SD = 2.41). The sample consisted of 124 females (50.6%), 121 males (49.4%). The majority of the sample identified as non-Hispanic white (N = 213; 86.9%), while 8.6% identified as another race or ethnicity. Regarding insurance, the most common insurance type was commercial (61.6%), followed by Medicare (13.5%), Medicaid (9.4%), and uninsured (6.5%). Those with unknown insurance status, race, or ethnicity were excluded from analyses of those variables.
Results:
Hospitalization incidence for the sample was significantly lower in the two years following a NPE, X2(1, N = 245) = 26.98, p < .001, compared to the two years prior. The mean number of hospitalizations were also lower following a NPE (t(244) = 4.83, p < .001). Insurance status did not show a significant main effect or interaction on mean number of hospitalizations over time. Regarding demographic variables, there was no significant main effects of race/ethnicity group or interaction between race/ethnicity and hospitalization rate change over time. However, there was a significant interaction between hospitalization rate change over time and gender (F(242) = 4.74, p = 0.030). A significant decrease in hospitalizations over time was seen for males (p < .001), while females showed a trend-level decrease that approached significance (p = .06).
Conclusions:
Consistent with previous research, significant reductions in hospitalization incidence and mean number of hospitalizations were seen following a NPE. This finding did not vary based on insurance status. However, hospitalization outcomes varied as a function of gender. These findings suggest that completing a NPE following a traumatic brain injury may contribute to improved hospitalization outcomes, but it does not appear that this benefit is seen equally for all patients. Insurance status may play a role in accessibility to care and hospitalization outcomes in this population, but that relationship is likely influenced by other factors, including racial identity, gender, and income. Future research is needed to investigate the extent that NPEs impact hospitalization rates in the broader context of insurance, demographic factors, and socioeconomic status.
Gambling marketing is frequently visible in the United Kingdom, especially around the national sport, soccer. Previous research has documented the frequency with which gambling marketing logos can be seen in domestic club soccer, and also the frequency of television advertising around international tournaments. The present research investigates the frequency and content of television advertising during the men’s 2020 Euro soccer tournament, a high-profile tournament shown since the industry’s voluntary “whistle-to-whistle ban” on gambling advertising came into effect. Overall, 113 gambling adverts were recorded (4.5 adverts per relevant match). Financial inducements were the most frequently shown category (56.6%), followed by adverts raising awareness of a given operator’s brand (19.5%), adverts featuring the odds on specific complex bets (18.6%), and adverts promoting safer gambling (5.3%). Adverts featured a range of safer gambling messages, with the “when the fun stops, stop” message featuring in 56.6% of adverts. This research indicates that gambling advertising remains a frequent part of the experience of watching live televised soccer in the UK, and shows how the content of this advertising was comparable to what has been seen in the previous literature.
Various global-scale proposals exist to reduce the loss of biological diversity. These include the Half-Earth and Whole-Earth visions that respectively seek to set aside half the planet for wildlife conservation or to diversify conservation practices fundamentally and change the economic systems that determine environmental harm. Here we assess these visions in the specific context of Bornean orangutans Pongo pygmaeus and their conservation. Using an expert-led process we explored three scenarios over a 10-year time frame: continuation of Current Conditions, a Half-Earth approach and a Whole-Earth approach. In addition, we examined a 100-year population recovery scenario assuming 0% offtake of Bornean orangutans. Current Conditions were predicted to result in a population c. 73% of its current size by 2032. Half-Earth was judged comparatively easy to achieve and predicted to result in an orangutan population of c. 87% of its current size by 2032. Whole-Earth was anticipated to lead to greater forest loss and ape killing, resulting in a prediction of c. 44% of the current orangutan population for 2032. Finally, under the recovery scenario, populations could be c. 148% of their current size by 2122. Although we acknowledge uncertainties in all of these predictions, we conclude that the Half-Earth and Whole-Earth visions operate along different timelines, with the implementation of Whole-Earth requiring too much time to benefit orangutans. None of the theorized proposals provided a complete solution, so drawing elements from each will be required. We provide recommendations for equitable outcomes.
