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The sulfur over calcium ratio (S/Ca) in foraminiferal shells was recently proposed as a new and independent proxy for reconstructing marine inorganic carbon chemistry. This new approach assumes that sulfur is incorporated into CaCO 3 predominantly in the form of sulfate (SO 4 2−) through lattice substitution for carbonate ions (CO 3 2–), and that S/Ca thus reflects seawater [CO 3 2–]. Although foraminiferal growth experiments validated this approach, field studies showed controversial results suggesting that the potential impact of [CO 3 2–] may be overwritten by one or more parameters. Hence, to better understand the inorganic processes involved, we here investigate S/Ca values in inorganically precipitated CaCO 3 (S/Ca (cc)) grown in solutions of CaCl 2 − Na 2 CO 3 − Na 2 SO 4 − B(OH) 3 − MgCl 2. Experimental results indicate the dependence of sulfate partitioning in CaCO 3 on the carbon chemistry via changing pH and suggest that faster precipitation rates increase the partition coefficient for sulfur. The S/Ca ratios of our inorganic calcite samples show positive correlation with modelled [CaSO 4 0] (aq) , but not with the concentration of free SO 4 2− ions. This challenges the traditional model for sulfate incorporation in calcite and implies that the uptake of sulfate potentially occurs via ion-ion pairs rather than being incorporated as single anions. Based on the [Ca2+] dependence via speciation, we here suggest a critical evaluation of this potential proxy. As sulfate complexation seems to control sulfate uptake in inorganic calcite, application as a proxy using foraminiferal calcite may be limited to periods for which seawater chemistry is well-constrained. As foraminiferal calcite growth is modulated by inward Ca2+ flow to the site of calcification coupled to outward H+ pumping, sulfate incorporation as CaSO 4 0 ion-pair in the foraminifer's shell also provides a mechanistic link for the observed relationship between S/Ca (cc) and [CO 3 2–]. [ABSTRACT FROM AUTHOR]

We compared the effects of different weekly calf training sets on muscle size changes. Sixty-one untrained young women performed a calf training program for 6 weeks, 3 d·wk–1 , with differences in resistance training volume. The participants were randomly assigned to one of the three groups: 6-SET, 9-SET, and 12-SET weekly calf training sets. The calf raise exercise was performed in sets of 15–20 repetitions maximum. The muscle thickness measurements of medial gastrocnemius (MG), lateral gastrocnemius (LG), and soleus (SOL) were taken via B-mode ultrasound. We used the sum of the three-muscle thickness as a proxy for the triceps surae (TSSUM). The 12-SET group elicited greater increases than the 6-SET in LG (6-SET=+ 8.1% vs. 12-SET=+ 14.3%; P =0.017), SOL (6-SET=+ 6.7% vs. 12-SET=+ 12.7%; P =0.024), and TSSUM (6-SET=+ 6.9% vs. 12-SET=+ 12.0%; P =0.005), but there was no significant difference in MG changes (6-SET=+ 6.6% vs. 12-SET=+ 9.9%; P =0.067). There were no significant differences when comparing 9-SET vs. 6-SET and 12-SET (P ≥0.099). Although all groups experienced calf muscle hypertrophy, our results suggest that the higher dose range may optimize triceps surae muscle size gains. [ABSTRACT FROM AUTHOR]

Background: Chronic, non-malignant diseases (CNMD) like chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF) and dementia in advanced stages are very burdensome for patients. Timely palliative care with strong collaboration between general practitioners (GPs) and specialist palliative home care (SPHC) teams can reduce symptom burden, hospitalization rates, hospitalization costs and overall healthcare costs. The KOPAL-study on strengthening interprofessional collaboration for patients with palliative care needs tested the effect of an intervention comprising of a SPHC nurse assessment and an interprofessional case conference. This qualitative evaluative study explores patients', proxies' and their associates' motivation to participate in the KOPAL-study and views on the (benefits of the) intervention. Methods: We interviewed 13 male and 10 female patients as well as 14 proxies of patients with dementia and six associates of study participants using a semi-structured interview guide. All interviews were digitally recorded, transcribed verbatim and analysed with deductive-inductive qualitative content analysis. Results: Motivation for participation was driven by curiosity, the aim to please the GP or to support research, respectively to help other patients. Few interviewees pointed out to have expected positive effects for themselves. The nurse visit was evaluated very positively. Positive changes concerning health care or quality of life were reported sparsely. Most study participants did not prepare for the SPHC nurse assessment. They had no expectations concerning potential benefits of such an assessment, the interdisciplinary case conference and an early integration of palliative care. The majority of interviewees reported that they did not talk about the nurse visit and the interprofessional case conference with their GPs. Conclusion: Our results lead to the conclusion that SPHC nurses can serve as an advocate for the patient and thereby support the patients' autonomy. GPs should actively discuss the results of the interdisciplinary case conference with patients and collaboratively decide on further actions. Patient participation in the interdisciplinary case conference could be another way to increase the effects of the intervention by empowering patients to not just passively receive the intervention. Trial registration: DRKS00017795 German Clinical Trials Register, 17Nov2021, version 05. [ABSTRACT FROM AUTHOR]

