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Declining labor force participation of older men throughout the 20th century and recent increases in participation have generated substantial interest in understanding the effect of public pensions on retirement. The National Bureau of Economic Research's International Social Security (ISS) Project, a long-term collaboration among researchers in a dozen developed countries, has explored this and related questions. The project employs a harmonized approach to conduct within-country analyses that are combined for meaningful cross-country comparisons. The key lesson is that the choices of policy makers affect the incentive to work at older ages and these incentives have important effects on retirement behavior.
White matter hyperintensity (WMH) burden is greater, has a frontal-temporal distribution, and is associated with proxies of exposure to repetitive head impacts (RHI) in former American football players. These findings suggest that in the context of RHI, WMH might have unique etiologies that extend beyond those of vascular risk factors and normal aging processes. The objective of this study was to evaluate the correlates of WMH in former elite American football players. We examined markers of amyloid, tau, neurodegeneration, inflammation, axonal injury, and vascular health and their relationships to WMH. A group of age-matched asymptomatic men without a history of RHI was included to determine the specificity of the relationships observed in the former football players.
Participants and Methods:
240 male participants aged 45-74 (60 unexposed asymptomatic men, 60 male former college football players, 120 male former professional football players) underwent semi-structured clinical interviews, magnetic resonance imaging (structural T1, T2 FLAIR, and diffusion tensor imaging), and lumbar puncture to collect cerebrospinal fluid (CSF) biomarkers as part of the DIAGNOSE CTE Research Project. Total WMH lesion volumes (TLV) were estimated using the Lesion Prediction Algorithm from the Lesion Segmentation Toolbox. Structural equation modeling, using Full-Information Maximum Likelihood (FIML) to account for missing values, examined the associations between log-TLV and the following variables: total cortical thickness, whole-brain average fractional anisotropy (FA), CSF amyloid ß42, CSF p-tau181, CSF sTREM2 (a marker of microglial activation), CSF neurofilament light (NfL), and the modified Framingham stroke risk profile (rFSRP). Covariates included age, race, education, APOE z4 carrier status, and evaluation site. Bootstrapped 95% confidence intervals assessed statistical significance. Models were performed separately for football players (college and professional players pooled; n=180) and the unexposed men (n=60). Due to differences in sample size, estimates were compared and were considered different if the percent change in the estimates exceeded 10%.
Results:
In the former football players (mean age=57.2, 34% Black, 29% APOE e4 carrier), reduced cortical thickness (B=-0.25, 95% CI [0.45, -0.08]), lower average FA (B=-0.27, 95% CI [-0.41, -.12]), higher p-tau181 (B=0.17, 95% CI [0.02, 0.43]), and higher rFSRP score (B=0.27, 95% CI [0.08, 0.42]) were associated with greater log-TLV. Compared to the unexposed men, substantial differences in estimates were observed for rFSRP (Bcontrol=0.02, Bfootball=0.27, 994% difference), average FA (Bcontrol=-0.03, Bfootball=-0.27, 802% difference), and p-tau181 (Bcontrol=-0.31, Bfootball=0.17, -155% difference). In the former football players, rFSRP showed a stronger positive association and average FA showed a stronger negative association with WMH compared to unexposed men. The effect of WMH on cortical thickness was similar between the two groups (Bcontrol=-0.27, Bfootball=-0.25, 7% difference).
Conclusions:
These results suggest that the risk factor and biological correlates of WMH differ between former American football players and asymptomatic individuals unexposed to RHI. In addition to vascular risk factors, white matter integrity on DTI showed a stronger relationship with WMH burden in the former football players. FLAIR WMH serves as a promising measure to further investigate the late multifactorial pathologies of RHI.
