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To evaluate the experiences and perspectives of otolaryngology residents regarding current parental leave (PL) practices, incorporating insights from both male and female trainees to assess institutional policies and support mechanisms.
Methods
A 43-item anonymous survey was distributed to 125 ACGME-accredited otolaryngology residency programs, yielding responses from 105 residents (response rate: 29%). Data were analyzed using descriptive statistics and thematic analysis to evaluate perceptions of PL policies, barriers to leave, and postpartum support.
Results
Most respondents were female (57%) and married (77%), with an average age of 30 years. Only 26% were aware of the American Board of Otolaryngology’s 8-week PL policy. Female residents typically took 4-6 weeks of leave, while male residents took none. Concerns about program strain (29%) and lack of lactation support (60%) were significant barriers. Despite this, most respondents felt supported by co-residents and faculty.
Conclusion
Otolaryngology residents reported dissatisfaction with PL policies, inadequate lactation support, and poor awareness of institutional guidelines. Addressing these issues is critical to fostering a supportive environment for residents pursuing parenthood during training.
In this paper we adopt the probabilistic mean value theorem in order to study differences of the variances of transformed and stochastically ordered random variables, based on a suitable extension of the equilibrium operator. We also develop a rigorous approach aimed at expressing the variance of transformed random variables. This is based on a joint distribution which, in turn, involves the variance of the original random variable, as well as its mean residual lifetime and mean inactivity time. Then we provide applications to the additive hazards model and to some well-known random variables of interest in actuarial science. These deal with a new notion, called the ‘centred mean residual lifetime’, and a suitably related stochastic order. Finally, we also address the analysis of the differences of the variances of transformed discrete random variables thanks to the use of a discrete version of the equilibrium operator.
This study aims to report our experience with endoscopic tenotomy in treatment of Ménière’s disease as its reported role in literature is still controversial.
Methods
Patients diagnosed with unilateral definite Ménière’s disease and underwent endoscopic tenotomy of middle-ear muscles in our tertiary care centre were retrospectively evaluated. Pure tone average, frequency of vertiginous attacks, functional level, tinnitus scale and Dizziness Handicap Inventory were compared pre-operatively and post-operatively.
Results
Twenty-eight cases were included in the study with an average age of 50.78 ± 12.16 years. At the 2-year follow-up period, 16 cases (57.14 per cent) achieved complete control of vertigo, 5 cases (17.85 per cent) had substantial vertigo control, and 3 cases (10.71 per cent) had limited control. Significant improvement in Dizziness Handicap Inventory and functional level also was found post-operatively.
Conclusion
Endoscopic tenotomy for Ménière’s disease is easy and simple with no serious complications, but its relatively low results of absolute vertigo control limit its consideration as a definitive treatment.
Pronatalist policies are on the rise in many countries. These have stemmed from several motivators, including economic concerns, nationalism, and promotion of traditional family values. As global fertility rates have fallen, many countries have instilled pronatalist policies to encourage people to have more children. In other countries, including the United States, religious traditionalism and nationalist forces have fueled pronatalist policies as a counter to improved female empowerment and global immigration. No matter the stated motivation, government-sanctioned pronatalism overtly leads to reproductive coercion or covertly results in limited reproductive autonomy as collateral damage. Herein, we review global examples of prior and current pronatalist policies, outlining the motivators for their promotion within each case. We demonstrate how these policies are not only ineffective, but are dangerous to the health and well-being of women and other populations and are in direct conflict with modern reproductive goals, reproductive justice, and decades of efforts towards achieving gender parity.
Resilient enterprises thrive under adverse conditions given their preparedness for crises. This study proposes that executives’ vigilant managerial cognition is essential for enhancing enterprise resilience. To measure this cognition, the study developed a textual index using machine learning methods and analyzed a sample of Chinese enterprises to assess the impact of executives’ vigilant managerial cognition on enterprise resilience. The findings indicate that this cognition is positively related to enterprise resilience, where the relationship is stronger in enterprises with robust internal controls. The primary contribution of this study is the conceptualization of vigilant managerial cognition and its established positive relationship with enterprise resilience. Furthermore, by introducing a novel quantitative measure of managerial cognition through textual analysis and machine learning, the study paves the way for future research on managerial cognition within firms.
The conventional historiography of eighteenth-century Prussia portrays peasants as completely dominated by their imperious Junker superiors. Since the 1980s, a revisionist tendency has challenged this asymmetrical picture of lord-peasant relations, downplaying the oppressiveness of the manorial system and arguing that peasants were equally capable competitors in the “tug-of-war” with their lords. This article evaluates the revisionists’ claims using the historical findings they, and others, have produced about the relationship of lords and peasants in rural Prussia. The evidence supports the contention that peasants were, to a significant extent, the victims of the Prussian manorial system.
