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Reproductive-age women with bleeding disorders (BDs) are underdiagnosed and understudied, despite their increased risk for adverse health outcomes and pregnancy complications.This study examines pregnancy outcomes and obstetric complications of Utah women with BDs.This retrospective cohort study utilized linked birth records and clinical billing data from two large Utah healthcare systems. Utah residents who had their first birth at 20 weeks gestation (2008-2015) and who received non-emergent care within either system before delivery were included (n = 61 226). Multivariable logistic regression models were used to examine relationships between BDs and neonatal and obstetric outcomes.A total of 295 women (.48%) were included in the BD study population. Women with BDs had significantly increased odds of preterm birth (aOR 1.85, 95% CI 1.32-2.60), Caesarean delivery (aOR 1.38, 95% CI 1.06-1.79), postpartum blood transfusion (aOR 2.55, 95% CI 1.05-6.22), unplanned postpartum hysterectomy (aOR 33.96, 95% CI 7.30-157.89) and transfer to an intensive care unit (aOR 18.18, 95% CI 7.17-46.08). All of the women with BDs who experienced these serious complications were not diagnosed with a BD until the year of their first birth. Additionally, those with BDs were more likely to experience maternal and infant mortality.Women with BDs had an increased risk for preterm birth, Caesarean delivery, blood transfusion, unplanned hysterectomy, intensive care unit admission, maternal and infant mortality. Those who were not diagnosed with a BD before the year of their first birth were at an increased risk for serious pregnancy complications.

OBJECTIVE: To investigate the association between pre-pregnancy body mass index (BMI) and subfertility within a population-based cohort, exploring Hispanic ethnicity as a potential effect modifier. METHODS: We used cross-sectional study data from the Utah Pregnancy Risk Assessment Monitoring System from 2012–2015. Relationships between maternal pre-pregnancy BMI and subfertility were evaluated via Poisson regression models with robust error variance, accounting for the stratified survey sampling. Preconception BMI was analyzed continuously and categorically. Women’s subfertility was defined via self-report in two ways: 1) time trying to achieve pregnancy; and 2) report of using fertility-related drugs/medical procedures. RESULTS: The median age was 27.0; 18.8% were obese, and 15.9% were Hispanic. Women with preconception obesity (BMI>30kg/m(2)), compared to normal weight women (18.4kg/ m(2)

Wild capture fisheries produce 90 million tonnes of food each year and have the potential to provide sustainable livelihoods for nearly 40 million people around the world (http://www.fao.org/3/a-i5555e.pdf). After decades of overfishing since industrialization, many global fish stocks have recovered, a change brought about through effective management. We provide a synthetic overview of three approaches that managers use to sustain stocks: regulating catch and fishing mortality, regulating effort and regulating spatial access. Within each of these approaches, we describe common restrictions, how they alter incentives to change fishing behaviour, and the resultant ecological, economic and community‐level outcomes. For each approach, we present prominent case‐studies that illustrate behaviour and the corresponding performance. These case‐studies show that sustaining target stocks requires a hard limit on fishing mortality under most conditions, but that additional measures are required to generate economic benefits. Different systems for allocation allow stakeholder communities to strike a locally acceptable balance between profitability and employment.

Marine protected areas (MPAs) have become a widely used tool for marine conservation and fisheries management. In coastal areas, it has become clear that the success of MPAs, and the achievement of sustainable fishery production, requires a combination of effective management and conservation frameworks, maintenance of decent fisheries livelihoods, and a governance system that allows for effective participation of coastal communities, fishing people, and other ocean users in considering, designing and implementing MPAs. These ingredients are crucial to provide the social sustainability needed to achieve ecological sustainability, and in particular, to reconcile fisheries and marine conservation objectives, in light of the United Nations Sustainable Development Goals and Aichi targets of the Convention on Biological Diversity (CBD). Since its inception in 1962, the series of World Parks Congresses (WPC) has focused on protected areas, in both terrestrial and marine domains. The 2014 WPC in Sydney reinforced the apparent movement, started at the Durban WPC of 2003, towards recognition of social and economic issues related to MPAs, including the importance of food security and livelihoods, and the crucial nature of interactions between MPAs and fisheries. Many discussions at the 2014 WPC focused on these human dimensions of MPAs, and the need to incorporate them into MPA decision-making. This article examines the process and outcomes of the 2014 WPC, with emphasis on the role of people (in particular, fishers) in marine conservation, and particularly in coastal MPAs. In doing so, the article examines the process of producing a Marine Statement at the end of the WPC, as a component of the final ‘Promise of Sydney’ declaration. That process led to a range of concerns including (i) issues over transparency and inclusiveness in the statement's development, and (ii) content issues focused on representation of the social and economic conclusions, and advocacy of a specific MPA target for no-take areas. The article focuses on potential strategies for moving constructively beyond the still existing tensions between environment- and people-focused conservation and development. Copyright © 2016 John Wiley & Sons, Ltd.