How do people make everyday decisions in order to achieve the most successful outcome? Decision making research typically evaluates choices according to their expected utility. However, this research largely focuses on abstract or hypothetical tasks and rarely investigates whether the outcome is successful and satisfying for the decision maker. Instead, we use an everyday decision making task in which participants describe a personally meaningful decision they are currently facing. We investigate the decision processes used to make this decision, and evaluate how successful and satisfying the outcome of the decision is for them. We examine how well analytic, attribute-based processes explain everyday decision making and predict decision outcomes, and we compare these processes to associative processes elicited through free association. We also examine the characteristics of decisions and individuals that are associated with good decision outcomes. Across three experiments we found that: 1) an analytic decision analysis of everyday decisions is not superior to simpler attribute-based processes in predicting decision outcomes; 2) contrary to research linking associative cognition to biases, free association generates valid cues that predict choice and decision outcomes as effectively as attribute-based approaches; 3) contrary to research favouring either attribute-based or associative processes, combining both attribute-based and associates best explains everyday decisions and most accurately predicts decision outcomes; and 4) individuals with a tendency to attempt analytic thinking do not make more successful everyday decisions. Instead, frequency, simplicity, and knowledge of the decision predict success. We propose that attribute-based and associative processes, in combination, both explain everyday decision making and predict successful decision outcomes.
Multiple guidelines recommend discontinuation of prophylactic antibiotics <24 hours after surgery. In a multicenter, retrospective cohort of 2,954 mastectomy patients ± immediate breast reconstruction, we found that utilization of prophylactic postdischarge antibiotics varied dramatically at the surgeon level among general surgeons and was virtually universal among plastic surgeons.
Cognitive behavior therapy (CBT) is effective for most patients with a social anxiety disorder (SAD) but a substantial proportion fails to remit. Experimental and clinical research suggests that enhancing CBT using imagery-based techniques could improve outcomes. It was hypothesized that imagery-enhanced CBT (IE-CBT) would be superior to verbally-based CBT (VB-CBT) on pre-registered outcomes.
Methods
A randomized controlled trial of IE-CBT v. VB-CBT for social anxiety was completed in a community mental health clinic setting. Participants were randomized to IE (n = 53) or VB (n = 54) CBT, with 1-month (primary end point) and 6-month follow-up assessments. Participants completed 12, 2-hour, weekly sessions of IE-CBT or VB-CBT plus 1-month follow-up.
Results
Intention to treat analyses showed very large within-treatment effect sizes on the social interaction anxiety at all time points (ds = 2.09–2.62), with no between-treatment differences on this outcome or clinician-rated severity [1-month OR = 1.45 (0.45, 4.62), p = 0.53; 6-month OR = 1.31 (0.42, 4.08), p = 0.65], SAD remission (1-month: IE = 61.04%, VB = 55.09%, p = 0.59); 6-month: IE = 58.73%, VB = 61.89%, p = 0.77), or secondary outcomes. Three adverse events were noted (substance abuse, n = 1 in IE-CBT; temporary increase in suicide risk, n = 1 in each condition, with one being withdrawn at 1-month follow-up).
Conclusions
Group IE-CBT and VB-CBT were safe and there were no significant differences in outcomes. Both treatments were associated with very large within-group effect sizes and the majority of patients remitted following treatment.
Despite recommendations to discontinue prophylactic antibiotics after incision closure or <24 hours after surgery, prophylactic antibiotics are continued after discharge by some clinicians. The objective of this study was to determine the prevalence and factors associated with postdischarge prophylactic antibiotic use after spinal fusion.
Design:
Multicenter retrospective cohort study.
Patients:
This study included patients aged ≥18 years undergoing spinal fusion or refusion between July 2011 and June 2015 at 3 sites. Patients with an infection during the surgical admission were excluded.
Methods:
Prophylactic antibiotics were identified at discharge. Factors associated with postdischarge prophylactic antibiotic use were identified using hierarchical generalized linear models.
Results:
In total, 8,652 spinal fusion admissions were included. Antibiotics were prescribed at discharge in 289 admissions (3.3%). The most commonly prescribed antibiotics were trimethoprim/sulfamethoxazole (22.1%), cephalexin (18.8%), and ciprofloxacin (17.1%). Adjusted for study site, significant factors associated with prophylactic discharge antibiotics included American Society of Anesthesiologists (ASA) class ≥3 (odds ratio [OR], 1.31; 95% CI, 1.00–1.70), lymphoma (OR, 2.57; 95% CI, 1.11–5.98), solid tumor (OR, 3.63; 95% CI, 1.62–8.14), morbid obesity (OR, 1.64; 95% CI, 1.09–2.47), paralysis (OR, 2.38; 95% CI, 1.30–4.37), hematoma/seroma (OR, 2.93; 95% CI, 1.17–7.33), thoracic surgery (OR, 1.39; 95% CI, 1.01–1.93), longer length of stay, and intraoperative antibiotics.