We explore debt and debt management among older Americans (ages 51–61 years) using the 2018 National Financial Capability Study. Though these individuals should have been at the peak of their retirement savings, we show that many were heavily indebted, often due to unpaid medical bills and student loans. Additionally, fewer than half (43%) could correctly answer three basic financial literacy questions; importantly, less financially literate people were more likely to hold excessive debt, be contacted by debt collectors, and carry medical debt or student loans. Our findings show that, even before the pandemic, a sizable proportion of older Americans was financially distressed, underscoring the need for researchers and policymakers to devote attention to specific types of debt that burden the older population. Particularly vulnerable groups include African-Americans, women, and the least-educated.
The gambler’s ruin problem for correlated random walks (CRWs), both with and without delays, is addressed using the optional stopping theorem for martingales. We derive closed-form expressions for the ruin probabilities and the expected game duration for CRWs with increments $\{1,-1\}$ and for symmetric CRWs with increments $\{1,0,-1\}$ (CRWs with delays). Additionally, a martingale technique is developed for general CRWs with delays. The gambler’s ruin probability for a game involving bets on two arbitrary patterns is also examined.
Nutrition education is crucial for improving nutritional knowledge. This study aims to evaluate the impact of healthy nutrition education on hedonic hunger, adherence to the Mediterranean diet and self-efficacy for healthy eating among early adolescence. This one-group, pre-test-post-test, quasi-experimental study included 202 middle-school students. Data were collected using a researcher-designed survey that included demographic variables, the Children’s Power of Food Scale, the Self-Efficacy for Healthy Eating Scale, the Mediterranean Diet Score and the Brief Nutritional Knowledge Assessment Form. Anthropometric measurements (weight, height, waist circumference, hip circumference and neck circumference) were also taken. After the pre-test, each student received 2 h of healthy nutrition education. A follow-up survey was administered 4 weeks later. The study revealed that most early adolescents exhibited unhealthy dietary habits, such as skipping main meals (15·3 % all the time and 60·2 % occasionally), snacking on sweet treats (33·3 %) and having irregular eating patterns (47·4 %). Additionally, the early adolescents had higher weights, BMI, neck circumferences and heights compared with reference values (P < 0·01). Significant changes were observed post-intervention: lower hedonic hunger scores (beginning: 2·90 (sd 0·68), follow-up: 2·70 (sd 0·76), P < 0·01), decreased self-efficacy for healthy eating (beginning: 5·41 (sd 3·50), follow-up: 4·33 (sd 3·61), P < 0·01) and increased knowledge about healthy nutrition (beginning: 67·23 (sd 14·39), follow-up: 80·00 (sd 17·22), P < 0·01). This study highlighted that healthy nutrition education enhances nutritional knowledge and decreases hedonic dietary tendencies among early adolescents. Continued nutrition education may further improve children’s preferences for healthy foods.
Adjunctive intraarterial (IA) thrombolysis after endovascular thrombectomy may improve clinical outcomes in patients with large vessel occlusion (LVO) stroke possibly due to improvement in microvascular reperfusion.
Methods:
We conducted a meta-analysis of randomized controlled trials (RCTs) evaluating IA thrombolysis with tenecteplase, alteplase or urokinase in anterior or posterior circulation LVO stroke after successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b–3). Efficacy outcomes were excellent functional outcome (modified Rankin Scale [mRS] 0–1), functional independence (mRS 0–2) and recovery without any disability (mRS 0) at 90 days. Safety outcomes included symptomatic intracerebral hemorrhage (ICH), any ICH and death. Odds ratios (OR) and 95% confidence intervals (CI) were pooled using random-effects models.
Results:
Seven RCTs (n = 2,130; 2022–2025) were included. IA thrombolytic drugs used were alteplase, tenecteplase and urokinase with doses ranging from 10 % to 50% of recommended IV dosage. IA thrombolysis significantly improved excellent functional outcome (mRS 0–1: OR 1.45, 95% CI 1.19–1.76) and recovery without any disability (mRS 0: OR 1.34, 95% CI 1.09–1.64), without safety risks (symptomatic ICH: 5.05% with IA thrombolytics vs. 4.49% in standard). Paradoxically, there was no difference in functional independence (mRS 0–2) (OR 1.09, 95% CI 0.99–1.20). Additionally, tenecteplase or alteplase at doses equivalent to 25% or 50% of recommended IV dosage significantly improved excellent functional outcome.
Conclusions:
IA thrombolysis offered immediately following EVT with successful reperfusion improved excellent functional outcome and recovery without disability at 90 days with an acceptable safety profile.
This paper presents the design, implementation, and characterization of a compact two-stage analog phase-shifter for the Ka-band, based on thin-film technology. The design utilizes a reflective-type configuration, employing four metal-insulator-graphene diodes as reflective loads. The fabricated prototype is realized on an 8-µ m-thick flexible polyimide substrate and occupies less than 0.7 mm2 of chip area including the contact pads. Performance evaluation of the fabricated circuit reveals an S11 of better than −13 dB and an S21 of −3.3 dB with a tolerance of ± 0.5 dB across the frequency band from 28 to 36 GHz, along with a tunable phase difference ($\Delta\phi$) exceeding 70∘. The introduced flexible thin-film technology promotes the realization of flexible cost-effective beam steering for smart surfaces implementations for communication and biomedical applications.