The c. 1.5–1.3 Ga Wilton package, the upper succession of the greater McArthur Basin, preserves detailed tectono-sedimentary evidence for the Mesoproterozoic evolution of the North Australian Craton (NAC). In addition, it is a valuable global sedimentary repository for the poorly explored Mesoproterozoic. New detrital zircon U–Pb age and Lu–Hf isotope data, collected from multiple, geographically separated, basins that make up the Wilton package, are compiled with previously published data to illuminate the basin evolution. The spatial and temporal variation in sedimentary provenance illustrates two major geographic changes that correspond to continent-scale tectonic convulsions of the NAC during the Mesoproterozoic. The first is shown by the influx of sediment sourced from east and southeast terranes. This is linked to rifting between Proterozoic Australia and Laurentia at c. 1.45 Ga, resulting in the uplift of the eastern margin of the NAC–SAC (South Australian Craton). The second basin geographic change is illustrated by a flux of southerly-sourced detritus that is interpreted to be tectonically driven by the uplift of the southern NAC, during the subduction/closure of the Mirning Ocean at c. 1.32 Ga. Spatially, sediment in the Wilton package is separated into two depositional systems: sedimentary rocks within the Birrindudu Basin, the western component of the Wilton package, have different detrital signatures relative to other Wilton package successions found east of the Daly Waters Fault Zone, in the Beetaloo Sub-basin, the McArthur Basin and the South Nicholson Basin. The Daly Waters Fault Zone is interpreted as an ancient bathymetric high, blocking sediment transport. Although they differ in sources, rocks in both the Birrindudu Basin and the eastern Wilton package record coeval shifts of basin provenance to southern sources. The coherent evolution of basin provenance indicates a consistent tectono-sedimentation history, and links the Birrindudu Basin and the other Wilton successions in a tectonic framework.
Reading difficulties are one of the most significant challenges for children with neurofibromatosis type 1 (NF1). The aims of this study were to identify and categorize the types of reading impairments experienced by children with NF1 and to establish predictors of poor reading in this population.
Method:
Children aged 7–12 years with NF1 (n = 60) were compared with typically developing children (n = 36). Poor word readers with NF1 were classified according to impairment type (i.e., phonological, surface, mixed), and their reading subskills were compared. A hierarchical multiple regression was conducted to identify predictors of word reading.
Results:
Compared to controls, children with NF1 demonstrated significantly poorer literacy abilities. Of the 49 children with NF1 classified as poor readers, 20 (41%) were classified with phonological dyslexia, 24 (49%) with mixed dyslexia, and 5 (10%) fell outside classification categories. Children with mixed dyslexia displayed the most severe reading impairments. Stronger working memory, better receptive language, and fewer inattentive behaviors predicted better word reading skills.
Conclusions:
The majority of children with NF1 experience deficits in key reading skills which are essential for them to become successful readers. Weaknesses in working memory, receptive language, and attention are associated with reading difficulties in children with NF1.
Gravitational waves from coalescing neutron stars encode information about nuclear matter at extreme densities, inaccessible by laboratory experiments. The late inspiral is influenced by the presence of tides, which depend on the neutron star equation of state. Neutron star mergers are expected to often produce rapidly rotating remnant neutron stars that emit gravitational waves. These will provide clues to the extremely hot post-merger environment. This signature of nuclear matter in gravitational waves contains most information in the 2–4 kHz frequency band, which is outside of the most sensitive band of current detectors. We present the design concept and science case for a Neutron Star Extreme Matter Observatory (NEMO): a gravitational-wave interferometer optimised to study nuclear physics with merging neutron stars. The concept uses high-circulating laser power, quantum squeezing, and a detector topology specifically designed to achieve the high-frequency sensitivity necessary to probe nuclear matter using gravitational waves. Above 1 kHz, the proposed strain sensitivity is comparable to full third-generation detectors at a fraction of the cost. Such sensitivity changes expected event rates for detection of post-merger remnants from approximately one per few decades with two A+ detectors to a few per year and potentially allow for the first gravitational-wave observations of supernovae, isolated neutron stars, and other exotica.