Long-term and well-managed marine protected areas (MPAs) can, under the right circumstances, contribute to biodiversity conservation and fisheries management, thus contributing to food security and sustainable livelihoods. This article emphasizes (1) the potential utility of MPAs as a fisheries management tool, (2) the costs and benefits of MPAs for fishing communities, and (3) the foundations of good governance and management processes for creating effective MPAs with a dual fisheries and conservation mandate. This article highlights case studies from numerous regions of the world that demonstrate practical and often successful solutions in bridging the divide between MPA management and fisheries sustainability, with a focus on small-scale coastal fisheries in order to emphasize lessons learned. To be an effective fisheries management tool, MPAs should be embedded in broader fisheries management and conservation plans. MPAs are unlikely to generate benefits if implemented in isolation. The spatial and temporal distribution of benefits and costs needs to be taken into account since proximal fishery-dependent communities may experience higher fishing costs over the short and long-term while the fisheries benefits from MPAs may only accrue over the long-term. Key lessons for effectively bridging the divide between biodiversity conservation and fisheries sustainability goals in the context of MPAs include: creating spaces and processes for engagement, incorporating fisheries in MPA design and MPAs into fisheries management, engaging fishers in management, recognizing rights and tenure, coordinating between agencies and clarifying roles, combining no-take-areas with other fisheries management actions, addressing the balance of costs and benefits to fishers, making a long-term commitment, creating a collaborative network of stakeholders, taking multiple pressures into account, managing adaptively, recognizing and addressing trade-offs, and matching good governance with effective management and enforcement. © 2014 The Authors. Aquatic Conservation: Marine and Freshwater Ecosystems published by John Wiley & Sons, Ltd.

Summary An embedded mesh method using piecewise constant multipliers originally proposed by Puso et al. (CMAME, 2012) is analyzed here to determine effects of the pressure stabilization term and small cut cells. The approach is implemented for transient dynamics using the central difference scheme for the time discretization. It is shown that the resulting equations of motion are a stable linear system with a condition number independent of mesh size. Next, it is shown that the constraints and the stabilization terms can be recast as non-proportional damping such that the time integration of the scheme is provably stable with a critical time step computed from the undamped equations of motion. Effects of small cuts are discussed throughout the presentation. A mesh study is conducted to evaluate the effects of the stabilization on the discretization error and conditioning and is used to recommend an optimal value for stabilization scaling parameter. Several nonlinear problems are also analyzed and compared with comparable conforming mesh results. Finally, several demanding problems highlighting the robustness of the proposed approach are shown. Copyright © 2014 John Wiley & Sons, Ltd.

Children are heavy users of the Internet and prior studies have shown that many of them lack a good understanding of the risks of doing so and how to avoid them. This study examined if the cross-age teaching zone (CATZ) intervention could help children acquire important knowledge of online risks and safety. It allowed older students to act as CATZ tutors to design and deliver a lesson to younger schoolmates (tutees), using content material about online risks and safety provided by adults. Students in Year 6 (mean age = 11.5 years) were randomly assigned to act as either CATZ tutors (n = 100) or age-matched controls (n = 46) and students in Year 4 (mean age = 9.5 years) acted as either CATZ tutees (n = 117) or age-matched controls (n = 28) (total N = 291). CATZ tutors, but not matched controls scored significantly higher on objective measures of knowledge of both online risks and safety, and CATZ tutees, but not matched controls did so for online safety. Effect sizes were moderate or large. CATZ was highly acceptable to participants. The results suggest that CATZ is a viable way to help school students learn about online dangers and how to avoid them.

