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America’s “crumbling roads” currently headline the infrastructure zeitgeist, but deteriorating sidewalks are also in desperate need. Sidewalks can be vibrant, social conduits in cities that, when safe and well-maintained, enhance public health and enable accessible passage for all residents, particularly the most vulnerable. The scant but burgeoning research on pedestrian infrastructure has largely focused on data collection technologies and spatial analysis. This research instead seeks to uncover the similarities and differences in how American cities treat their road versus sidewalk networks by asking: are these two indispensable assets of daily urban public life repaired, maintained, and funded disparately? The research was structured around interviews with employees of 16 U.S. cities about their road and sidewalk policies and procedures. We found multiple disparities between roads and sidewalks in and among American cities, including: municipality responsibility, repair timeliness, data availability, and condition assessment. We also discuss cities’ pressing concerns for these assets and directions for future research. The implications of this study could affect several themes across transportation infrastructure, including project prioritization, equity, and efficient government spending.

Many meat-eaters experience cognitive dissonance when aware that their eating behaviors contradict their moral values, such as desires to protect the environment or animals from harm. One way in which people morally disengage from their behaviors—and thus avoid dissonance—is to displace responsibility onto others. Aligning with this notion, results of three studies (total N = 1,501) suggest that expressing moral outrage at third-party transgressors reduces dissonance and preserves moral identity among meat-eaters. When participants understood their in-group as responsible for factory farming’s negative impact or read about factory farming’s harms to animals, expressing moral outrage at third-party transgressors reduced guilt and elevated self-rated moral character. Moreover, reflecting on the morally troublesome nature of meat-eating led participants to express more moral outrage at a third-party organization responsible for animal abuse, an effect eliminated by self-affirmation. These findings substantiate moral outrage as a new mechanism to justify meat consumption.

There have been proposals to expand definitions for categorical disorders and dimensionally conceptualized syndromes (e.g., psychopathy) to include negative mood lability and dysregulation (NMD). Factor analytic results are often presented in support of these proposals, and we provide factor analytic demonstrations across clinically oriented samples showing that NMD indicators load strongly onto factors with a range of psychopathology. This is unsurprising from a transdiagnostic perspective but shows that factor analysis could potentially be used to justify expanding definitions for specific constructs even though NMD indicators show strong, nonspecific loadings on psychopathology factors ranging widely in nature. Expanding construct definitions and assessment approaches to emphasize NMD also may negatively impact discriminant validity. We agree that targeting NMD is essential for comprehensive assessment, but our demonstrative analyses highlight a need for using factor analysis and other statistical methods in a careful, theoretically driven manner when evaluating psychopathology structure and developing measures.

Individual instances of the knock resonant response are easy to acquire but these are subject to noise and vary considerably from cycle to cycle due to random variations in the knock process. This work provides a new way to quantify and model the stochastic properties of knock signals, capturing both the time domain resonant characteristics within a cycle as well as the random variations from cycle to cycle. A new phase alignment method enables the ensemble mean knock waveform to be identified from the data which also removes noise components without the need for narrowband filtering. This ensemble waveform shows the empirical characteristics of knock onset, decay, and frequency slurring within the cycle as the gas expands and cools. The phase-aligned cyclic variations of the knock waveform are also shown to approximate a (time-varying) dual-Gaussian distribution, and fitting such a model to the data enables the statistical properties of the dataset as a whole to be decomposed into separate knocking and non-knocking populations providing further insight into the knock process. The technique is applied both to filtered cylinder pressure signals and to accelerometer-based knock signals, and the results are compared and contrasted.