In this article we consider the spectral behaviour of turbulence-driven power fluctuations for a single horizontal-axis turbine. To this end, a small-scale instrumented axial-flow hydrokinetic turbine model ($\textrm {diameter}=0.724\ \textrm {m}$) is deployed in the long water flume situated in the laboratory facilities of IFREMER in Boulogne-sur-Mer, France, and synchronous measurements of the upstream velocity and the rotor are collected for different tip-speed ratios. The study confirms previous findings suggesting that the power spectra follow the velocity spectra behaviour in the large scales region and a steeper power law slope behaviour ($-11/3$) over the inertial frequency sub-range. However, we show that both the amplitude of the power spectra and low-pass filtering effect over the inertial sub-range also depend on the rotor aero/hydrodynamics (e.g. $\mathrm {d}C_L/\mathrm {d}\alpha$) and the approaching flow deceleration and not solely on the rotational effects. In addition, we present a novel semi-analytical model to predict the dominant blade-passing frequency harmonics in the high-frequency regime using the rotationally sampled spectra technique. For all calculations, the distortion of incoming turbulence is taken into account.
Inorganic calcite precipitation experiments were conducted to determine whether inducing specific orientations of calcite crystal growth can cause the enrichment of cations larger than Ca. Malonic acid (CH2(COOH)), a di-carboxylic acid, was used to poison growth on acute kink sites, promoting growth on obtuse kink sites, causing calcite crystals elongated along their c-axes to form in a mechanism similar to that seeninthe growth of E. huxleyi coccoliths. Calcite was precipitated with a range of malonic acid concentrations (0 to 10-1 M), and 9x10-5 M of either SrCl2 or MgCl2. The results show that calcite crystals precipitated in the presence of large malonic acid concentrations show significant elongation along the c axis, and suggest that increasing malonate concentrations corresponded with increasing DSr. Experiments with 10-1 M malonic acid caused elevated DSr comparable to that predicted for E. huxleyi coccolith calcite (Langer et al., 2006).
Despite extensive research on organizational virtue, our understanding about factors that promote virtue within organizations remains unclear. Drawing on upper echelon theory, we examine the relationship between five top management team (TMT) characteristics and organizational virtue orientation (OVO)—the integrated set of values and beliefs that support ethical traits and virtuous behaviors of an organization. Specifically, we utilize prospectuses of initial public offering (IPO) firms and 10-K post-IPO filings to explore how TMT composition with respect to member age, tenure, education, functional background, and gender influences OVO. Additionally, we examine the moderating effects of organizational size, and argue that the more expansive structures and processes associated with larger organizations diminish the main relationships. Our findings, using two sources of data, are consistent, but somewhat mixed in their support for our hypotheses. Overall, TMT characteristics do appear to influence OVO, but in more complex and counterintuitive ways than initially expected.
Vestari-Hagafellsjökull is a surge-type outlet glacier from the Langjökull ice cap, Iceland. Intensive hydrological investigations were carried out during non-surge conditions in the summers of 1999 and 2000, and 14 boreholes were drilled using pressurized hot water over an area 800 m from the margin and approximately 5000 m2 in size, where ice thickness ranged from 60 to 70 m. Initial investigations showed that a large fraction of the boreholes drilled to the bed did not drain and were assumed not to connect to the subglacial drainage system. Subsequently, we investigated the hypothesis that boreholes which remain full may do so as a consequence of a balance between englacial inflow and basal drainage rather than the standard assumption that such boreholes are simply unconnected. In testing this hypothesis, we developed a new technique for measuring water motion within the borehole by monitoring the passage of a saline solution down the borehole’s water column. The technique allows rates of motion to be established, as well as allowing the quantification of net addition and loss of water from the borehole. Observations based on the motion of saline plumes within the boreholes lead us to the conclusion that some boreholes do indeed remain full as a consequence of a balance between englacial inflow and subglacial drainage. The abrupt dilution that occurs at the top of these boreholes suggests inflow from a near-surface englacial water source, while the descent of the saline plumes implies that water is being lost at the base to the subglacial system. The system appears to be driven by excess water head in the boreholes over flotation and implies that the borehole/bedrock interface can be ‘leaky’.