Accurate assessment of self-perceived stress is crucial because perceived stress has been linked to post-stroke depression in persons with aphasia and may be related to linguistic performance. Measuring self-reported perceived stress can be difficult in persons with aphasia (PWA) due to linguistic impairments; therefore, using proxy ratings could be an alternative. The accuracy of proxy ratings of perceived stress may be influenced by the proxy's familiarity with the person with aphasia and/or the condition of aphasia. Additionally, accuracy may be affected by genuine or mistaken signs of perceived stress in PWA due to linguistic behavioural markers common in both stress and aphasia. An observation of stress in a PWA may also trigger a stress response in the proxy. This physiological stress response, known as stress contagion, may be mediated by trait empathy and impact proxy ratings of perceived stress in PWA. The current study investigates the accuracy of proxy ratings of perceived stress made by proxy reporters unfamiliar with PWA and unfamiliar with aphasia by exploring the agreement between PWA self- and unfamiliar proxy-reported stress ratings, the effect of aphasia severity on proxy ratings, stress contagion, and the contribution of trait empathy to proxy ratings. Fifty-five proxy reporters unfamiliar with aphasia self-reported their trait empathy and perceived stress, then watched two video cases of unfamiliar PWA and rated the stress of the PWA and their own stress level. No correlation was found between self-report and unfamiliar proxy report of PWA perceived stress. Aphasia severity did not affect proxy ratings. The proxy reporter's self-reported stress matched the PWA's stress level. Trait empathy did not predict proxy ratings. The lack of association between PWA self-report and the ratings of proxy reporters unfamiliar with PWA and aphasia indicates that unfamiliar proxy ratings are not ideal for representing objective measures of perceived stress. While aphasia severity does not affect ratings by proxy reporters unfamiliar with PWA and aphasia, unfamiliar proxy reporters may overestimate perceived stress levels in PWA. The correlation between proxy reporter self-report and PWA self-report suggests that some aspect of stress contagion is present. [ABSTRACT FROM AUTHOR]

Introduction During the coronavirus disease of 2019 (COVID-19) pandemic, routine childhood immunization rates dropped dramatically across the world, and the Military Health System (MHS) was no exception. In the MHS, which is a large, universally covered, low-to-no-cost health system, the immunization rates with the measles, mumps, and rubella (MMR) vaccine remain below the rate necessary to prevent community transmission of measles. We aimed to improve childhood immunization rates in the MHS with an expansive quality improvement project. Materials and Methods Measles, mumps, and rubella immunization rates served as proxy outcome measures for routine immunization rates tracked by the Center for Disease Control multi-immunization combination measures. The tracked measure was the percentage of 16- to 18-month olds and 6-year olds who had received MMR #1 and MMR #2, respectively. Various countermeasures were implemented throughout the study period, and standard quality improvement analyses informed the effect of countermeasures. Results By January 2023, the percentage of 16- to 18-month olds and 6-year olds who had received MMR #1 and MMR #2 was 85% and 91%, respectively, with no positive shift in immunization rates despite various countermeasures introduced during the study period. For reference, the MMR immunization rates of commercial health maintenance organization and commercial preferred provider organization for 24-month-old populations were 92% and 90.3%, respectively. On chart review, the most common cause for under-immunization (55%) was vaccine abandonment. MMR #1 rates rose to 92% in 24-month olds. Conclusions Measles, mumps, and rubella immunization rates within the MHS remained below commercial health system rates and below public health standards required for herd immunity despite various countermeasures throughout the COVID-19 pandemic. Immunization rates increased with age, suggesting that children within the MHS eventually catch up despite potential barriers. [ABSTRACT FROM AUTHOR]

