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To advance cross-country understanding of parental perceptions of school climate, this study examined the psychometric properties of the Delaware School Climate Survey--Home version (DSCS-H) and also compared the parental perception of school climate among Chinese (n = 999) and American (n = 1,251) parents. Confirmatory factor analyses revealed that the DSCS-H was best supported by a second-order factor model in both samples and full measurement invariance across countries was evident. Comparison of overall school climate latent means revealed that American parents from elementary schools perceived a more positive overall school climate than did Chinese parents. Conversely, Chinese parents of students in high school perceived a more positive overall school climate than the American parents. The latent-mean difference of parental perception of the overall school climate in middle schools across the United States and China was not significantly different. Finally, the latent mean differences in school climate subfactors varied across grade levels. Implications for using the DSCS-H for assessing and understanding the perception of school climate among parents from diverse cultural and linguistic backgrounds are discussed.

To advance our scientific understanding about school climate and bullying victimization from the perspectives of both parents and cross-country comparisons, the present study examined the cross-country similarities and differences of the associations between overall school climate and 3 forms of bullying victimization between United States (U.S.; N = 1,251) and Chinese (N = 999) parents across elementary, middle, and high schools. Confirmatory factor analyses and measurement invariance tests were first conducted to examine the cross-country validity of the Delaware Bullying Victimization Survey--Home (DBVS-H) between U.S. and Chinese parents. Comparison of latent means of bullying victimization revealed that U.S. parents reported higher frequencies of social/relational and verbal bullying victimization compared with Chinese parents. Structural equation modeling (SEM) was then used to examine the cross-country differences of the relationship between school climate and bullying victimization. For parents in both China and the U.S., school climate was found to be significantly associated with 3 types of bullying victimization (i.e., physical, verbal, and social/relational). The negative associations between school climate and all 3 types of bullying victimization reported by U.S. parents were significantly stronger than those found in Chinese parents. Implications for bullying prevention efforts involving parents from diverse cultural and linguistic backgrounds were discussed.

Introduction: Designated high-quality trauma services have been shown to improve outcomes of trauma patients by virtue of access to specialized personnel and resources. It remains unclear if a 'halo effect' extends these benefits more generally to non-trauma populations. Obstetric patients who develop severe postpartum hemorrhage often require close attention in intensive care units and utilize more resources. Given the overlapping needs between trauma and obstetric patients, we hypothesize that the 'halo effect' might extend to patients with severe postpartum hemorrhage. Methods: The Nationwide Inpatient Sample for years 2008 to 2011 was queried. Patients with severe postpartum hemorrhage were identified as those requiring transfusion, hysterectomy, or uterine repair. After stratifying by level 1 trauma center versus non-level 1 trauma center status, unadjusted univariate comparisons were made. Adjusted odds ratio of end-organ failure and death were analyzed using multivariable logistic regression. Results: A total of 11,135 patients were identified with severe postpartum hemorrhage. The majority were hospitalized at non-level 1 trauma centers rather than level 1 trauma centers (71.4% vs. 28.6%). Patients at non-level 1 trauma centers were younger, more likely to be white, admitted electively, insured, and healthier with a lower comorbidity index. There was no significant difference in rates of mortality or organ failure. However, after adjustment for differences in comorbidity index, race, and emergency admission, patients at non-level 1 trauma centers had a significantly higher risk of respiratory failure (odds ratio, 1.27; 95% confidence interval, 1.01–1.59). Conclusions: These findings suggest that the outcomes of obstetric patients with severe postpartum hemorrhage admitted in level 1 trauma centers are not overall significantly different when compared to those in non-level 1 trauma centers. However, after adjusting for baseline characteristics, there was a reduced risk of respiratory failure in patients admitted to level 1 trauma centers. [ABSTRACT FROM AUTHOR]

The article focuses on a model developed by the authors for locating idiosyncratic risks in corporate yield spreads. Topics discussed include the use of the U.S. capital market liquidity index and credit default swap (CDS) spreads as liquidity factor and default factor respectively; evaluation of corporate bond with global liquidity and decomposition coefficients used in different models.

