Search

Objective: To determine the prevalence of systemic embolic complications after oil-based contrast lymphangiography. Patients and Methods: A retrospective medical record review of all patients undergoing oil-based lymphangiographic procedures from January 1, 2000, to December 31, 2021 was performed to identify the following: (a) the rate of systemic embolic complications after the procedure; (b) the presence of preprocedure echocardiographic assessment for right-to-left shunting; and (c) the presence of right-to-left shunting after a systemic embolic complication. Results: A total of 350 patients (200 male, 57%) underwent 400 oil-based lymphangiographic procedures. A total of 2 systemic embolic complications occurred for a prevalence of 0.5% (2/400). Preprocedure echocardiography was performed in 226 patients (226/350, 65%). Identification of a right-to-left shunt was made in 25 patients (25/226, 11%, with the majority reporting shunting at rest (23/25, 92%). Of the patients with systemic embolic complications, one had multifocal systemic oil contrast emboli, and one had a large territorial cerebrovascular infarct without the presence of oil-based contrast noted. Both cases underwent preprocedure echocardiography reporting a structurally normal heart with no evidence of a shunt through color flow Doppler evaluation, but neither case had undergone a true shunt study. Both patients were identified to have a right-to-left shunt during the dedicated echocardiographic shunt study postprocedure. Conclusion: Risk of a systemic embolic complication after oil-based contrast lymphangiography is rare but can be catastrophic. A standardized assessment for patients undergoing the procedure may be necessary to identify those at risk and to allow for appropriate preventive strategies to be employed.

Abstract The Upper Carboniferous protorothyridid amniote Brouffia orientalis from Czech Republic is redescribed. Photogrammetric scanning of the holotype and only known specimen yields considerable new information on the skull and postcranium of this tetrapod and allows us to amend previous morphological descriptions to a substantial degree. A virtual 3D model built from photogrammetry scan data is used as the basis for a new reconstruction of the skull in dorsal, lateral, and ventral aspects and the lower jaw in lateral aspect. We expand and refine the diagnosis of Brouffia and compare it with other protorothyridids. We discuss the affinities of this taxon by coding it in a recently published data matrix of early amniotes, which we subject to maximum parsimony and Bayesian fossilized birth–death analyses. Brouffia emerges as the sister taxon to Coelostegus in all analyses, but the position of these two taxa within amniotes varies. In a parsimony analysis with unweighted characters, the (Brouffia + Coelostegus) clade forms the sister group to Synapsida. In various experiments of character reweighting, that clade is placed crownward of Captorhinidae on the stem-group of Reptilia, but anticrownward of remaining protorothyridids. The latter constitute either a paraphyletic array relative to Diapsida or their monophyletic sister group. The Bayesian analysis retrieves (Brouffia + Coelostegus) as the most basal plesion on the stem-group of Reptilia.

Abstract AI-enabled ECGs have previously been shown to accurately predict patient sex in adults and correlate with sex hormone levels. We aimed to test the ability of AI-enabled ECGs to predict sex in the pediatric population and study the influence of pubertal development. AI-enabled ECG models were created using a convolutional neural network trained on pediatric 10-second, 12-lead ECGs. The first model was trained de novo using pediatric data. The second model used transfer learning from a previously validated adult data-derived algorithm. We analyzed the first ECG from 90,133 unique pediatric patients (aged ≤18 years) recorded between 1987–2022, and divided the cohort into training, validation, and testing datasets. Subgroup analysis was performed on prepubertal (0–7 years), peripubertal (8–14 years), and postpubertal (15–18 years) patients. The cohort was 46.7% male, with 21,678 prepubertal, 26,740 peripubertal, and 41,715 postpubertal children. The de novo pediatric model demonstrated 81% accuracy and an area under the curve (AUC) of 0.91. Model sensitivity was 0.79, specificity was 0.83, positive predicted value was 0.84, and the negative predicted value was 0.78, for the entire test cohort. The model’s discriminatory ability was highest in postpubertal (AUC = 0.98), lower in the peripubertal age group (AUC = 0.91), and poor in the prepubertal age group (AUC = 0.67). There was no significant performance difference observed between the transfer learning and de novo models. AI-enabled interpretation of ECG can estimate sex in peripubertal and postpubertal children with high accuracy.