Understanding how useful any particular set of event data might be for conflict research requires appropriate methods for assessing validity when ground truth data about the population of interest do not exist. We argue that a total error framework can provide better leverage on these critical questions than previous methods have been able to deliver. We first define a total event data error approach for identifying 19 types of error that can affect the validity of event data. We then address the challenge of applying a total error framework when authoritative ground truth about the actual distribution of relevant events is lacking. We argue that carefully constructed gold standard datasets can effectively benchmark validity problems even in the absence of ground truth data about event populations. To illustrate the limitations of conventional strategies for validating event data, we present a case study of Boko Haram activity in Nigeria over a 3-month offensive in 2015 that compares events generated by six prominent event extraction pipelines—ACLED, SCAD, ICEWS, GDELT, PETRARCH, and the Cline Center’s SPEED project. We conclude that conventional ways of assessing validity in event data using only published datasets offer little insight into potential sources of error or bias. Finally, we illustrate the benefits of validating event data using a total error approach by showing how the gold standard approach used to validate SPEED data offers a clear and robust method for detecting and evaluating the severity of temporal errors in event data.

Working conditions may be an important lever to support special educators’ reading instruction for students with emotional and behavioral disorders (EBD). Thus, we explored how working conditions relate to the quality of special educators’ reading instruction in upper-elementary, self-contained classes for students with EBD. Using mixed methods to examine video observations of reading instruction and varied data sources on working conditions, we found that special educators who provided stronger instruction had a partner coleading their program, and consistent paraprofessionals, with time and support for training. Partners and paraprofessionals, together, protected special educators’ instruction time. Other conditions (i.e., material resources, role differentiation, role conceptions, planning time) emerged as potentially important, but evidence was less robust. Results indicate partners and paraprofessionals may be important forms of collegial support. These findings have important implications for improving the quality of instruction in self-contained settings for students with EBD.

In this study, using Office of Special Education Programs (OSEP) personnel data from 2006 to 2014, we identified seven states with consistently low shortages of highly qualified special education teachers and seven states with persistently high shortages. We employed Guarino et al.’s framework to guide our assumptions and selection of demographic, supply, and demand variables and compared two groups in this descriptive analysis. We found significant differences across supply and demand variables. Low shortage states make greater investments in per pupil expenditures; have higher teacher salaries, generally; have greater preparation capacity; and produce more special education graduates. Taken together, our findings suggest that special education teaching is a relatively better job in low shortage states than in high shortage states. We situate the discussion of our findings within policy recommendations that states may use to address shortages. Limitations of our analysis are addressed, and implications for future research are proposed.

Special educators are responsible for providing quality reading instruction to students with emotional and behavioral disorders (EBD), but they often experience difficulties fulfilling this responsibility, especially for students with EBD who are placed in dedicated settings, including self-contained classes. Administrators can help by ensuring special educators have what they need to provide effective reading instruction. We highlight how administrators can leverage special educators’ working conditions to improve the reading instruction that students with EBD receive in self-contained settings.

Classical knock control strategies are still widely used in production vehicles but exist in several variant forms whose performance with respect to one another, and to engine efficiency, ease of calibration and analytical tractability has not been rigorously evaluated. This paper examines the absolute and relative performance of these strategies subject to both transient and systematic disturbances using both time history simulation methods and analytical methods. The former illustrates the response to specific instances of the knock process, while the latter enables the statistical properties of the closed loop response to be computed and compared.

Background Despite epinephrine's historical use for over a century and Food and Drug Administration (FDA) approval for EpiPen's use in 1987 to treat anaphylaxis, little information exists regarding selection of the 0.3 mg adult dose. A review of literature was conducted to provide a historical retrospective regarding the evolution of the dosage selected for today's EpiPen. The first adrenal gland extract, isolation of the epinephrine active ingredient, observation of physiological effect, selection of the intramuscular route for administration, the dosage range recommended by independent physicians based on their clinical observations and selection of the ultimate standardized dosage are profiled. Conclusion This retrospective review illustrates the drug development process prior to the rigors required for today's clinical trials and provides clinical evidence supporting the dose in EpiPen and other similar life-saving epinephrine products.