This article examines the political work performed by the weather within contemporary big data predictive analytics. As a sociotechnical construction, the weather has long served as a predictive medium for forecasting human behaviour across historical contexts in order to reinforce settler colonial and imperial projects of spatial domination. Now, within twenty-first century big data systems, the weather has become a proxy for predicting human activity. Examining industrial materials from the predictive policing software HunchLab and the social media sentiment analysis platform Social Doppler, I argue that the weather proxy underwrites claims to prediction by collapsing the distinction between correlation and causation. Key here is how the proxy remediates the mechanism of impressibility that structured the weather as a racial technique for population management within nineteenth century statistical research. Through the weather proxy, big data programmes channel biopolitical frameworks of impressibility – or impressibility by proxy – in ways that causally bind individual behaviour to group-differentiated vulnerabilities of environmental exposure. At stake is how the weather proxy serves as a universal baseline condition for predicting population-level behaviour, which aims to mitigate accusations of racial bias by deferring to environmental conditions beyond human design. As a cultural construction tied to ubiquity, the weather thus is a rhetorical device that works to legitimate predictive analytics as impartial and universal while simultaneously effacing the violence that inheres within algorithmic technologies. Ultimately, by taking a comparative historical approach to the weather, I argue that we might better grasp the transformations in data science that underpin how ubiquity operates as a site of racial violence within contemporary surveillance systems. [ABSTRACT FROM AUTHOR]

The isotopic and elemental composition of the fossil shells of foraminifera are often used for reconstructing past environments and climates. These so-called proxy relations are based on the effect of environmental conditions (e.g. seawater temperature, pH) on the isotopic ratio (e.g. δ11 B or δ18 O) or partitioning of elements (commonly expressed as El/Ca or DEl ) during calcification. Whereas many studies focused on proxy-calibrations of divalent cations, incorporation of monovalent cations are less well constrained. Here we calibrate shell potassium content (K/Cacc) as a function of 1) seawater K+ concentration, 2) the ratio of potassium and calcium in seawater (K/Casw) and 3) temperature. Moreover, we analyze Na+ incorporation into the calcite as a function of seawater K+ and Ca2+ concentrations. First, we cultured specimens of the larger benthic foraminifer at four different seawater [Ca2+] and constant [K+], resulting in a range of K/Casw. Secondly, we cultured specimens of the same species at four different [Ca2+]sw and [K+]sw while keeping the ratio between these two ions constant. Finally, we tested the effect of temperature (from 18 to 28°C) on K-incorporation in this species. Measured K/Cacc values are not notably affected by [Ca2+]sw, while seawater [K+] positively influences potassium incorporation, resulting in a positive correlation between seawater K/Ca values and K/Cacc. Although the [Na+] in the culture media was constant throughout both experiments, incorporated Na responded positively to decreasing [Ca2+]sw, resulting in a positive correlation between sea water Na/Ca and Na/Cacc. The difference in the controls on K- and Na-incorporation suggests that the (biological) control on these ions differs. Part of the observed variability in element partitioning may be explained by differences in chemical speciation and crystallographic coordination in the calcite lattice. [ABSTRACT FROM AUTHOR]

Purpose: Proxy assessment can be elicited via the proxy-patient perspective (i.e., asking proxies to assess the patient's quality of life (QoL) as they think the patient would respond) or proxy-proxy perspective (i.e., asking proxies to provide their own perspective on the patient's QoL). This review aimed to identify the role of the proxy perspective in explaining the differences between self-rated and proxy-rated QoL in people living with dementia. Methods: A systematic literate review was conducted by sourcing articles from a previously published review, supplemented by an update of the review in four bibliographic databases. Peer-reviewed studies that reported both self-reported and proxy-reported mean QoL estimates using the same standardized QoL instrument, published in English, and focused on the QoL of people with dementia were included. A meta-analysis was conducted to synthesize the mean differences between self- and proxy-report across different proxy perspectives. Results: The review included 96 articles from which 635 observations were extracted. Most observations extracted used the proxy-proxy perspective (79%) compared with the proxy-patient perspective (10%); with 11% of the studies not stating the perspective. The QOL-AD was the most commonly used measure, followed by the EQ-5D and DEMQOL. The standardized mean difference (SMD) between the self- and proxy-report was lower for the proxy-patient perspective (SMD: 0.250; 95% CI 0.116; 0.384) compared to the proxy-proxy perspective (SMD: 0.532; 95% CI 0.456; 0.609). Conclusion: Different proxy perspectives affect the ratings of QoL, whereby adopting a proxy-proxy QoL perspective has a higher inter-rater gap in comparison with the proxy-patient perspective. [ABSTRACT FROM AUTHOR]

