Language is the primary technology clinical ethicists use as they offer guidance about norms. Like any other piece of technology, to use the technology well requires attention, intention, skill, and knowledge. Word choice becomes a matter of professional practice. The Brief Report offers clinical ethicists several reasons for rejecting the phrase “aggressive care.” Instead, ethicists should consider replacing “aggressive care” with the adjacent concept of a “recovery-focused path.” The virtues of this neologism include: the opportunity to set aside the emotion of “aggression,” the phrase’s accuracy when capturing the intention of the patient or their representative, and an unappreciated rhetorical force—and transparent logic—that arises when the patient’s recovery is unlikely.

We study how the Conditioning on Added Regression Predictions (CARP) statistics from different item pairs can be aggregated into a single overall test of monotone homogeneity. As a pairwise statistic, we use the mean conditional covariance (MCC) or its standardized value ($Z$). We use three different estimates of the covariance matrix of the pairwise test statistics: (1) the covariance matrix of the MCCs, based on the sample moments; (2) the covariance matrix of the MCCs or $Z$s, based on bootstrapping; and (3) the covariance matrix of the $Z$s, equated to the identity matrix. We consider various aggregation methods, including (a) the chi-bar-square statistic; (b) the preselected standardized partial sum of pairwise statistics; (c) the product of preselected $p$-values; (d) the minimum of preselected $p$-values; and (e–h) the same statistics, but now conditioned on post-selecting only the negative values in the test sample. We study the Type 1 error rate and power of the ensuing 20 tests based on simulations. The tests with the highest power among the tests that control the Type I error rate are based on $Z$-statistics with the identity matrix: the conditional likelihood ratio test, the conditionalized product of $p$-values, the conditionalized sum of Z-values, and the preselected product of $p$-values.

In redundancy analysis (RA), the redundancy variates are interpreted in terms of the predictor variables that have the prominent redundancy loadings. Israels (1986) advocated the rotation of redundancy loadings to facilitate the interpretation of the rotated redundancy variates. In this paper, the purpose is to obtain the standard error estimates for rotated redundancy loadings that can facilitate the interpretation of the rotated redundancy variates. To this end, we modify the original RA-L model (Gu et al., 2023) and specify two modified RA-L models for orthogonal and oblique rotations, separately. On the basis of the modified RA-L models, we describe the infinitesimal jackknife (IJ) method that can produce the standard error estimates for rotated RA estimates. A simulation study is conducted to validate the standard error estimates from the IJ method, and two real examples are used to demonstrate the use of the standard error estimates for rotated redundancy loadings. Finally, we summarize the paper and provide additional remarks regarding the rotation methods and the use of numeric derivatives in the implementation of the IJ method.

Survey questionnaires are commonly used by psychologists and social scientists to measure various latent traits of study subjects. Various causal inference methods such as the potential outcome framework and structural equation models have been used to infer causal effects. However, the majority of these methods assume the knowledge of true causal structure, which is unknown for many applications in psychological and social sciences. This calls for alternative causal approaches for analyzing such questionnaire data. Bayesian networks are a promising option as they do not require causal structure to be known a priori but learn it objectively from data. Although we have seen some recent successes of using Bayesian networks to discover causality for psychological questionnaire data, their techniques tend to suffer from causal non-identifiability with observational data. In this paper, we propose the use of a state-of-the-art Bayesian network that is proven to be fully identifiable for observational ordinal data. We develop a causal structure learning algorithm based on an asymptotically justified BIC score function, a hill-climbing search strategy, and the bootstrapping technique, which is able to not only identify a unique causal structure but also quantify the associated uncertainty. Using simulation studies, we demonstrate the power of the proposed learning algorithm by comparing it with alternative Bayesian network methods. For illustration, we consider a dataset from a psychological study of the functional relationships among the symptoms of obsessive-compulsive disorder and depression. Without any prior knowledge, the proposed algorithm reveals some plausible causal relationships. This paper is accompanied by a user-friendly open-source R package OrdCD on CRAN.