In this article, the authors describe the complexity of special education teacher (SET) shortage, how shortage undermines equal educational opportunity, and strategies that school districts and state and federal governments have used to combat them. The authors consider the economic consequences of shortage and describe how school budgets are burdened by turnover and, in some cases, litigation. The authors consider specific aspects of SET shortages, including the problems of staffing high-poverty urban and rural schools, recruiting and retaining teachers of color, and staffing alternative educational placements. The authors then consider more general factors related to shortage, including the valence of teaching as a profession, attrition, working conditions, and compensation. The authors describe how broad policy-based interventions, such as federal spending on personnel preparation and alternative route entrées to teaching, have largely failed to remedy SET shortage. Finally, the authors posit that SET shortage cannot be addressed successfully without improving working conditions and differentiating compensation for shortage area teachers and teachers working with struggling students. Although special education cannot achieve such sweeping change alone, the time seems ripe for moving forward on this important agenda.

Using data from the National Longitudinal Transition Study 2 (NLTS2), we examined risk and protective factors associated with post-secondary outcomes among youth with emotional and behavioral disorders (EBD). Results indicate that, compared to their male peers, females with EBD demonstrated higher levels of social and behavioral skills and higher grades. We also discovered discrepancies between teacher reports and female students’ self-reports of academic, social, and behavioral competencies, suggesting females with EBD underestimate their own skills or that teachers are not fully aware of these students’ areas of difficulty. We discuss implications of these results related to existing prevention and intervention strategies for females with EBD.

Background: Intravenous vitamin C therapy has been associated with reduced mortality in patients with sepsis. Of potential concern with this therapy are falsely elevated point-of-care (POC) blood glucose values vs laboratory analyzed (LA) readings. The purpose of this study was to compare POC and LA blood glucose measurements in patients receiving intravenous vitamin C therapy. Methods: All adults (≥18 years old) admitted from January 2017 to December 2018 who received at least two doses of intravenous vitamin C and had at least one paired blood glucose collection were eligible for inclusion. The primary endpoint was the accuracy in paired blood glucose values determined using the International Organization for Standardization (ISO) 15197:2013 criteria. Paired values were assessed for clinical impact using the Parkes consensus error grid analysis. A subgroup analysis was conducted to determine the impact of impaired renal function on outcomes. Results: Fourteen patients were included for analysis with 46 paired blood glucose levels. Compliance with ISO15197:2013 criteria was met in 34 (73.9%) paired values, which did not meet the minimum criteria for accuracy. Subgroup analysis showed that the paired values from patients with impaired renal function did not meet the minimum requirements for compliance, while those from patients without impaired renal function did. The Parkes error grid showed that the variation in POC measurements likely had minimal clinical impact. Conclusions: Our study suggests that most patients receiving vitamin C for sepsis may still be monitored at POC with the glucose meter used in our study with minimal clinical impact.

This article provides a framework and description of pedagogies that may be used in teacher preparation across a range of settings from college classrooms to P-12 settings to support teacher candidates as they learn to use high-leverage practices (HLPs). These “pedagogies of enactment” must include a continuum of opportunities to use teaching practices in increasingly authentic settings, ranging from video analysis, case studies, rehearsal, and virtual simulations to use of practices with coaching support in a classroom (e.g., lesson study, structured tutoring, and aligned field experiences). In this article, we use research on the development of professional expertise and from cognitive science to identify pedagogies from the teacher education research base that have promise for promoting candidates’ learning and describe how these pedagogies might be scaffolded over the duration of a teacher education program to promote learning.

