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Introduction Adolescents undergoing pediatric orthopaedic surgery typically experience an uncomplicated postoperative course. However, adolescence represents a unique transition period from pediatric to adult physiology. As a result, the astute pediatric orthopaedic surgeon will be aware of unique medical and social scenarios which are relevant to adolescents during the perioperative course including the risk of venous thromboembolism (VTE), prevalence of mental health conditions, and rising use of electronic cigarettes or "vaping" to consume nicotine and cannibas. Discussion Adolescents are at a greater risk of VTE after pediatric orthopaedic surgery. In particular, adolescent females with a family history of blood clotting disorders and those with a change in mobility after surgery should be considered for prophylaxis. The prevalence of adolescent mental health conditions including anxiety, depression, and behavioral issues is increasing in the United States. Higher levels of preoperative anxiety and the presence of mental health pathology are associated with slower recovery, higher levels of postoperative pain, and the increased likelihood for chronic pain. Several quick screening instruments are available to assess adolescents for preoperative anxiety risk, including the Visual Analogue Scale for Anxiety or the Amsterdam Perioperative Anxiety Information Scale. Unfortunately, electronic cigarettes have become increasingly popular for the consumption of nicotine and cannabis among adolescents. Preoperative use of combustive cigarettes (nicotine/cannabis) represents perioperative risks for induction/anesthesia, postoperative pain, and analgesia requirements and issues with delayed wound and fracture healing. Conclusions VTE, underlying mental health conditions, and usage of nicotine and cannabis are clear detriments to the recovery and healing of adolescent patients following orthopaedic surgery. Therefore, standardized screening for adolescents before orthopaedic surgery is indicated to identify perioperative risk factors which have negative impacts on functional outcomes.

Perceived organizational support (POS) may promote healthcare worker mental health, but organizational factors that foster POS during the COVID-19 pandemic are unknown. The goals of this study were to identify actions and policies regarding COVID-19 that healthcare organizations can implement to promote POS and to evaluate the impact of POS on physicians' mental health, burnout, and intention to leave patient care.We conducted a cross-sectional national survey with an online panel of internal medicine physicians from the American College of Physicians in September and October of 2020. POS was measured with a 4-item scale, based on items from Eisenberger's Perceived Organizational Support Scale that were adapted for the pandemic. Mental health outcomes and burnout were measured with short screening scales.The response rate was 37.8% (N = 810). Three healthcare organization actions and policies were independently associated with higher levels of POS in a multiple linear regression model that included all actions and policies as well as potential confounding factors: opportunities to discuss ethical issues related to COVID-19 (β (regression coefficient) = 0.74, p = .001), adequate access to personal protective equipment (β = 1.00, p = .005), and leadership that listens to healthcare worker concerns regarding COVID-19 (β = 3.58, p.001). Sanctioning workers who speak out on COVID-19 safety issues or refuse pandemic deployment was associated with lower POS (β = -2.06, p.001). In multivariable logistic regression models, high POS was associated with approximately half the odds of screening positive for generalized anxiety, depression, post-traumatic stress disorder, burnout, and intention to leave patient care within 5 years.Our results suggest that healthcare organizations may be able to increase POS among physicians during the COVID-19 pandemic by guaranteeing adequate personal protective equipment, making sure that leaders listen to concerns about COVID-19, and offering opportunities to discuss ethical concerns related to caring for patients with COVID-19. Other policies and actions such as rapid COVID-19 tests may be implemented for the safety of staff and patients, but the policies and actions associated with POS in multivariable models in this study are likely to have the largest positive impact on POS. Warning or sanctioning workers who refuse pandemic deployment or speak up about worker and patient safety is associated with lower POS and should be avoided. We also found that high degrees of POS are associated with lower rates of adverse outcomes. So, by implementing the tangible support policies positively associated with POS and avoiding punitive ones, healthcare organizations may be able to reduce adverse mental health outcomes and attrition among their physicians.

Barrier island lagoons are the most common type of estuary in the world and can be prone to eutrophication as well as the formation and closure of ocean inlets via severe storm activity. This study describes the biological, chemical, and physical changes that occurred along the south shore of Long Island, NY, USA, following the formation of a new ocean inlet in eastern Great South Bay (GSB) by Hurricane Sandy in October of 2012. Time series sampling and experiments were performed at multiple locations within GSB and neighboring Moriches Bay from 2013 through to 2018. Historical comparisons to prior water quality monitoring data, fecal coliform concentrations, and hard clam growth rates were also made. Measurements indicated that the New Inlet provided asymmetrical ocean flushing. Within locations north (Bellport Bay) and east (Narrow Bay, western Moriches Bay) of the New Inlet, water residence times, summer water temperatures, total and dissolved nitrogen, chlorophyll a, the harmful brown tide alga, Aureococcus anophagefferens, pigments associated with diatoms and dinoflagellates (fucoxanthin and peridinin), and fecal coliform bacteria levels all significantly decreased, while salinity, dissolved oxygen, and water clarity significantly increased. In contrast, waters west of the New Inlet within the center of GSB experienced little change in residence times, significant increases in chlorophyll a and harmful brown tides caused by A. anophagefferens, as well as a significant decrease in water clarity and summer dissolved oxygen levels. Growth rates of juvenile hard clams (Mercenaria mercenaria) near the New Inlet increased compared to before the inlet and were significantly higher than in central GSB, where growth rates significantly declined compared to before the inlet. Hence, while enhanced ocean flushing provided a series of key ecosystem benefits for regions near the New Inlet, regions further away (> 10 km) experienced more frequent HABs and poorer performance of bivalves, demonstrating that enhanced ocean flushing provided by the breach was not adequate to fully restore the whole GSB ecosystem.