Conclusions:
Postdischarge prophylactic antibiotics were uncommon after spinal fusion. Patient and perioperative factors were associated with continuation of prophylactic antibiotics after hospital discharge.
In October 2017, the American Association of Blood Bankers (AABB; Bethesda, Maryland USA) approved a petition to allow low-titer group O whole blood as a standard product without the need for a waiver. Around that time, a few Texas, USA-based Emergency Medical Services (EMS) systems incorporated whole blood into their ground ambulances. The purpose of this project was to describe the epidemiology of ground ambulance patients that received a prehospital whole blood transfusion. The secondary aim of this project was to report an accounting analysis of these ground ambulance prehospital whole blood programs.
Methods:
The dataset came from the Harris County Emergency Service District 48 Fire Department (HCESD 48; Harris County, Texas USA) and San Antonio Fire Department (SAFD; San Antonio, Texas USA) whole blood Quality Assurance/Quality Improvement (QA/QI) databases from September 2017 through December 2018. The primary outcome of this study was the prehospital transfusion indication. The secondary outcome was the projected cost per life saved during the first 10 years of the prehospital whole blood initiative.
Results:
Of 58 consecutive prehospital whole blood administrations, the team included all 58 cases. Hemorrhagic shock from a non-traumatic etiology accounted for 46.5% (95% CI, 34.3%-59.2%) of prehospital whole blood recipients. In the non-traumatic hemorrhagic shock cohort, gastrointestinal hemorrhage was the underlying etiology of hemorrhagic shock in 66.7% (95% CI, 47.8%-81.4%) of prehospital whole blood transfusion recipients. The projected average cost to save a life in Year 10 was US$5,136.51 for the combined cohort, US$4,512.69 for HCESD 48, and US$5,243.72 for SAFD EMS.
Conclusion:
This retrospective analysis of ground ambulance patients that receive prehospital whole blood transfusion found that non-traumatic etiology accounted for 46.5% (95% CI, 34.3%-59.2%) of prehospital whole blood recipients. Additionally, the accounting analysis suggests that by Year 10 of a ground ambulance whole blood transfusion program, the average cost to save a life will be approximately US$5,136.51.
The Huanglongpu carbonatites are located in the north-western part of the Qinling orogenic belt in central China. Calcite carbonatite dykes at the Dashigou open pit are unusual due to their enrichment in heavy rare earth elements (HREE) relative to light rare earth elements (LREE), leading to a flat REE pattern, and in that the majority of dykes have a quartz core. They also host economic concentrations of molybdenite. The calcite carbonatite dykes show two styles of mineralogy according to the degree of hydrothermal reworking, and these are reflected in REE distribution and concentration. The REE in the little-altered calcite carbonatite occur mostly in magmatic REE minerals, mainly monazite-(Ce), and typically have ΣLREE/(HREE+Y) ratios from 9.9 to 17. In hydrothermally altered calcite carbonatites, magmatic monazite-(Ce) is partially replaced to fully replaced by HREE-enriched secondary phases and the rocks have ΣLREE/(HREE+Y) ratios from 1.1 to 3.8. The fluid responsible for hydrothermal REE redistribution is preserved in fluid inclusions in the quartz lenses. The bulk of the quartz lacks fluid inclusions but is cut by two later hydrothermal quartz generations, both containing sulfate-rich fluid inclusions with sulfate typically present as multiple trapped solids, as well as in solution. The estimated total sulfate content of fluid inclusions ranges from 6 to >33 wt.% K2SO4 equivalent. We interpret these heterogeneous fluid inclusions to be the result of reaction of sulfate-rich fluids with the calcite carbonatite dykes. The final HREE enrichment is due to a combination of factors: (1) the progressive HREE enrichment of later magmatic calcite created a HREE-enriched source; (2) REE–SO42– complexing allowed the REE to be redistributed without fractionation; and (3) secondary REE mineralisation was dominated by minerals such as HREE-enriched fluorocarbonates, xenotime-(Y) and churchite-(Y) whose crystal structures tends to favour HREE.