Lung gas exchange efficiency deteriorates during general anaesthesia due to ventilation–perfusion ( V/Q) scatter. Propofol total intravenous anaesthesia (TIVA) may preserve V/Q matching better than inhalational agents. We compared V/Q matching in patients randomized to either TIVA or sevoflurane anaesthesia, using deadspace and shunt measurements and the MIGET (Multiple Inert Gas Elimination Technique). Baseline arterial blood and mixed expired gas sampling was done before induction and repeated after one to two hours of relaxant general anaesthesia in 20 patients, supine with controlled ventilation at an FiO2of 0.3 and a target end-tidal PCO2of 30–35 mmHg. Blood samples for MIGET were processed after headspace equilibration by gas chromatography. The primary endpoint was a comparison of the two groups in the change from baseline of absolute difference between log standard deviation of ventilation and blood flow distributions (∂(σV−σQ)). Deadspace fraction increased and PaO2/FiO2ratio decreased across both groups overall with anaesthesia, but change in deadspace was not different between groups (mean (standard deviation, SD) sevoflurane 21.8% (11.7%) versus TIVA 20.5% (10.6%), P = 0.601). Change in PaO2/FiO2ratio was also similar between groups (mean (SD) sevoflurane −51.9 (69.1) mmHg versus TIVA −78.3 (76.9) mmHg, P = 0.43), as was change in shunt fraction (δQs/Qt mean (SD) sevoflurane −5.1% (12.6%) versus TIVA 0.4% (7.7%), P = 0.174). The primary endpoint ∂(σV−σQ) was not different between sevoflurane and propofol TIVA groups (mean (SD) 0.17 (0.81) versus 0.17 (0.29), P = 0.94). TIVA did not better preserve V/Q matching in patients undergoing anaesthesia with controlled ventilation compared with sevoflurane.

This article builds off previous literature addressing the phenomenon of value conversion. We explored how aware counselors were of this phenomenon, what they did about it if they were, and how explicit they made the potential of value conversion to their clients. A total of 10 mental health counselors were interviewed from local community mental health clinics and group practices in a Midwestern city. Counselors identified which personal moral values influenced the bulk of their counseling practice. Based on various levels of uncertainty, we concluded that training discussions and clinical considerations of value conversion seldom take place. Counselors may benefit from interdisciplinary involvement from philosophical frameworks of moral theory. Future directions, limitations, and clinical implications are discussed.

Introduction: Reduction mammoplasty (RM) is one of the most common operations performed in plastic surgery. While US national surgical expenditures have risen in recent years, studies have reported decreasing reimbursement rates for plastic surgeons. The purpose of this study is to characterize the trends in charges and payments for a common plastic surgery operation, ambulatory RM, for facilities and physicians. Methods: A Medicare patient records database was used to capture hospital, surgeon, and anesthesiologist charges and payments for ambulatory RM from 2005 to 2014. Values were adjusted for inflation. A ratio of hospital to surgeon charges and payments were calculated: charge multiplier (CM) and payment multiplier (PM), respectively. Charges, payments, Charlson comorbidity index, CM, and PM values were analyzed for trends. Results: This study included 1001 patients. During the study period, the facility charge for RM per patient increased from $8477 to $11,102 (31% increase; p