The advent of new technologies, particularly artificial intelligence (AI), has expanded the array of options and enhanced performance in addressing biothreats. This article provides a comprehensive overview of the specific applications of AI in addressing biothreats, aiming to inform and enhance future practices. Research indicates that AI has significantly contributed to infectious disease surveillance and emergency responses, as well as bioterrorism mitigation; despite its limitations, it merits ongoing attention for further study and exploration. The effective deployment of next-generation AI in mitigating biothreats will largely hinge on our ability to engage in continuous experiential learning, acquire high-quality data, refine algorithms, and iteratively update practices. Meanwhile, it is essential to assess the operational risks associated with AI in the context of biothreats and develop robust solutions to mitigate potential risks.
Synthetic-aperture radar images and mesoscale models show that wind-farm wakes differ from single-turbine wakes. For instance, wind-farm wakes often narrow and do not disperse over long distances, contrasting the broader and more dissipating wakes of individual turbines. In this work, we aim to better understand the mechanisms that govern wind-farm wake behaviour and recovery. Hence we study the wake properties of a $1.6$ GW wind farm operating in conventionally neutral boundary layers with capping-inversion heights $203$, $319$, $507$ and $1001$ m. In shallow boundary layers, we find strong flow decelerations that reduce the Coriolis force magnitude, leading to an anticlockwise wake deflection in the Northern Hemisphere. In deep boundary layers, the vertical turbulent entrainment of momentum adds clockwise-turning flow from aloft into the wake region, leading to a faster recovery rate and a clockwise wake deflection. To estimate the wake properties, we propose a simple function to fit the velocity magnitude profiles along the spanwise direction. In the vertical direction, the wake spreads up to the capping-inversion height, which significantly limits vertical wake development in shallow-boundary-layer cases. In the horizontal direction and for shallow boundary layers, the wake behaves as two distinct mixing layers located at the lateral wake edges, which expand and turn towards their low-velocity side, causing the wake to narrow along the streamwise direction. A detailed analysis of the momentum budget reveals that in deep boundary layers, the wake is predominantly replenished through turbulent vertical entrainment. Conversely, in shallow boundary layers, wakes are mostly replenished by mean flow advection in the spanwise direction.
Bubble–particle collisions in turbulence are key to the froth flotation process that is widely employed industrially to separate hydrophobic from hydrophilic materials. In our previous study (Chan et al., 2023 J. Fluid Mech.959, A6), we elucidated the collision mechanisms and critically reviewed the collision models in the no-gravity limit. In reality, gravity may play a role since, ultimately, separation is achieved through buoyancy-induced rising of the bubbles. This effect has been included in several collision models, which have remained without a proper validation thus far due to a scarcity of available data. We therefore conduct direct numerical simulations of bubbles and particles in homogeneous isotropic turbulence with various Stokes, Froude and Reynolds numbers, and particle density ratios using the point-particle approximation. Generally, turbulence enhances the collision rate compared with the pure relative settling case by increasing the collision velocity. Surprisingly, however, for certain parameters the collision rate is lower with turbulence compared with without, independent of the history force. This is due to turbulence-induced bubble–particle spatial segregation, which is most prevalent at weak relative gravity and decreases as gravitational effects become more dominant, and reduced bubble slip velocity in turbulence. The existing bubble–particle collision models only qualitatively capture the trends in our numerical data. To improve on this, we extend the model by Dodin & Elperin (2002 Phys. Fluids14, 2921–2924) to the bubble–particle case and found excellent quantitative agreement for small Stokes numbers when the history force is negligible and segregation is accounted for.
Research informed by sociological neoinstitutionalism often frames organizational reactions to legal norms as either loose coupling, where formal legal commitments are only weakly aligned with actual practices, or tight coupling, where strong internal or external compliance pressures drive close alignment. This article introduces a third pattern – contentious coupling – where some organizational members attempt to realign practices with legal commitments, but these very efforts provoke pushback from others, resulting in substantive yet constrained success. This paradox is key to understanding the widespread yet limited effects of legal rights. I illustrate contentious coupling by examining how international human rights law has shaped solitary confinement reform in Taiwan. While hierarchical enforcement led by rights advocates and policymakers has successfully reduced prolonged solitary confinement, it has also alienated frontline correctional officers by triggering a sense of relative deprivation and perception of hypocrisy, encapsulated in their complaints of a “human rights upsurge.” In response, these officers engage in two forms of passive resistance – formalistic care and resistance spillover – both of which undermine the authority of human rights and hinder their capacity to transform correctional culture.