Sulfur-bearing monazite-(Ce) occurs in silicified carbonatite at Eureka, Namibia, forming rims up to ~0.5 mm thick on earlier-formed monazite-(Ce) megacrysts. We present X-ray photoelectron spectroscopy data demonstrating that sulfur is accommodated predominantly in monazite-(Ce) as sulfate, via a clino-anhydrite-type coupled substitution mechanism. Minor sulfide and sulfite peaks in the X-ray photoelectron spectra, however, also indicate that more complex substitution mechanisms incorporating S2– and S4+ are possible. Incorporation of S6+ through clino-anhydrite-type substitution results in an excess of M2+ cations, which previous workers have suggested is accommodated by auxiliary substitution of OH– for O2–. However, Raman data show no indication of OH–, and instead we suggest charge imbalance is accommodated through F– substituting for O2–. The accommodation of S in the monazite-(Ce) results in considerable structural distortion that may account for relatively high contents of ions with radii beyond those normally found in monazite-(Ce), such as the heavy rare earth elements, Mo, Zr and V. In contrast to S-bearing monazite-(Ce) in other carbonatites, S-bearing monazite-(Ce) at Eureka formed via a dissolution–precipitation mechanism during prolonged weathering, with S derived from an aeolian source. While large S-bearing monazite-(Ce) grains are likely to be rare in the geological record, formation of secondary S-bearing monazite-(Ce) in these conditions may be a feasible mineral for dating palaeo-weathering horizons.
In the context of a motivating study of dynamic network flow data on a large-scale e-commerce website, we develop Bayesian models for online/sequential analysis for monitoring and adapting to changes reflected in node–node traffic. For large-scale networks, we customize core Bayesian time series analysis methods using dynamic generalized linear models (DGLMs). These are integrated into the context of multivariate networks using the concept of decouple/recouple that was recently introduced in multivariate time series. This method enables flexible dynamic modeling of flows on large-scale networks and exploitation of partial parallelization of analysis while maintaining coherence with an over-arching multivariate dynamic flow model. This approach is anchored in a case study on Internet data, with flows of visitors to a commercial news website defining a long time series of node–node counts on over 56,000 node pairs. Central questions include characterizing inherent stochasticity in traffic patterns, understanding node–node interactions, adapting to dynamic changes in flows and allowing for sensitive monitoring to flag anomalies. The methodology of dynamic network DGLMs applies to many dynamic network flow studies.
The Cretaceous Okorusu carbonatite, Namibia, includes diopside-bearing and pegmatitic calcite carbonatites, both exhibiting hydrothermally altered mineral assemblages. In unaltered carbonatite, Sr, Ba and rare earth elements (REE) are hosted principally by calcite and fluorapatite. However, in hydrothermally altered carbonatites, small (<50 µm) parisite-(Ce) grains are the dominant REE host, while Ba and Sr are hosted in baryte, celestine, strontianite and witherite. Hydrothermal calcite has a much lower trace-element content than the original, magmatic calcite. Regardless of the low REE contents of the hydrothermal calcite, the REE patterns are similar to those of parisite-(Ce), magmatic minerals and mafic rocks associated with the carbonatites. These similarities suggest that hydrothermal alteration remobilised REE from magmatic minerals, predominantly calcite, without significant fractionation or addition from an external source. Barium and Sr released during alteration were mainly reprecipitated as sulfates. The breakdown of magmatic pyrite into iron hydroxide is inferred to be the main source of sulfate. The behaviour of sulfur suggests that the hydrothermal fluid was somewhat oxidising and it may have been part of a geothermal circulation system. Late hydrothermal massive fluorite replaced the calcite carbonatites at Okorusu and resulted in extensive chemical change, suggesting continued magmatic contributions to the fluid system.