Door closers are widely used for doors in commercial buildings, not only for safety purposes but also for reducing the airflow through door openings. This study aimed to develop a method for quickly assessing, in the design phase, the heating and cooling energy cost saving from using an effective door closer. The method developed in this study consists of a stop angle model, airflow model, and energy cost calculation. This investigation also conducted experimental measurements in a full-scale test facility to validate the models. This study then used the proposed method to assess the heating and cooling energy cost saving from using an effective door closer in the cities of Minneapolis, Boston, San Francisco, and Phoenix. It was found that, under a greater indoor–outdoor pressure differential, using an effective door closer would save more energy cost. When using a closer with a larger size, the energy cost lost would decrease, but a large closing torque may significantly reduce ease of use and accessibility and potentially violate building codes related to the Americans with Disabilities Act (ADA). Furthermore, the energy cost saving from using an effective door closer in San Francisco would be lower than that in Minneapolis, Boston, and Phoenix. [ABSTRACT FROM AUTHOR]

Background: 21st birthday celebrations are among the highest risks for alcohol use throughout emerging adulthood and celebrants often experience a range of alcohol-related consequences. Objectives: The present research considered what happens when drinking games are paired with an already high-risk event (i.e., 21st birthday celebrations) and how drinking games compare with other contextual factors on 21st birthdays. Methods: Approximately four days after turning 21, 1124 college students (55% women) completed an online survey assessing alcohol use and related consequences experienced during their birthday celebrations. Participants were also asked whether drinking games and other contextual factors were associated with their celebrations. Results: Overall, 18% of participants reported playing drinking games during their 21st birthday celebrations. These individuals reported consuming more alcohol, had higher estimated BACs, and experienced more negative consequences than those who did not play drinking games. The association between playing drinking games and alcohol use and negative consequences was stronger for men. The effect of drinking games on negative consequences was mediated through elevated BAC levels. Receiving bar specials, having drinks purchased, playing drinking games, and loud music were uniquely and significantly associated with all alcohol outcomes. Conclusion: Together, these results suggest that drinking games are part of a larger context of risk contributing to extreme drinking on 21st birthdays. Furthermore, these results will help to facilitate interventions that are more individually tailored to target specific contextual risks, behaviors, and events. [ABSTRACT FROM AUTHOR]

BACKGROUND: City-to-city differences have been reported for the increase in short-term mortality associated with a given increase in ozone concentration (ozone mortality coefficient). Although ozone concentrations are monitored at central outdoor locations, a large fraction of total ozone exposure occurs indoors. OBJECTIVES: To clarify the influence of indoor exposure to ozone of outdoor origin on short-term mortality, we conducted an analysis to determine whether variation in ozone mortality coefficients among U.S. cities might be partly explained by differences in total ozone exposure (from both outdoor and indoor exposures) resulting from the same outdoor ozone concentration. METHODS: We estimated average annual air change rates (the overall rate at which indoor air is replaced with outdoor air) and used these to estimate the change in total ozone exposure per unit change in outdoor ozone exposure (ozone exposure coefficient) for 18 cities that had been included in the National Morbidity and Mortality Air Pollution Study (NMMAPS). We then examined associations between both parameters and published ozone mortality coefficients. RESULTS: For the 18 targeted NMMAPS cities, the association between ozone mortality coefficients and ozone exposure coefficients was strong (1-hr ozone metric: R2 = 0.58, p < 0.001; 8-hr ozone: R2 = 0.56, p < 0.001; 24-hr ozone: R2 = 0.48, p = 0.001). When extended to another 72 NMMAPS cities, the associations remained strong (R2 = 0.47-0.63; p < 0.001). CONCLUSIONS: Differences in ozone mortality coefficients among cities appear to partially reflect differences in total ozone exposure resulting from differences in the amount of outdoor ozone that is transported indoors. [ABSTRACT FROM AUTHOR]