This paper discusses results from the second phase of the European Ice Sheet Modelling Initiative (EISMINT). It reports the intercomparison of ten operational ice-sheet models and uses a series of experiments to examine the implications of thermomechanical coupling for model behaviour. A schematic, circular ice sheet is used in the work which investigates both steady states and the response to stepped changes in climate. The major finding is that the radial symmetry implied in the experimental design can, under certain circumstances, break down with the formation of distinct, regularly spaced spokes of cold ice which extended from the interior of the ice sheet outward to the surrounding zone of basal melt. These features also manifest themselves in the thickness and velocity distributions predicted by the models. They appear to be a common feature to all of the models which took part in the intercomparison, and may stem from interactions between ice temperature, flow and surface form. The exact nature of these features varies between models, and their existence appears to be controlled by the overall thermal regime of the ice sheet. A second result is that there is considerable agreement between the models in their predictions of global-scale response to imposed climate change.
Physically based projections of the Greenland ice sheet contribution to future sea-level change are subject to uncertainties of the atmospheric and oceanic climatic forcing and to the formulations within the ice flow model itself. Here a higher-order, three-dimensional thermomechanical ice flow model is used, initialized to the present-day geometry. The forcing comes from a high-resolution regional climate model and from a flowline model applied to four individual marine-terminated glaciers, and results are subsequently extended to the entire ice sheet. The experiments span the next 200 years and consider climate scenario SRES A1B. The surface mass-balance (SMB) scheme is taken either from a regional climate model or from a positive-degree-day (PDD) model using temperature and precipitation anomalies from the underlying climate models. Our model results show that outlet glacier dynamics only account for 6–18% of the sea-level contribution after 200 years, confirming earlier findings that stress the dominant effect of SMB changes. Furthermore, interaction between SMB and ice discharge limits the importance of outlet glacier dynamics with increasing atmospheric forcing. Forcing from the regional climate model produces a 14–31 % higher sea-level contribution compared to a PDD model run with the same parameters as for IPCC AR4.
The Omani basement is located spatially distant from the dominantly juvenile Arabian–Nubian Shield (ANS) to its west, and its relationship to the amalgamation of those arc terranes has yet to be properly constrained. The Jebel Ja'alan (NE Oman) basement inlier provides an excellent opportunity to better understand the Neoproterozoic tectonic geography of Oman and its relationship to the ANS. To understand the origin of this basement inlier, we present new radiogenic isotopic data from igneous bodies in Jebel Ja'alan. U–Pb and 40Ar/39Ar geochronological data are used to constrain the timing of magmatism and metamorphism in the jebel. Positive εHf and εNd values indicate a juvenile origin for the igneous lithologies. Phase equilibria modelling is used to constrain the metamorphic conditions recorded by basement. Pressure–temperature (P–T) pseudosections show that basement schists followed a clockwise P–T path, reaching peak metamorphic conditions of c. 650–700°C at 4–7.5 kbar, corresponding to a thermal gradient of c. 90–160°C/kbar. From the calculated thermal gradient, in conjunction with collected trace-element data, we interpret that the Jebel Ja'alan basement formed in an arc environment. Geochronological data indicate that this juvenile arc formed during Tonian time and is older than basement further west in Oman. We argue that the difference in timing is related to westwards arc accretion and migration, which implies that the Omani basement represents its own tectonic domain separate to the ANS and may be the leading edge of the Neoproterozoic accretionary margin of India.