SUMMARY A new technique for treating the mechanical interactions of overlapping finite element meshes is presented. Such methods can be useful for numerous applications, for example, fluid–solid interaction with a superposed meshed solid on an Eulerian background fluid grid. In this work, we consider the interaction of two elastic domains: one mesh is the foreground and defines the surface of interaction, the other is a background mesh and is often a structured grid. Many of the previously proposed methods employ surface defined Lagrange multipliers or penalties to enforce the boundary constraints. It has become apparent that these methods will cause mesh locking under certain conditions. Appropriately applied, the Nitsche method can overcome this locking, but, in its canonical form, is generally not applicable to non-linear materials such as hyperelastics. The relationship between interior point penalty, discontinuous Galerkin and Nitsche's method is well known. Based on this relationship, a nonlinear theory analogous to the Nitsche method is proposed to treat nonlinear materials in an embedded mesh. Here, a discontinuous Galerkin derivative based on a lifting of the interface surface integrals provides a consistent treatment for non-linear materials and demonstrates good behavior in example problems. Published 2012. This article is a US Government work and is in the public domain in the USA.

The past 10–15 years have seen important extensions of the mortar method, a technique for joining dissimilar grids popularized by the domain decomposition community, to the more general problem of contact and impact interactions in finite element analysis. This development has taken place largely in response to several long-standing problems in computational contact mechanics: lack of robustness in solution of the nonlinear and nonsmooth equations of evolution; degradation of spatial convergence rates in problems involving nonconforming meshes on interfaces; lack of a variationally consistent technique for stress recovery on interfaces; and so on. This survey paper summarizes some of the major steps in development of mortar contact formulations. It begins with a basic summary of the mortaring idea in the context of tied contact, it discusses key concepts required for the extension of these methods to large deformation, large sliding formulations of contact-impact, and it previews new results where lessons learned from mortar contact formulations can be extended to a much broader class of interface mechanics applications, considering in particular enriched interface formulations and embedded interface approaches to fluid–structure interaction.

A new technique for treating the mechanical interactions of overlapping finite element meshes is proposed. Numerous names have been applied to related approaches, here we refer to such techniques as embedded mesh methods. Such methods are useful for numerous applications e.g., fluid-solid interaction with a superposed meshed solid on an Eulerian background fluid grid or solid-solid interaction with a superposed meshed particle on a matrix background mesh etc. In this work we consider the interaction of two elastic domains: one mesh is the foreground and defines the surface of interaction, the other is a background mesh and is often a grid. We first employ a classical mortar type approach [see Baaijens (Int J Numer Methods Eng 35:743---761, 2001)] to impose constraints on the interface. It turns out that this approach will work well except in special cases. In fact, many related approaches can exhibit mesh locking under certain conditions. This motivates the proposed version of Nitsche's method which is shown to eliminate the locking phenomenon in example problems.

Computational treatment of immersed rigid bodies, especially in the presence of free surfaces and/or breaking waves, poses several modeling challenges. A motivating example where these systems are of interest is found in offshore wave energy harvesting systems, where a floating structure converts mechanical oscillations to electrical energy. In this study, we take the first step in developing a robust computational strategy for treating rigid bodies with possible internal dynamics, such that they may be fully coupled to a fluid environment with free surfaces and arbitrarily large fluid motion. Many schemes for fluid–solid interaction involve formulating and solving all of the equations of motion on a structured cartesian finite difference grid, but with overlaying Lagrangian representation of the solid that is used to track its position. Ultimately, most of these techniques, which include methods for deformable solids as well, solve the equations of motion completely on the Eulerian grid (see, for example, (J. Comput. Phys. 2005; 205:439–457) and (J. Comput. Phys. 2008; 227:3114–3140)). By contrast, we solve Lagrangian-type rigid body equations coupled with the Eulerian formulation of the Navier Stokes equations for an immersed solid. This departure from the standard method facilitates the addition of the internal dynamics characteristic of power conversion systems. The study is based on a finite difference and level set description of a free surface between two immiscible fluids (for example water and air) for incompressible flow by Summan (J. Comput. Phys. 1994; 114:146–159). Copyright © 2010 John Wiley & Sons, Ltd.