Chronic and excessive alcohol consumption enhances the formation of reactive oxygen species (ROS) and ethanol-derived free radicals. 8-Hydroxy-2′-deoxyguanosine (8-OHdG) is a marker to estimate ROS-induced DNA damage. The study objective was to compare serum 8-OHdG levels between patients with alcohol dependence and healthy controls and to investigate the correlation between this marker and the severity of alcohol withdrawal syndrome (AWS). We recruited 79 patients with alcohol dependence and 63 healthy control subjects. The severity of AWS was evaluated using the Chinese version of the revised Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-Ar-C) every 8 hours. Levels of 8-OHdG, malondialdehyde (MDA), and other biologic indexes were assayed at baseline for patient and control groups, and after 1-week detoxification for the patient group. The 8-OHdG and MDA levels in the alcoholic group were significantly higher than those in the control group (0.34 vs. 0.27 ng/ml and 13.5 vs. 10.1 μM, respectively). Both 8-OHdG and MDA were significantly correlated with the highest CIWA-Ar-C (correlation coefficient = 0.39, p < 0.001 and 0.26, p = 0.02, respectively). In linear regression analysis, only 8-OHdG level was significantly correlated with the highest CIWA-Ar, but not MDA level (regression coefficient beta = 0.33, p = 0.003 and 0.17, p = 0.12, respectively). MDA, but not 8-OHdG levels, significantly decreased after 1 week of detoxification. These results indicate that our alcohol-dependent individuals are vulnerable to excessive production of free radicals. Notably, the oxidative DNA damage persisted after 1-week detoxification. The AWS severity was correlated with the increase in oxidative stress, particularly the 8-OHdG levels. The impact of sustained abstinence in alcoholic patients needs to be investigated in future studies. [ABSTRACT FROM AUTHOR]

This article investigates the return autocorrelation in four stock markets around the Asia-Pacific rim: the USA, Japan, Taiwan and South Korea. The results indicate that there are conditional return autocorrelation in Taiwan's and South Korea's stock markets for daily data. Moreover, there are negative relationships between autocorrelation and two factors (trading volume and return volatility) significantly in Taiwan and South Korea, implying that the stock markets in Taiwan and South Korea are not as efficient as those in developed countries (the USA and Japan). For weekly data, however, none of the above four markets has significant return autocorrelation. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To provide information about meat consumption and factors that explain differences among subpopulations, and to evaluate how knowledge and attitudes about nutrition and awareness of diet and health influence meat consumption. Design: The 1994–1996 Continuing Survey of Food Intakes by Individuals provided two nonconsecutive 24-hour recalls. The Diet and Health Knowledge Survey was administered at least 1 week after the last 24-hour recall. Meat subgroups (chicken, beef, pork, and processed pork products) were calculated from Food Guide Pyramid meat groups by using recipe ingredients. Subjects: The study sample included 4,802 children and 9,460 adults from the Continuing Survey of Food Intakes by Individuals and 5,649 adults from the Diet and Health Knowledge Survey. Statistics: Weighted percentages and means described the food intake and self-assessed dietary characteristics. Relationships among types of meat intake, dietary characteristics, and demographics were evaluated using a two-stage, multivariate regression model. Results: Individuals in higher income households consumed relatively more chicken; those in low-income households consumed more processed pork products. Those consuming no beef and smaller amounts of chicken had the lowest discretionary fat intakes. Beef and pork consumers were more likely to think that their diets were too high in fat, but less likely to believe it is important to eat a low-fat diet. Region of residence affected the probability of consuming most meats. Having a high level of education was associated with a lower likelihood of consuming beef and pork. Conclusions: Sociodemographic factors are strong predictors of the probability of choosing particular types of meat and of the amounts eaten. Knowledge and attitudes about diet and meat products also influence choices. [Copyright &y& Elsevier]