Background Early detection of left and right ventricular systolic dysfunction (LVSD and RVSD respectively) in children can lead to intervention to reduce morbidity and death. Existing artificial intelligence algorithms can identify LVSD and RVSD in adults using a 12‐lead ECG; however, its efficacy in children is uncertain. We aimed to develop novel artificial intelligence–enabled ECG algorithms for LVSD and RVSD detection in pediatric patients. Methods and Results We identified 10 142 unique pediatric patients (age≤18) with a 10‐second, 12‐lead surface ECG within 14 days of a transthoracic echocardiogram, performed between 2002 and 2022. LVSD was defined quantitatively by left ventricular ejection fraction (LVEF). RVSD was defined semiquantitatively. Novel pediatric models for LVEF ≤35% and LVEF

In the 2023 hurricane season, the Hurricane Analysis and Forecast System (HAFS) based Ensemble Prediction System (EPS) was being ported to the Amazon Web Service cloud. This relocation aimed to provide real-time hurricane probabilistic forecast guidance for National Hurricane Center (NHC) forecasters. The system comprises Stochastically Perturbed Physics Tendencies (SPPT), Stochastically Kinetic Energy Backscatter (SKEB), and Stochastically Perturbed PBL Humidity (SHUM). Initial and boundary conditions are derived from the National Centers for Environmental Prediction (NCEP) operational Global Ensemble Forecast System (GEFS) 21-member forecast data. The performance of HAFS-EPS for 2023 Atlantic hurricane forecasts was compared with the global GEFS, global ECMWF ensemble, and operational HAFS-A/B forecasts. This comparison highlighted the advantages of higher-resolution regional ensemble forecasts for hurricane track, intensity, Rapid Intensification (RI) probability, and various hazards, including wind, wave, and storm surge probability guidance.

Watermarking signal authentication is a technique in which a global navigation satellite system (GNSS) provider cryptographically perturbs the spreading code to allow for limited cryptographic authentication of a signal. Several proposals and studies have been presented or are underway to augment GNSS signals with this capability. This work reintroduces a generalized combinatorial watermarking function that affords a flexible pathway to cryptographically prove the authentication security of a signal with receiver observables under certain assumptions. The security levels are comparable to those of standard cryptographic security (e.g., 128-bit security) and require little or no additional use of the navigation data bandwidth. We show how our methods can be applied to signals of different designs and signal-to-noise ratios. With our receiver processing strategy, one can design a watermarking signal authentication scheme and the accompanying receiver to have high confidence in a signal’s authenticity.

Here we delineate a complete satellite-based augmentation system (SBAS) authentication scheme, including over-the-air rekeying (OTAR), that uses the elliptic curve digital signature algorithm (ECDSA) and timed efficient stream loss-tolerant authentication (TESLA) without the quadrature (Q) channel. This scheme appends two new message types to the SBAS scheduler without over-burdening the message schedule. We have taken special care to ensure that our scheme (1) meets the appropriate security requirements needed to prevent and deter spoofing; (2) is compatible with existing cryptographic standards; (3) is flexible, expandable, and future-proof to different cryptographic and implementation schemes; and (4) is backward compatible with legacy receivers. The scheme accommodates a diverse set of features, including authenticating core-constellation ephemerides. We discuss the SBAS provider and receiver machine state and its startup, including its use by aircraft that traverse differing SBAS coverage areas. We tested our scheme with existing SBAS simulation and analysis tools and found that it had negligible effects on current SBAS availability and continuity requirements.

Purpose – The purpose of this research is to explore the utility of autonomous transport across two independent airframe maintenance operations at a single location. Design/methodology/approach – This study leveraged discrete event simulation that encompassed real-world conditions on a United States Air Force flight line. Though the Theory of Constraints (TOC) lens, a high-demand, human-controlled delivery asset is analyzed and the impact of introducing an autonomous rover delivery vehicle is assessed. The authors’ simulations explored varying numbers and networks of rovers as alternative sources of delivery and evaluated these resources’ impact against current flight line operations. Findings – This research indicates that the addition of five autonomous rovers can significantly reduce daily expediter delivery tasks, which results in additional expertise necessary to manage and execute flight line operations. The authors assert that this relief would translate into enhancements in aircraft mission capable rates, which could increase overall transport capacity and cascade into faster cargo delivery times, systemwide. By extension, the authors suggest overall inventory management could be improved through reduction in transportation shipping time variance, which enhances the Department of Defense’s overall supply chain resilience posture. Originality/value – When compared against existing practices, this novel research provides insight into actual flight line movement and the potential benefits of an alternative autonomous delivery system. Additionally, the research measures the potential savings in the workforce and vehicle use that exceeds the cost of the rovers and their employment.

Purpose – Pilot upgrade training is critical to aircraft and passenger safety. This study aims to identify variances in the US Air Force C-130J pilot upgrade training based on geographic location and provide a model to enhance policy that will impact future pilot training efforts that lower cost and increase operator quality and proficiency. Design/methodology/approach – This research employed a mixed-method approach. First, the authors collected data and analyzed 90 C-130J pilots' aviation records and then contextualized this analysis with interviews of experts. Finally, the authors present a modified version of Six Sigma's define–measure–analyze–improve–control (DMAIC) that identifies and reduces the variances in C-130J pilot training, translating into higher quality outcomes. Findings – The results indicate significant statistical variances across geographically separated C-130J pilot training organizations. This leads some organizations to have higher proficiency levels in specific tasks and others with comparative deficiencies. Additionally, the data analysis in this study enabled a recommended number of flight hours in several distinct categories that should be obtained before upgrading a pilot to aircraft commander to enhance standards. Research limitations/implications – This research was limited to C-130J pilot upgrades, but these results can be implemented within any field that utilizes hours as a measure of experience. Implications from this research can be employed to scope policy that will influence pilot training requirements across all airframes in civilian and military aviation. Originality/value – This research proposes a process improvement methodology that could be immediately implemented within the C-130J community and, more importantly, in any upgrade training where humans advance into higher echelons of a profession.