This study aimed to investigate the effects of physical multimorbidity on the trajectory of cognitive decline over 17 years and whether vary across wealth status. The study was conducted in 9035 respondents aged 50+ at baseline from nine waves (2002–2019) of the English Longitudinal Study of Aging. A latent class analysis was used to identify patterns of physical multimorbidity, and mixed multilevel models were performed to determine the association between physical multimorbidity and trajectories of cognitive decline. Joint analyses were conducted to further verify the influence of wealth status. Four patterns of physical multimorbidity were identified. Mixed multilevel models with quadratic terms of time and status/patterns indicated significant non-linear trajectories of multimorbidity on cognitive function. The magnitude of the association between complex multisystem patterns and cognitive decline increased the most as follow-up progressed. Individuals with high wealth and hypertension/diabetes patterns have significantly lower composite global cognitive z scores over time as compared with respiratory/osteoporosis patterns. Physical multimorbidity at baseline is associated with the trajectory of cognitive decline, and the magnitude of the association increased over time. The trend of cognitive decline differed in specific combinations of wealth status and physical multimorbidity.

Crowdsourcing platforms—such as Vivino—that aggregate the opinions of large numbers of amateur wine reviewers represent a new source of information on the wine market. We assess the validity of aggregated Vivino ratings based on two criteria: correlation with professional critics’ ratings and sensitivity to weather conditions affecting the quality of grapes. We construct a large, novel dataset consisting of Vivino ratings for a portfolio of red wines from Bordeaux, review scores from professional critics, and weather data from a local weather station. Vivino ratings correlate substantially with those of professional critics, but these correlations are smaller than those among professional critics. This difference can be partly attributed to differences in scope: Whereas amateurs focus on immediate pleasure, professionals gauge the wine’s potential once it has matured. Moreover, both crowdsourced and professional ratings respond to weather conditions in line with what viticulture literature has identified as ideal, but also hint to detrimental effects of global warming on wine quality. In sum, our results demonstrate that crowdsourced ratings are a valid source of information and can generate valuable insights for both consumers and producers.

Sleep value is the relative worth individuals assign to sleep. We previously found that individual differences in several sleep value subfactors relate to demographic, health and sleep variables. Given the pivotal role values play in health behavior and the positive association between sleep value and sleep disturbance, individual differences in sleep value may influence vulnerability/resilience to sleep and circadian disturbance. This survey study (N = 455) aimed to establish the latent factor structure of sleep value and identify whether sleep value profiles relate to demographic and sleep characteristics. Factor analysis on the Sleep Valuation Item Bank 2.0 identified five factors (wanting, prioritizing, devaluing, appreciating and preferring). Latent profile analyses revealed five distinct sleep value profiles (unconcerned, appreciative, devalue, ambivalent priority and concerned). Depression, sleep disturbance and sleep-related impairment were highest among those who highly value sleep (concerned profile) and lowest among those who neither value nor devalue sleep (unconcerned profile). Findings suggest sleep value is a complex aspect of sleep health rather than a “more is better” construct and highlight that individual differences in sleep value profiles may be associated with vulnerability/resilience to sleep disturbance.

We analyzed the oxygen isotope composition of biogenic apatite phosphate (δ18Op) in fossil tooth enameloid to investigate the paleoecology of Late Cretaceous sharks in the Gulf Coastal Plain of Alabama, USA. We analyzed six different shark taxa from both the Mooreville Chalk and the Blufftown Formation. We compared shark δ18Op with the δ18Op of a co-occurring poikilothermic bony fish Enchodus petrosus as a reference for ambient conditions. Enchodus petrosus tooth enamel δ18Op values are similar between formations (21.3‰ and 21.4‰ Vienna Standard Mean Ocean Water [VSMOW], respectively), suggesting minimal differences in water δ18O between formations. Most shark taxa in this study are characterized by δ18Op values that overlap with E. petrosus values, indicating they likely lived in similar habitats and were also poikilothermic. Ptychodus mortoni and Cretoxyrhina mantelli exhibit significantly lower δ18Op values than co-occurring E. petrosus (P. mortoni δ18Op is 19.1‰ VSMOW in the Mooreville Chalk; C mantelli δ18Op is 20.2‰ VSMOW in the Mooreville Chalk and 18.1‰ VSMOW in the Blufftown Formation). Excursions into brackish or freshwater habitats and thermal water-depth gradients are unlikely explanations for the lower P. mortoni and C. mantelli δ18Op values. The low P. mortoni δ18Op value is best explained by higher body temperature relative to surrounding temperatures due to active heating (e.g., mesothermy) or passive heating due to its large body size (e.g., gigantothermy). The low C. mantelli δ18Op values are best explained by a combination of mesothermy (e.g., active heating) and migration (e.g., from the Western Interior Seaway, low-latitude warmer waters, or the paleo–Gulf Stream), supporting the hypothesis that mesothermy evolved in lamniform shark taxa during the Late Cretaceous. If the anomalous P. mortoni δ18Op values are also driven by active thermoregulation, this suggests that mesothermy evolved independently in multiple families of Late Cretaceous sharks.