Background: Hypothermic therapy has been shown to have clinical efficacy in a variety of cardiovascular injuries including cardiac arrest and myocardial infarction.1 It is standard of care for the treatment of neonates with hypoxic-ischemic encephalopathy (HIE) and has shown improved outcomes with traumatic brain injury (TBI)2, and sports-related injuries. Additionally, in several anecdotal studies, cold therapy has been hypothesized to be equally as effective in limiting the damaging effects of the body’s response to mild traumatic brain injury, commonly known as concussion; but the primary limitation of these studies has been sample size.3, 4 Hypothesis/Purpose: This study is being conducted to quantify the clinical safety and efficacy of head and neck cooling when applied after mild traumatic brain injury (mTBI) among adolescents participating in sporting activities. Methods: A multi-center, prospective, randomized, non-blinded, dual-arm comparator study employing an adaptive design with two-phases: the 60-patient pilot study presented here, and the pivotal phase currently underway. After randomization, subjects in the standard of care arm receive brain rest. Subjects in the treatment group receive brain rest plus 30 minutes of cooling therapy at the initial and 72 hour visits. Primary endpoint: SCAT5 symptom severity score, evaluated from initial clinic visit through 4 weeks post injury. SCAT5 measured at initial visit (pre/post treatment, both arms), 72 hour visit (pre/post treatment for intervention arm, once for standard of care arm) and once at 10 day and 4 week follow up visits for both arms. Results: To evaluate primary endpoint, a Repeated Measures Analysis of Variance was conducted as intended for pivotal phase, with unstructured covariance and utilizing last observation carried forward technique. Dependent variable modelled as absolute change from initial SCAT5. Significant main effects and interaction effects noted (p-value < 0.01, < 0.01 and 0.02 respectively). To evaluate secondary endpoint, a Wilcoxon Rank Sum Test was conducted to examine potential differences in ImPACT Cognitive Efficiency Index, there was no evidence in the sample of significant differences (p-value = 0.600). All testing evaluated at alpha level of significance = 0.05. Conclusion: Preliminary results from pilot phase indicate significant treatment effects that change differently over time, depending on group. Pivotal phase to determine efficacy is currently underway. Tables/Figures: Table 1.1. Summary Statistics for Baseline Demographics and Clinical Outcomes; Repeated Measures ANOVA Results Summary Statistics Standard of Care Arm (n = 27) Treatment Arm (n = 28) Mean (SD) Min/Max Mean (SD) Min/Max Age at Consent (yrs) 14.3 (1.4) 12.0/17.0 14.7 (1.6) 12.0/17.0 Height 167.9 (9.6) 141.0/184.9 169.1 (9.2) 151.5/188.0 Weight 66.9 (16.6) 40.1/105.0 66.1 (17.6) 36.7/116.2 SCAT5 Absolute Differences Baseline - Time 1 (Initial Visit, Post Tx Score) 0.9 (14.2) -40.0/33.0 -13.2 (13.0) -48.0/7.0 Baseline - Time 2 (72 Hr Visit, Pre Tx Score) -2.6 (9.6) -21.0/19.0 -11.8 (12.1) -40.0/7.0 Baseline - Time 3 (72 Hr Visit, Post Tx Score) -3.7 (12.7) -40.0/19.0 -19.2 (14.0) -54.0/0.0 Baseline - Time 4 (10 Day Visit) -13.9 (14.9) -45.0/15.0 -19.8 (13.6) -55.0/4.0 Baseline - Time 5 (4 Wk Visit) -22.7 (20.3) -63.0/12.0 -23.4 (17.3) -76.0/4.0 Repeated Measures ANOVA Post Hoc Pairwise Analyses: SCAT5 Mean Difference Between Groups (95% Confidence Interval) Baseline - Time 1 (Initial Visit, Post Tx Score) 14.1 (6.7, 21.4) Baseline - Time 2 (72 Hr Visit, Pre Tx Score) 9.2 (3.3, 15.1) Baseline - Time 3 (72 Hr Visit, Post Tx Score) 15.5 (8.2, 22.8) Baseline - Time 4 (10 Day Visit) 5.8 (-1.9, 13.5) Baseline - Time 5 (4 Wk Visit) 0.7 (-9.5, 10.9) Figure 1.2. References: The effect of mild induced hypothermia on outcomes of patients after cardiac arrest: a systematic review and meta-analysis of randomized controlled trials. Zhang et al. Critical Care (2015) 19:417.Therapeutic hypothermia for acute brain injuries. Andresen et al. Scandinavian Journal of trauma, Resuscitation and Emergency Medicine (2015) 23:42.The effect of selective head-neck cooling on physiological and cognitive functions in healthy volunteers. Jackson et al. Translational Neuroscience (2015) 6:131.Neurobiological effect of selective brain cooling after concussive injury. Walter et al. Brain imaging and behavior (2018) 2:891.