This chapter traces the historical relationship between Systemic Functional Linguistics (SFL) and Critical Discourse Analysis (CDA). I describe Fairclough’s linguistic SFL approach to CDA focusing on his seminal 1989 work Language and Power and outline his three-stage methodology, which enables analysts to account for discourse as (i) text, (ii) discursive practice, and (iii) societal practice. Text samples are used to illustrate how SFL is able to analyze language use as text and practice. Furthermore, I show that the Marxist heritage underpinning the genesis of SFL is shown to fully harmonize linguistic theory with social theory. Various criticisms of SFL-flavoured CDA such as the unrepresentativeness of data, subjectivity of analyses, and an anti-mentalist theory of context are discussed and dismissed. A claim that cognitive linguistics is the missing link in the analysis of ideological patterns underpinning social action is considered and mostly rejected on the grounds of its seeming incompatibility with social theory and individual-centred focus. Finally, technological developments which have the potential to add to the power of CDA descriptions and explanations in language and other modes are briefly outlined, as are some of the tensions remaining between theory and practice.
The objective of this study was to prospectively validate the “Brief Developmental Assessment”, which is a new early recognition tool for neurodevelopmental abnormalities in children with heart disease that was developed for use by cardiac teams.
Methods
This was a prospective validation study among a representative sample of 960 pre-school children with heart disease from three United Kingdom tertiary cardiac centres who were analysed grouped into five separate age bands.
Results
The “Brief Developmental Assessment” was successfully validated in the older four age bands, but not in the youngest representing infants under the age of 4 months, as pre-set validation thresholds were met – lower 95% confidence limit for the correlation coefficient above 0.75 – in terms of agreement of scores between two raters and with an external measure the “Mullen Scales of Early Learning”. On the basis of American Association of Pediatrics Guidelines, which state that the sensitivity and specificity of a developmental screening tool should fall between 70 and 80%, “Brief Developmental Assessment” outcome of Red meets this threshold for detection of Mullen scores >2 standard deviations below the mean.
Conclusion
The “Brief Developmental Assessment” may be used to improve the quality of assessment of children with heart disease. This will require a training package for users and a guide to action for abnormal results. Further research is needed to determine how best to deploy the “Brief Developmental Assessment” at different time points in children with heart disease and to determine the management strategy in infants younger than 4 months old.
The dimethylamine salt of 2,4-DB [4-(2,4-dichlorophenoxy)butyric acid] combined with toxaphene (chlorinated camphene) or acifluorfen [5-(2-chloro-4-(trifluoromethyl)phenoxy)-2-nitrobenzoic acid] and toxaphene combined with acifluorfen at several rates each were applied in the greenhouse and field to sicklepod (Cassia obtusifolia L.) to determine interactions. Toxaphene plus 2,4-DB treatments produced synergistic or additive responses in the greenhouse and in the field. Antagonistic or additive responses were observed with acifluorfen plus 2,4-DB treatments in the greenhouse, but not in the field. Acifluorfen plus toxaphene produced only additive responses in the greenhouse with synergistic interactions observed under field conditions.
In the greenhouse, naptalam at 1.1 to 4.5 kg ai ha−1 antagonized activity of paraquat at 0.04 to 0.14 kg ai ha−1 in 14 of 16 rate combinations when applied to sicklepod. Sicklepod shoot fresh weight reduction was less compared to that obtained with paraquat alone when paraquat at 0.04 kg ha−1 was mixed with bentazon at 0.42 to 0.84 kg ai ha−1 or monocarbamide dihydrogensulfate at 14 to 58 kg ai ha−1. Paraquat activity on Florida beggarweed was antagonized by mixtures of paraquat at 0.04 or 0.07 kg ha−1 with bentazon at 0.63 or 0.84 kg ha−1 or paraquat at 0.04 to 0.14 kg ha−1 with naptalam at 3.4 or 4.5 kg ha−1. Mixtures of lactofen at 0.06 to 0.22 kg ai ha−1 with monocarbamide dihydrogensulfate at 14 kg ha−1 or lactofen at 0.06 or 0.16 kg ha−1 with alachlor at 1.4 to 2.8 kg ai ha−1 synergistically increased tall morningglory shoot fresh weight reduction. In the field, excellent sicklepod shoot fresh weight reduction by paraquat applied alone masked most antagonistic effects of paraquat mixtures. Addition of alachlor to monocarbamide dihydrogensulfate at 29 kg ha−1 improved activity on sicklepod compared to monocarbamide dihydrogensulfate applied alone.