This paper introduces a novel fiber-based picosecond burst-mode laser system capable of operating at high power and high repetition rates. A pulse-circulating fiber ring was developed as a burst generator, achieving an intra-burst repetition rate of 469 MHz without the need for a high-repetition-rate seed source. This design also allows for flexible adjustment of the number of sub-pulses, burst repetition rate and burst shape. In addition, a master oscillator power amplifier was employed to analyze the amplification characteristics of bursts. The system demonstrated a maximum average power of 606 W, with a measured sub-pulse duration of 62 ps and the highest sub-pulse peak power of 980 kW. To the best of our knowledge, this marks the highest average power obtained in burst-mode ultrafast lasers. Such a laser system holds potential for applications in precision manufacturing, high-speed imaging, high-precision ranging and other diverse domains.

Risk-based surveillance is now a well-established paradigm in epidemiology, involving the distribution of sampling efforts differentially in time, space, and within populations, based on multiple risk factors. To assess and map the risk of the presence of the bacterium Xylella fastidiosa, we have compiled a dataset that includes factors influencing plant development and thus the spread of such harmful organism. To this end, we have collected, preprocessed, and gathered information and data related to land types, soil compositions, and climatic conditions to predict and assess the probability of risk associated with X. fastidiosa in relation to environmental features. This resource can be of interest to researchers conducting analyses on X. fastidiosa and, more generally, to researchers working on geospatial modeling of risk related to plant infectious diseases.

The normative principle that every individual is equally entitled to continued life is a subject of debate in ethics, health economics and policy. We reconsider this principle in the context of setting priorities for healthcare interventions. When applied without restriction, the principle overlooks quality of life concerns entirely. However, we contend that it remains ethically relevant in certain situations, particularly when patients suffer from conditions unrelated to the therapeutic areas and treatments under consideration. Thus, we defend the principle while also emphasizing the need for its application within tight limits.

Variations in stable oxygen isotopic compositions in sea ice provide information on environmental conditions during sea ice formation and also are important in understanding the regional and temporal aspects of the fresh water budget of the Arctic Ocean. We analyzed the oxygen isotope fractionation between sea ice and sea water using ice core and surface ocean samples obtained in a field study in the Lincoln Sea/Switchyard region of the Arctic Ocean. Using the Sea Ice Tracking Utility, we track the sea ice backward in time along drift trajectories, and use a simple model to calculate ice growth rates. Our results indicate that sea ice at the bottom of the floes that we sampled in the Switchyard Region grew within the past winter along a trajectory extending back to the North Pole. The effective fractionation coefficients from the bottom ice layers and the parent water mass are close to 2.11‰ with a standard error of ±0.06‰. Knowing this sea-ice oxygen isotope fractionation coefficient for high Arctic drifting ice is critical for use of equations for mass balance, salinity, oxygen isotopes and nutrients to calculate water mass fractions and sources to understand freshwater balance.

The relation between epistemic relativism and epistemic oppression is contentious but undertheorized. Both positions rest on one or the other version of the situated knowledge thesis, based on the idea that access to and justification of knowledge is dependent on a particular context or, to be precise, an epistemic system. Whether this notion is coextensive in both schools of thought is, however, unclear. In this article, I aim to examine the relation between epistemic relativism and epistemic oppression by analyzing the notion of “epistemic system.” Through this analysis, I shall argue that the epistemic relativism literature has neglected power imbalances within epistemic systems since it rests on idealizing epistemic systems to sets of epistemic principles. Understanding epistemic systems as necessarily social and political, I then confront the idea formulated in the epistemic oppression literature that some forms of oppression are “irreducibly epistemic.” I argue that epistemic principles can never fully determine their applications and thus essentially require the social. Thus, insisting on the “irreducibly epistemic” might not be a favorable option for epistemic oppression or epistemic relativism scholarship.