Providing home and community-based services (HCBS) is critical for active and healthy aging. However, in China, the positive factors for improving HCBS provision are unclear, limiting its contribution to improving older adults' quality of life and promoting active and healthy aging. Therefore, this study examines the configurations that produce differences in HCBS and identifies multiple pathways for improving them and narrowing regional disparities. Using data from multiple datasets comprising 23 cases, we performed configuration analysis using fuzzy-set qualitative comparative analysis. Four pathways producing high HCBS provision and three pathways producing low HCBS provision were found. Different combinations of the aging population, economic development, institutional support, financial support, and development of multiple stakeholders influence HCBS provision. Thus, measures based on the main factor characteristics should be implemented to improve the HCBS provision level., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The body fluid status in acute stroke is a crucial determinant in early stroke recovery but a real-time method to monitor body fluid status is not available. This study aims to evaluate the relationship between salivary conductivity and body fluid status during the period of intravenous fluid hydration. Between June 2020 to August 2022, patients presenting with clinical signs of stroke at the emergency department were enrolled. Salivary conductivities were measured before and 3 h after intravenous hydration. Patients were considered responsive if their salivary conductivities at 3 h decreased by more than 20% compared to their baseline values. Stroke severity was assessed using the National Institutes of Health Stroke Scale, and early neurological improvement was defined as a decrease of ≥ 2 points within 72 h of admission. Among 108 recruited patients, there were 35 of stroke mimics, 6 of transient ischemic attack and 67 of acute ischemic stroke. Salivary conductivity was significantly decreased after hydration in all patients (9008 versus 8118 µs/cm, p = 0.030). Among patients with acute ischemic stroke, the responsive group, showed a higher rate of early neurological improvement within 3 days compared to the non-responsive group (37% versus 10%, p = 0.009). In a multivariate logistic regression model, a decrease in salivary conductivity of 20% or more was found to be an independent factor associated with early neurological improvement (odds ratio 5.42, 95% confidence interval 1.31-22.5, p = 0.020). Real-time salivary conductivity might be a potential indicator of hydration status of the patient with acute ischemic stroke., (© 2023. The Author(s).)

Objectives: Racially ambiguous face categorization research is growing in prominence, and yet the majority of this work has focused on White and Western samples and has primarily used biracial Black/White stimuli. Past findings suggest that biracial Black/White faces are more often seen as Black than White, but without testing these perceptions with other groups, generalizability cannot be guaranteed., Methods: We tested 3-7-year-old Asian children living in Taiwan-an Eastern cultural context ( N = 74)-and Asian children living in the U.S.-a Western cultural context ( N = 65) to explore the role that cultural group membership may play in biracial perceptions. Children categorized 12 racially ambiguous biracial Black/White faces and 12 biracial Asian/White faces in a dichotomous forced-choice task and completed a racial constancy measurement., Results: Regarding biracial Black/White faces, Taiwanese and Asian American children both categorized the faces as White significantly more often compared to chance levels, regardless of racial constancy beliefs. For biracial Asian/White faces, Taiwanese children with racial constancy beliefs categorized the faces significantly more often as White, whereas Taiwanese children without racial constancy beliefs categorized the faces significantly more often as Asian. However, Asian American children did not show a bias in categorizing biracial Asian/White faces., Conclusions: Results suggest that hyperdescent over hypodescent for more commonly studied biracial Black/White faces generalizes in both cultural contexts. However, biracial Asian/White stimuli may be perceived in more fixed-like patterns in predominately Asian contexts, since only Taiwanese children showed increased outgroup categorizations once racial constancy beliefs were endorsed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Atopic dermatitis (AD) is a chronic, inflammatory, pruritic form of dermatosis with heterogeneous manifestations that can substantially affect patients' quality of life. AD has a complex pathogenesis, making treatment challenging for dermatologists. The Janus kinase (JAK)-signal transducer and activator of transcription (STAT) pathway plays a central role in modulating multiple immune axes involved in the immunopathogenesis of AD. In particular, Th2 cytokines, including interleukin (IL)-4, IL-5, IL-13, IL-31, and thymic stromal lymphopoietin, which contribute to the symptoms of chronic inflammation and pruritus in AD, are mediated by JAK-STAT signal transduction. Furthermore, JAK-STAT is involved in the regulation of the epidermal barrier and the modulation of peripheral nerves related to the transduction of pruritus. Targeting the JAK-STAT pathway may attenuate these signals and show clinical efficacy through the suppression of various immune pathways associated with AD. Topical and oral JAK inhibitors with variable selectivity have emerged as promising therapeutic options for AD. Notably, topical ruxolitinib, oral upadacitinib, and oral abrocitinib were approved by the U.S. Food and Drug Administration for treating patients with AD. Accordingly, the present study reviewed the role of JAK-STAT pathways in the pathogenesis of AD and explored updated applications of JAK inhibitors in treating AD., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Huang, Chung, Wu and Chen.)