Glasshouse experiments were conducted to evaluate the effects of preemergence applications of metribuzin, pendimethalin, alachlor, and imazaquin on the competitive relationship between soybean and sicklepod, tall morningglory, or common cocklebur. An equal-ratio series design was employed where the proportion of species in a mixture remained constant and total plant density was varied. The ratio of soybean:sicklepod fresh weights was altered by alachlor and imazaquin while the ratio of soybean:tall morningglory fresh weights was altered only by imazaquin. The ratio of soybean:common cocklebur fresh weights was altered by metribuzin and imazaquin. Increasing herbicide rates resulted in higher soybean:weed fresh weight ratios and higher herbicide response coefficients.
The influence of wheat straw cover, tillage, and irrigation on metribuzin and alachlor movement and dissipation in an Appling coarse sandy loam (Typic Hapludult) and the influence of soil depth on their rate of dissipation were measured in field and laboratory experiments conducted in 1987 and 1988. Overall, metribuzin moved more than alachlor in both years. Alachlor movement was greater in tilled plots compared to no-till plots in 1988. Metribuzin movement was greater in no-till plots in 1987. Straw cover had little effect on the movement of alachlor, but the presence of 2800 kg ha−1 of straw on the soil surface increased the downward movement of metribuzin in both years compared to soil with no straw cover. The rate of alachlor dissipation in the soil was faster in straw-covered and no-till plots in both years and in the high irrigation level in 1988. Metribuzin dissipation was not affected by any of these factors. Alachlor rate of dissipation did not differ among depths in the field; however, dissipation differed in the laboratory in the order 0 to 20 cm > 20 to 45 cm = 45 to 68 cm. Metribuzin dissipated faster at the 8-cm depth in the field compared to the 58-cm depth. In the laboratory, metribuzin dissipation rates followed the order 0 to 20 cm > 20 to 45 cm > 45 to 68 cm. At the greatest depth, the dissipation of metribuzin was faster in the field than in the laboratory.
The dissipation of flurtamone was determined in three Georgia soils in 1987 to 1989. Flurtamone dissipation in soil was initially rapid but gradually slowed throughout the sampling interval. Dissipation was not affected by rate (0.8 or 1.7 kg ai ha-1) or application method (PPI or PRE). Dissipation rates were slightly more rapid in the Greenville and Dothan soils than in the Cecil soil, with calculated initial half-lives for each respective soil being 6 to 7, 8 to 10, and 9 to 23 days. There was no effect of previous flurtamone exposure on the dissipation rate in soil at any location.
Field and greenhouse experiments in 1981 and 1982 determined the potential interactions of three preemergence and three postemergence herbicides with four granular insecticides in soybeans [Glycine max (L.) Merr.]. Generally, metribuzin [4-amino-6-tert-butyl-3-(methylthio)-as-triazin-5(4H)-one] increased soybean injury and lowered yields when applied to plots treated with an organophosphate insecticide at planting. Soybean injury from these treatments and from aldicarb [2-methyl-2-(methylthio)-propionaldehyde-o-(methylcarbamoyl)oxime] plus metribuzin applied in the field was greater in 1982 than 1981 due to excessive rainfall immediately after planting. Oryzalin (3,5-dinitro-N4,N4 -dipropylsulfanilamide) plus several of the in-furrow insecticide treatments in the greenhouse increased injury to soybeans. Other than this, the method of insecticide application, banded or in-furrow, had no effect on that caused by each pesticide combination.