The earliest estimates of protein requirements, such as those of Smith
(1863) and Pavy (1874) who recommended about 125 g per day for the average
working man, were based on studies of the diets of individuals or of groups
of subjects who were considered to be healthy and leading normal active
lives. Such estimates were simply a reflection of the dietary habits of
those under study, but helped to establish minimum standards of feeding in
institutions. About the turn of the century, similar recommendations ranging
from 118 to 150 g were made by Voit (1881), Atwater (1895) and Rubner (1903)
(Fig. 1), and these came to be vigorously defended as representing not
merely feeding standards but as irreducible minima below which a proper
state of health and vigour could not be maintained.
The aims of this study were to examine the prevalence and potential correlates of feeding difficulties in infants who underwent cardiac surgery in the neonatal period and to investigate resource utilisation by infants with feeding difficulties.
Methods
All neonates who underwent their first cardiac surgery at the Heart Centre for Children, The Children’s Hospital at Westmead, between January and December, 2009 were included. Demographic, preoperative, intraoperative, and postoperative data were collected via electronic medical records. For the purpose of this study, feeding difficulty was defined as the requirement for ongoing tube feeding at the time of discharge home or transfer to another hospital.
Results
Out of a total of 79 neonates, 24 (30%) were discharged home or transferred to another hospital with a feeding tube. Feeding difficulties were associated with the presence of a genetic syndrome (p<0.0001), assisted feeding preoperatively (odds ratio (OR)=4.4, p=0.03), and having a palliative procedure before biventricular repair (OR=5.1, p=0.02). Infants with feeding difficulties had significantly more reviews by speech pathologists (M=5.9, SD=7.9), dieticians (M=5.9, SD=5.4), and cardiac clinical nurse consultants (M=1.2, SD=1.4) compared with those without feeding difficulties.
Conclusions
This study identified factors that can be used in the early recognition of infant feeding difficulties, to help guide the direction of limited health resources, as well as being focal points for future research and clinical practice improvement.
Universal screening for postpartum depression is recommended in many countries. Knowledge of whether the disclosure of depressive symptoms in the postpartum period differs across cultures could improve detection and provide new insights into the pathogenesis. Moreover, it is a necessary step to evaluate the universal use of screening instruments in research and clinical practice. In the current study we sought to assess whether the Edinburgh Postnatal Depression Scale (EPDS), the most widely used screening tool for postpartum depression, measures the same underlying construct across cultural groups in a large international dataset.
Method
Ordinal regression and measurement invariance were used to explore the association between culture, operationalized as education, ethnicity/race and continent, and endorsement of depressive symptoms using the EPDS on 8209 new mothers from Europe and the USA.
Results
Education, but not ethnicity/race, influenced the reporting of postpartum depression [difference between robust comparative fit indexes (∆*CFI) < 0.01]. The structure of EPDS responses significantly differed between Europe and the USA (∆*CFI > 0.01), but not between European countries (∆*CFI < 0.01).
Conclusions
Investigators and clinicians should be aware of the potential differences in expression of phenotype of postpartum depression that women of different educational backgrounds may manifest. The increasing cultural heterogeneity of societies together with the tendency towards globalization requires a culturally sensitive approach to patients, research and policies, that takes into account, beyond rhetoric, the context of a person's experiences and the context in which the research is conducted.
USDA uses the concept of “publish-ability” rather than statistical reliability of an estimate for quality validation of USDA estimates, which is solely based on the sample size and the coefficient of variation (CV). We demonstrate conceptually how the reliability of the sample mean can be tested by estimating the upper and lower bounds of the confidence interval for an unknown population mean using the CV. However, the reliability test for the sample mean can be made only under the normality assumption. USDA multiple-way Agricultural Resource Management Survey (ARMS) estimates are used to illustrate the relative measure of precision for sample-based estimators.