SUMMARY Enriched finite element approaches such as the extended finite element method provide a framework for constructing approximations to solutions of non-smooth problems. Internal features, such as boundaries, are represented in such methods by using discontinuous enrichment of the standard finite element basis. Within such frameworks, however, imposition of interface constraints and/or constitutive relations can cause unexpected difficulties, depending upon how relevant fields are interpolated on un-gridded interfaces. This work address the stabilized treatment of constraints in an enriched finite element context. Both the Lagrange multiplier and penalty enforcement of tied constraints for an arbitrary boundary represented in an enriched finite element context can lead to instabilities and artificial oscillations in the traction fields. We demonstrate two alternative variational methods that can be used to enforce the constraints in a stable manner. In a ‘bubble-stabilized approach,’ fine-scale degrees of freedom are added over elements supporting the interface. The variational form can be shown to have a similar form to a second approach we consider, Nitsche’s method, with the exception that the stabilization terms follow directly from the bubble functions. In this work, we examine alternative variational methods for enforcing a tied constraint on an enriched interface in the context of two-dimensional elasticity. We examine several benchmark problems in elasticity, and show that only Nitsche’s method and the bubble-stabilization approach produce stable traction fields over internal boundaries. We also demonstrate a novel difference between the penalty method and Nitsche’s method in that the latter passes the patch test exactly, regardless of the stabilization parameter’s magnitude. Results for more complicated geometries and triple interface junctions are also presented. Copyright 2008 John Wiley & Sons, Ltd.

Many adolescents choose not to tell teachers when they have been bullied. Three studies with 12–16 year-old English adolescents addressed possible reasons. In study 1, students (N = 411, 208 females/203 males) identified reasons with no prompting. Three perceived negative outcomes were common; peers would disapprove, disclosers would feel weak/undermined, and disclosers desired autonomy. In study 2, students (N = 297, 153 females/134 males/10 unspecified) indicated how much they believed that the perceived negative outcomes would happen to them, and a substantial proportion did so. Perceived negative outcomes significantly predicted intentions to disclose being bullied. Study 3 (N = 231, 100 females/131 males) tested if the perceived negative outcomes would be strong enough to stop participants from telling a teacher even though the teacher would stop the bullying. This was the case for many of them. Participants did not report disliking peers who disclosed bullying. Theoretical and practical implications are discussed.

Students training to be educators frequently exhibit voice disorders prior to employment. To date, there exist no similar studies of future speech-language pathologists (SLPs). The study is designed as a prospective, nonrandomized survey. The objective of this study is to determine the voice problems of first year graduate students training to be SLPs. Participants were 104 first year graduate students majoring in speech-language pathology at two universities. The Quick Screen for Voice was administered. Participants who failed completed a questionnaire regarding voice problems, medical history, daily habits, and voice use. When responses further indicated voice-related problems, endoscopic examination was completed. Fourteen percent (N=15) of the participants failed the screening by demonstrating two or more abnormal voice characteristics. These included persistent glottal fry (present in all who failed), low habitual pitch, juvenile resonance, hoarse, breathy, or strained phonation, abnormally low pitch on sustained vowels, and voice breaks during the frequency range. Twelve percent (N=12) failed both the screening and follow-up questionnaire. Responses included self-reported dysphonia, medical history with voice-related side effects, difficulty with excessive voice use, and voice problems occurring daily or weekly. Endoscopic evaluation showed one participant with bilateral vocal nodules. The results suggest that voice problems among future SLPs (12%) are more common than the 3-9% reported in the general population and similar to the 11% previously reported for teachers. However, future SLP voice problems are less frequent than those reported among education majors (21%) and all college students (17%). Faculty should identify students with voice problems and emphasize optimal voice use in classroom and clinical settings.

The past decade or so has shown the mortar method to be a helpful foundation for formulation of new methods for contact/impact analysis. As originally formulated, the advantage of the mortar method is that it preserves inf-sup conditions associated with interfacial constraints, such that stability and convergence are more or less guaranteed, at least when some regularity of the solution is expected. In more recent work, interest has been shown by a number of researchers in extending many of these ideas to treatment of interfaces in extended finite element frameworks, and also to embedded surface techniques. In these cases, use of the mortar method with naive multiplier space choices can readily lead to instability. This paper highlights some of these issues, and contemplates stabilization methods which seem to be effective in such settings.

This paper serves as an investigation into the response of the NASA space shuttle wing in the event of a debris impact during launch. The explicit finite element method is used to model the leading edge of the shuttle wing and the event of impact with a piece of a material from the shuttle's external tank. The results will be utilised by the Impact Penetration Sensor System (IPSS) to help characterise the signal received by the system in the event of an actual impact. Numerical results are validated by experiments done at the Southwest Research Institute (SwRI).