Purpose: Dental caries is prevalent among low-income and minority children despite oral health promotion programs. The purpose of this study was to examine disparities associated with caregiver-reported cavities and toothaches among children in the United States aged 2-4 years by their eligibility for and participation in the Special Supplemental Nutrition for Women, Infants, and Children (WIC) program. Methods: A secondary data analysis was performed using the 2016 National Survey of Children's Health (NSCH) data on children aged 2-4 years (n=7,719) with complete WIC participation information. Three groups were formed based on WIC eligibility and participation status: WIC participants, income-eligible non-participants, and higher-income non-participants. Caregiver-reported cavities and toothaches were compared by WIC eligibility and participation using chi-square tests and multivariate logistic regression analysis. Results: Among all children in the data set, 2,069 were WIC eligible, 49.8% of whom participated in WIC. Participants in WIC had higher reported cavities and toothaches (10.0% and 5.2%) than income-eligible, or higher-income non- WIC participating children (8.9% and 3.2%; 4.4% and 0.1%, respectively; p < 0.001). However, non-Hispanic, white WIC participants, had a higher proportion of reported cavities (14.0%) and toothaches (8.2%) than income-eligible non-participants (6.7% and 1.9%, respectively; p < 0.05). While non-Hispanic, black WIC participating children, had nearly 3.6 times more reported cavities than income-eligible nonparticipants (9.0% vs. 2.5%, p < 0.05). Conclusion: Caregiver-reported cavities and toothaches varied by sociodemographic characteristics within WIC participation and eligibility groups. These findings suggest that more research is warranted to explore factors that are contributing to oral health disparities associated with WIC eligibility and participation., (Copyright © 2022 The American Dental Hygienists’ Association.)

Abstract: Observational studies indicate that vaccine-induced immunity can decline over time. However, few researchers have incorporated this kind of waning effect into their virus spread models. In this study, we simulate an influenza epidemic that considers the effects of waning immunity by fitting epidemiological models to CDC secondary historical data aggregated on a weekly basis, and derive the transmission rates at which susceptible individuals become infected over the course of the influenza season. Using a system of differential equations, we define four groups of individuals in a population: susceptible, vaccinated, infected, and recovered. We show that a larger number of initially infected individuals might not only bring the influenza season to an end sooner but also reduce the epidemic size. Moreover, any influenza virus that entails a faster recovery rate does not necessarily lead to a smaller epidemic size. We illustrate how simulation helps in understanding the effects of influenza epidemiological model in the presence of waning influenza vaccine immunity., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

To advance cross-country understanding of parental perceptions of school climate, this study examined the psychometric properties of the Delaware School Climate Survey-Home version (DSCS-H) and also compared the parental perception of school climate among Chinese ( n = 999) and American ( n = 1,251) parents. Confirmatory factor analyses revealed that the DSCS-H was best supported by a second-order factor model in both samples and full measurement invariance across countries was evident. Comparison of overall school climate latent means revealed that American parents from elementary schools perceived a more positive overall school climate than did Chinese parents. Conversely, Chinese parents of students in high school perceived a more positive overall school climate than the American parents. The latent-mean difference of parental perception of the overall school climate in middle schools across the United States and China was not significantly different. Finally, the latent mean differences in school climate subfactors varied across grade levels. Implications for using the DSCS-H for assessing and understanding the perception of school climate among parents from diverse cultural and linguistic backgrounds are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