In April 2023, the superBIT telescope was lifted to the Earth’s stratosphere by a helium-filled super-pressure balloon to acquire astronomical imaging from above (99.5% of) the Earth’s atmosphere. It was launched from New Zealand and then, for 40 days, circumnavigated the globe five times at a latitude 40 to 50 degrees south. Attached to the telescope were four “drs” (Data Recovery System) capsules containing 5 TB solid state data storage, plus a gnss receiver, Iridium transmitter, and parachute. Data from the telescope were copied to these, and two were dropped over Argentina. They drifted 61 km horizontally while they descended 32 km, but we predicted their descent vectors within 2.4 km: in this location, the discrepancy appears irreducible below ∼2 km because of high speed, gusty winds and local topography. The capsules then reported their own locations within a few metres. We recovered the capsules and successfully retrieved all of superBIT’s data despite the telescope itself being later destroyed on landing.

Purpose – This paper aims to explore effective supply chain principles, through the theory of transaction cost economics, as measures to improve current contingency pharmaceutical item shortfalls in the Air Force Medical Service (AFMS) Contingency Pharmaceutical Programme. Design/methodology/approach – In this research, AFMS contingency pharmaceutical data was collected from various databases, including the Joint Medical Asset Repository, Medical Contingency Requirements Workflow and the Medical Requirements List. Through the methodology of cost-benefit analysis, alternative sourcing and fulfilment practices are evaluated. Findings – The findings of this research indicate that the application of centralized purchasing principles, in an effort to leverage prime vendor contract fill rates for shortage items, can lead to 12%–17% increases in pharmaceutical material availability across the programme. Originality/value – This research clearly shows that consolidating demand for shortage items across Active Duty War Reserve Material assemblages, though applications of centralized purchasing principles that leverage prime vendor contract fill rates, can lead to substantial increases in material availability at costs that justify the calculated benefits.

The purpose of this research was to explore how principals in eight high-functioning elementary schools in one American school district balanced teacher supervision and evaluation in their role as an instructional leader. Using the theoretical framework of ‘wicked problems’, to unpack the circular used to problematize teacher supervision and evaluation, the findings analyse how elementary principals in these eight buildings acknowledge the tensions and conflicts between supervision and evaluation, specifically as they relate to improving teacher instruction. Specifically, the results of this study highlight not only the differences between supervision and evaluation, but also the intersection between the two functions, as well as how high-performing elementary school principals serve as an instructional coach rather than a manager of teachers. While the two functions of supervision and evaluation are inherently different, it is the acknowledgement of the intersection between the two functions that can allow building principals to progress as instructional coaches who can better develop human resources and create higher-functioning school systems. Overall, this study points toward the importance of elementary principals having the instructional leadership skills to differentiate supervision and professional development need for teachers, which in turn influences the evaluation of a teacher is in her/his respective career.

Murine pharmacokinetics (PK) represents the absorption, distribution, metabolism, and elimination of drugs from the body, which helps to guide clinical studies, ultimately resulting in more effective drug treatment. The purpose of this protocol is to describe a serial bleeding protocol, obtaining blood samples at six time points from single mouse to yield a complete PK profile. This protocol has proved to be rapid, highly repeatable, and relatively easy to acquire. Comparing with the conventional PK studies, this method not only dramatically reduces animal usage, but also decreases sample variation obtained from different animals.

This paper reports on a comparative case study of the multilingual practices of eight secondary teachers of English from across India, all identified as experts of their contexts using multiple criteria. Both qualitative and quantitative data from classroom observations, interviews and other sources were collected, analysed and compared across cases. It finds that, while there was noticeable variation among the participants, all engaged in complex translingual practices that were inclusive of their learners' languages, invariably prioritising learner participation over language choice. It also finds that, in each context, learners invariably mirrored the varied translingual practices of their teachers, and that the practices of the classroom community were found to be reflective of practices in wider Indian society, enabling learners both to meet the normative requirements of monolingual written exams while also learning to integrate English more flexibly in their spoken repertoires. Given these findings, two recommendations are offered for educational policy and practice, both in India and comparable multilingual contexts across the Global South: for policy-makers and institutions to avoid the unqualified endorsement of monolingual target language (e.g. 'English-only') practices in language instruction, and for teachers to prioritise learner inclusion in classroom discourse and activities over maximal target language use.