Currently, studies of cognition and cognitive decline in the United States are limited by the use of samples that only provide data for respondents during one stage of the adult life course. By using an Integrative Data Analysis (IDA) framework, it is possible to pool multiple national representative samples together in order to create a unified dataset that includes respondents over the entire adult life course. This study applies an IDA framework to two independent public health datasets to create a commensurate measure of cognition using Modified Non-Linear Factor Analysis (MNLFA). The overall goal is to demonstrate the process of using MNLFA for the study of cognition in a pooled dataset.

Prior work on the mechanism of carbon monoxide (CO) formation from stored wood pellets has provided the basis for a continuous process that results in the production of pellets that do not off-gas CO. It had been shown that exposure to ozone eliminated the unsaturated hydrocarbons that autoxidize to produce hydroxyl radicals, which, in turn, react with the hemicellulose to produce CO. To develop a practical process to eliminate the CO formation, a kinetic study of the continuous ozonolysis of wood fiber was conducted using a small materials auger. The reaction was found to follow a pseudo-first-order reaction such that the reduction in CO emissions was linearly proportional to the ozone exposure (concentration × time). The exposure needed to reduce or eliminate the formation of CO from the exposed fiber was around 42 000 ppm min at a flow rate of 0.57 kg/min of fiber or approximately 0.032 g of O3/kg of fiber to be passivated. The volatile organic compounds produced during the ozonolysis of fiber were ana...

A ranking on a graph is an assignment of positive integers to its vertices such that any path between two vertices of the same rank contains a vertex of strictly larger rank. The rank number of a graph is the fewest number of labels that can be used in a ranking. In this paper we determine rank numbers for some trees and unicyclic graphs.

Spatial prioritization techniques are commonly used in conservation planning, but are relatively new for planning restoration programs. Typically, ecological data, and more recently data on economic costs and vulnerability of sites, are used. However, the effectiveness of restoration action ultimately relies on a combination of the appropriate ecological restoration techniques and the human and social dynamics of social-ecological systems. Surveys were conducted with 29 land managers within the Makana Municipality of the Eastern Cape, South Africa, to identify a range of human and social factors hypothesized to define the potential effectiveness of restoration action. Land managers with similar characteristics were grouped using a cluster analysis, and the groups ranked and mapped in geographical information system (GIS) to provide a spatial representation of restoration opportunity. The total number of questions were reduced by 35.6%, a step toward developing a rapid assessment approach for assessing land managers' potential participation in restoration initiatives. Identifying and incorporating human and social factors that directly influence restoration prioritization should promote efficient and effective implementation of restoration actions by the Working for Woodlands programme, who are looking to funding landscape-scale restoration through carbon trading.

The Mackenzie Basin in northwestern Canada covers approximately 1.8 million km2 and extends from 52°N to 70°N. Much of the Basin is currently too cool and remote from markets to support a viable agricultural sector, but the southern portion of the Basin has the physical potential to support commercial agriculture. This case study employed agricultural land rating and crop models to estimate the degree to which a CO2 -induced global warming might alter the physical potential for commercial agriculture throughout the Basin. The two climate change scenarios considered in this analysis would relax the current constraints imposed by a short and cool frost-free season, but without adaptive measures, drier conditions and accelerated crop development rates were estimated to offset potential gains stemming from elevated CO2 levels and warmer temperatures. In addition to striving for a better understanding of the extent to which physical constraints on agriculture might be modified by climate change, there is a need to expand the research context and to consider the capacity of agriculture to adapt to altered climates.

Dans l'état actuel de la science, nous ne savons pas encore avec précision comment les expériences perceptives, liées à l'environnement, ou celles qui n'en dépendent plus directement, comme les représentations mentales, interagissent avec les dispositifs de simulation. L'auteur, Patrick Curran, professeur à l'université Paris-VIII s'efforce de mettre en évidence certains des traits hybrides, prometteurs ou préoccupants, apparus dans notre société depuis que le « virtuel » se développe, entre le « réel de la vie imaginaire » et l'« imaginaire de la vie réelle »., Curran Patrick. Des objets virtuels aux univers virtuels. In: Communication et langages, n°99, 1er trimestre 1994. pp. 98-119.

This paper discusses the concept of Open Standards and proposes criteria for judging the extent to which standards developed by a particular Standards Setting Organization may be considered Open. The Java Community Process - the mechanism set up by Sun Microsystems to develop Java standards, and now continued by Oracle - is described and discussed in the context of these criteria.

One of the most important stages in the development of any real-time system is the generation of a consistent design that satisfies an authoritative specification of requirements. Management of the development of complex real-time systems requires the appropriate level of decomposition, encapsulation and abstraction, and their implementation requires languages incorporating concurrency and error-handling facilities. This paper shows that Modular Object Oriented Notation (MOON) specifications cater for the specification of real-time systems, which can be suitably transformed for concurrent implementation using Occam and similar languages.

We provide 1985 estimates of the work force of epidemiologists in the United States, the number of graduates from training programs in epidemiology, and a projection of the future need for these health professionals. Our methods included a search of mailing lists from professional organizations, mail contact with graduate training programs, telephone interviews with experts, and a review of job announcements in professional journals. The study indicates that the current work force of epidemiologists in the United States is estimated to include 4,600 persons, more than half of whom are physicians; most epidemiologists are located in either a state with a major federal public health agency or one with a large population; and programs in epidemiology graduate an average of 475 persons with one or two years of master's level education and approximately 80 with doctoral-level education each year. After considering the factors that influence the supply of epidemiologists, we project a substantial need for more epidemiologists in the future than current sources will provide.