Aim: Time outdoors and contact with nature are positively associated with a broad range of children’s health outcomes. Pediatricians are uniquely positioned to promote active play in nature (APN) but may face challenges to do so during well child visits. The objective of this study was to understand barriers to children’s APN, before and during the COVID-19 pandemic, and how health care providers could promote APN. Methods: Focus groups were conducted with 14 pediatric providers and interviews with 14 parents (7 in English, 7 in Spanish) of children ages 3 to 10 on public insurance. Dedoose was used for coding and content analysis. We contextualized this work within the WHO’s Commission on Social Determinants of Health conceptual framework. Results: Parents mentioned a range of material circumstances (time, finances, family circumstances, access to safe outdoor play spaces and age-appropriate activities) and behavioral/psychosocial factors (previous experiences in nature, safety, and weather concerns), many of which were exacerbated by the pandemic, that serve as barriers to children’s APN. Providers said they were motivated to talk to families about children’s APN but mentioned barriers to this conversation such as time, other pressing priorities for the visit, and lack of resources to give families. Conclusions: Many pre-pandemic barriers to APN were exacerbated by the COVID-19 pandemic. Well-child visits may be an effective setting to discuss the benefits of APN during and beyond the pandemic, and there is a need for contextually appropriate resources for pediatric providers and families.

The Pearson test is used to confirm that knock intensity data closely approximate a cyclically independent random process which is therefore fully characterized by its probability density function or cumulative distribution function. Although these distributions are often assumed to be log-normal, other results have shown that the data do not conform to a log-normal distribution at the 5% significance level. A new dual log-normal model is therefore proposed based on the assumption that the data comprise a mixture of two distributions, one knocking and one non-knocking. Methods for estimating the parameters of this model, and for assessing the quality of fit, are presented. The results show a significantly improved model fit.

This article shares the results of a case study that explored Annie’s socially situated identity as a secondary English Language Arts teacher-mentor over 5 years at an urban school. Annie’s identities as a teacher-mentor occupied the space of the hyphen—sometimes a teacher, sometimes a mentor, sometimes both. Using discourse analysis, we describe how Annie positioned herself and was positioned as a mentor and a teacher. We explore Annie’s transformations informed by figured worlds associated with the Discourses of Mentor and Teacher at College Prep. Annie’s teacher-mentor identity shifted, evolved, and overlapped in this space as she interacted at College Prep and was influenced by institutional and societal Discourses, including students’ home Discourses. The study points to the need for more and perhaps different kinds of support for mentor-teacher/teacher-mentors who work in urban school environments to prepare them to negotiate potential conflicts in their identities.

The Problem Reinforcement theory has inspired many types of human resource development (HRD) initiatives. Despite their widespread use, reinforcement-focused programs, designed to control the outcome of behavior through external rewards, have proven expensive and cumbersome to manage and have an alarmingly low rate of return on investment. There is a critical need to better understand motivation in work environments as well as to explore more efficacious forms of motivation, both intrinsic and extrinsic simultaneously. The Solution Self-determination theory (SDT) is concerned with forward influence, independent choice, and the degree to which behavior is internalized as self-determined. Sources of employee motivation are influenced by employee perceptions of the work environment as well as behavioral outcomes. The most optimal forms of motivation are believed to originate from internal regulation of basic psychological needs rather than external forms of motivation such as those central to reinforcement-focused theory and practice. The Stakeholders We question which forms of motivation are most optimal for influencing employee behavior in the workplace, including long-held traditions of reinforcement-grounded programming, and present new models for understanding the role of motivation in HRD. Results of this study focus the conversation on SDT and explore specific implications for practice.

In this commentary, we revisit “NCLB and the Demand for Highly Qualified Teachers: Challenges and Solutions for Rural Schools,” an article we published in this journal in 2005. We consider the predictions we made then about the impact of the Highly Qualified Teacher mandate on special education teacher (SET) shortages in rural states and regions, acknowledging that we overlooked the diversity of rural areas and their differentiated needs in our original article. We then update strategies and programs for preparing, recruiting, and retaining SETs in rural schools and discuss the implications of the Every Student Succeeds Act, which has replaced the No Child Left Behind Act, for special education in rural areas. We note with optimism the resilience that rural areas have exhibited in the face of teacher shortages and see hope in recent technology applications and other context-based strategies.