To advance our scientific understanding about school climate and bullying victimization from the perspectives of both parents and cross-country comparisons, the present study examined the cross-country similarities and differences of the associations between overall school climate and 3 forms of bullying victimization between United States (U.S.; N = 1,251) and Chinese (N = 999) parents across elementary, middle, and high schools. Confirmatory factor analyses and measurement invariance tests were first conducted to examine the cross-country validity of the Delaware Bullying Victimization Survey-Home (DBVS-H) between U.S. and Chinese parents. Comparison of latent means of bullying victimization revealed that U.S. parents reported higher frequencies of social/relational and verbal bullying victimization compared with Chinese parents. Structural equation modeling (SEM) was then used to examine the cross-country differences of the relationship between school climate and bullying victimization. For parents in both China and the U.S., school climate was found to be significantly associated with 3 types of bullying victimization (i.e., physical, verbal, and social/relational). The negative associations between school climate and all 3 types of bullying victimization reported by U.S. parents were significantly stronger than those found in Chinese parents. Implications for bullying prevention efforts involving parents from diverse cultural and linguistic backgrounds were discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Specific ethnic genetic backgrounds are associated with the risk of Stevens-Johnson syndrome / toxic epidermal necrolysis (SJS/TEN) especially in Asians. However, there have been no large cohort, multiple-country epidemiological studies of medication risk related to SJS/TEN in Asian populations. Thus, we analyzed the registration databases from multiple Asian countries who were treated during 1998-2017. A total 1,028 SJS/TEN cases were identified with the algorithm of drug causality for epidermal necrolysis. Furthermore, those medications labeled by the US Food and Drug Administration (FDA) as carrying a risk of SJS/TEN were also compared with the common causes of SJS/TEN in Asian countries. Oxcarbazepine, sulfasalazine, COX-II inhibitors, and strontium ranelate were identified as new potential causes. In addition to sulfa drugs and beta-lactam antibiotics, quinolones were also a common cause. Only one acetaminophen-induced SJS was identified, while several medications (e.g., oseltamivir, terbinafine, isotretinoin, and sorafenib) labeled as carrying a risk of SJS/TEN by the FDA were not found to have caused any of the cases in the Asian countries investigated in this study., (© 2018 The American Society for Clinical Pharmacology and Therapeutics.)

Objective: To evaluate the risk of cancer among patients diagnosed with hemorrhoids and benign anal inflammatory lesions., Methods: A population-based, retrospective cohort study was conducted that included patients diagnosed with hemorrhoids or benign inflammatory anal lesions (eg, anal fissure, fistula, and perianal abscesses) that were registered in the National Health Insurance Research Database in Taiwan between January 1, 2000 and December 31, 2010. Standardized incidence ratios (SIRs) were calculated to compare the cancer incidence of these patients to the general population., Results: During a median observation period of 6.23 years, 3080 cancers developed among 70,513 hemorrhoid patients, with a follow-up period of 438,425.6 person-years, entailing the SIR of 1.52 (95% confidence interval [CI], 1.47-1.58). Increased cancer risk (SIR 1.16; 95% CI, 1.11-1.21) was still noted even after excluding the first year of observation. Significant long-term risk for colorectal cancer (SIR 1.50; 95% CI, 1.35-1.66) and prostate cancer (SIR 1.40; 95% CI, 1.17-1.66) was observed after corrections were made for multiple comparisons. In contrast, there was no remarkable increase in cancer risk for patients with inflammatory anal lesions when cancers detected within the first year of diagnosis were excluded., Conclusion: The presence of hemorrhoids is associated significantly with a long-term risk of developing colorectal cancer or prostate cancer. In contrast, benign inflammatory anal lesions do not appear to increase the risk of malignancy., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: Patient discharge summaries provide detailed medical information about hospitalized patients and are a rich resource of data for clinical record text mining. The textual expressions of this information are highly variable. In order to acquire a precise understanding of the patient, it is important to uncover the relationship between all instances in the text. In natural language processing (NLP), this task falls under the category of coreference resolution., Design: A key contribution of this paper is the application of contextual-dependent rules that describe relationships between coreference pairs. To resolve phrases that refer to the same entity, the authors use these rules in three representative NLP systems: one rule-based, another based on the maximum entropy model, and the last a system built on the Markov logic network (MLN) model., Results: The experimental results show that the proposed MLN-based system outperforms the baseline system (exact match) by average F-scores of 4.3% and 5.7% on the Beth and Partners datasets, respectively. Finally, the three systems were integrated into an ensemble system, further improving performance to 87.21%, which is 4.5% more than the official i2b2 Track 1C average (82.7%)., Conclusion: In this paper, the main challenges in the resolution of coreference relations in patient discharge summaries are described. Several rules are proposed to exploit contextual information, and three approaches presented. While single systems provided promising results, an ensemble approach combining the three systems produced a better performance than even the best single system.