Translanguaging theory and pedagogy have emerged as central to the recent multilingual turn in educational linguistics and language teaching, including ELT. This article will explore translanguaging from theoretical and practical perspectives, aiming to clarify what it is and is not claiming, and what types of pedagogic practice it advocates, both in its stronger and weaker forms. I argue that a paradigm shift is occurring in the field, parallel with the shift in understanding of the nature of language itself that underpins both translanguaging theory and integrationism in linguistics. Implications for practice in ELT are also explored, including a reorientation concerning the goals of language teaching, a recognition of English as a social construct with traditions of use rather than immutable rules, and a repositioning of the many translingual teachers around the world as the experts at the centre of the multilingual turn that is defining early twenty-first century language pedagogy.

The Drosophila testis is a well-established system for studying stem cell self-renewal and competition. In this tissue, the niche supports two stem cell populations, germ line stem cells (GSCs), which give rise to sperm, and somatic stem cells called cyst stem cells (CySCs), which support GSCs and their descendants. It has been established that CySCs compete with each other and with GSCs for niche access, and mutations have been identified that confer increased competitiveness to CySCs, resulting in the mutant stem cell and its descendants outcompeting wild type resident stem cells. Socs36E, which encodes a negative feedback inhibitor of the JAK/STAT pathway, was the first identified regulator of niche competition. The competitive behavior of Socs36E mutant CySCs was attributed to increased JAK/STAT signaling. Here we show that competitive behavior of Socs36E mutant CySCs is due in large part to unbridled Mitogen-Activated Protein Kinase (MAPK) signaling. In Socs36E mutant clones, MAPK activity is elevated. Furthermore, we find that clonal upregulation of MAPK in CySCs leads to their outcompetition of wild type CySCs and of GSCs, recapitulating the Socs36E mutant phenotype. Indeed, when MAPK activity is removed from Socs36E mutant clones, they lose their competitiveness but maintain self-renewal, presumably due to increased JAK/STAT signaling in these cells. Consistently, loss of JAK/STAT activity in Socs36E mutant clones severely impairs their self-renewal. Thus, our results enable the genetic separation of two essential processes that occur in stem cells. While some niche signals specify the intrinsic property of self-renewal, which is absolutely required in all stem cells for niche residence, additional signals control the ability of stem cells to compete with their neighbors. Socs36E is node through which these processes are linked, demonstrating that negative feedback inhibition integrates multiple aspects of stem cell behavior.

Building information modelling (BIM) enables the creation of a digital representation of a designed facility combined with additional information about the project attributes, performance criteria, and construction process. Users of BIM tools point to the ability to visualize the final design along with the construction process as a beneficial feature of using BIM. Knowing the construction process in relationship to a facility’s design benefits both safety professionals when planning worker safety measures for a project and designers when creating a project’s design. Success in using BIM to enhance safety partly depends on the familiarity of project personnel with BIM tools and the extent to which the tools can be used to identify and eliminate safety hazards. In a separate, ongoing study, the authors investigated the connection between BIM and safety to document the opportunities, barriers, and impacts. Utilizing an on-line survey of project engineers who work for construction firms together with a comprehensive literature review, the study found those who use BIM feel that it aids in communication of project information and project delivery, both of which have been found to have positive impacts on construction site safety. Further, utilizing the survey results, the authors apply the binary logistic regression econometric framework to better understand the factors that lead to safety professionals believing that BIM increases safety in the work place. In addition, according to the survey results, a large percentage of the engineers who use BIM feel that ultimately it helps to eliminate safety hazards and improve worker safety. The study findings suggest that improvements in safety performance across the construction industry may be due in part to increased use of BIM in the construction industry.

Reformed Experimental Activities (REActivities) is an innovative approach to the delivery of the traditional material in an undergraduate organic chemistry laboratory. To better understand the fidelity of implementing this pedagogy and what effects the framework of REActivities has on student-instructor interactions, an observational protocol study was employed. This paper also describes the Evaluation of Lab Instructor Time and Engagement (ELITE) observational instrument developed to evaluate instructional behaviors in a lab setting. The instrument was used in first semester undergraduate organic chemistry laboratories across seven universities to measure the robustness of the guided-inquiry materials when implemented and the nature of the instructor's interactions. The ELITE data was analyzed for laboratories delivered using REActivities and compared with expert delivery as well as with traditional expository methods. The data revealed that instructor behaviors when using REActivities were consistent and comparable and could be distinguished from traditional lab deliveries. The nature of the instructor's behaviors also showed a remarkably consistent trend for coded conceptual-based discussion when REActivities was employed, in contrast to the near absence of similar interactions when expository methods were employed for comparable laboratories.