Objectives: The EQ-TIPS was developed to measure the Health-Related Quality of Life in infants/toddlers. Considering the rapid development in this period, this study aimed to investigate age-related variations in EQ-TIPS performance. Methods: Data from 551 infants/toddlers living with a health condition were analysed. Infants/toddlers were grouped by age: 0–6 months (n = 100), 6–12 months (n = 95), 12–24 months (n = 147), and 36–48 months (n = 97). Differences in item responses and item correlations across age groups were calculated by Kruskal–Wallis and Spearman's correlations, respectively. Results: The report of problems was significantly higher for movement, play, and communication in the 36–48-month group compared to the 0–6-month group. There were strong correlations (r > 0.50) across all age groups between play and movement and communication and social interaction/play; neither pain nor eating showed a clear pattern of association. Conclusions: There is an age-related difference in the reporting of items linked to developmental milestones (movement, play, and communication) with most problems reported in the 36–48-month group when deviation from peers and continued dependence on caregivers is notable. Consideration should be given to including broader examples of play in the EQ-TIPS. Redefining the items to represent social communication and/or (social) emotion, rather than communication and social interaction, may be warranted. Future research should explore the psychometric performance of items to further inform item inclusion and/or revision. [ABSTRACT FROM AUTHOR]

AbstractRisk-needs assessments (RNAs) are an evidence-based practice used by practitioners to assign supervision and programming. While foundational to day-to-day practices, these tools are typically applied ‘off-the shelf,’ and are mistakenly assumed to demonstrate equivalent prediction accuracy regardless of location or population. Although researchers and providers are aware these tools experience performance shrinkage, the issue is commonly ignored. In 2016 the Tennessee Department of Correction (TDOC) collaborated with the developers of the Static Risk Offender Needs Guide – Revised (STRONG-R) to create a staged development of a locallydeveloped risk needs assessment. Using propensity score matching, a proxy sample was used to create an initial version of the STRONG-R, representing a TDOC-like sample. This version was deployed in 2017. Following data collection, developers recrafted the tool with local data to make Version 2.0. Findings demonstrate improved performance using this innovative method, effectively eliminating performance shrinkage for the TDOC STRONG-R. [ABSTRACT FROM AUTHOR]

Purpose: To examine agreement between patient- and proxy-reported Health-Related Quality of Life (HRQoL) scores, and their associations with clinical measures and patient demographics. Methods: We examined the patient-proxy agreement in HRQoL within a cohort of community-dwelling frail older patients (Clinical Frailty Scale [CFS] score 4–6) planned for discharge from the Emergency Department (ED) of a 1700-bed tertiary hospital in Singapore. Patients were recruited as part of the Emergency Department Interventions for Frailty (EDIFY) program, a quasi-experimental study evaluating the effectiveness of a multicomponent frailty intervention (MFI) in maintaining or improving functional outcomes. HRQoL was measured using the EuroQoL five-dimensional questionnaire (EQ-5D-5L) for patients and proxies. We analysed a sample of dyadic-reported HRQoL to explore the inter-rater agreement using intraclass correlation coefficients (ICC), and the influencing factors of concordance. Results: We recruited 140 participants with 23 pairs of patient-proxy dyads having concurrent EQ-5D reported. There was poor inter-rater agreement between patient- and proxy-reported EQ-5D (ICC 0.18) with proxies perceiving poorer average HRQoL than patients. On the domain level, there was poor agreement in self-care and pain domains (ICC − 0.07 and 0.20), where proxies perceived more problems than patients. In multivariate regressions, lower frailty scores were associated with poorer agreement in EQ-5D scores (p < 0.05). Conclusion: In conclusion, our findings demonstrate differences between patient- and proxy-reported HRQoL outcomes among frail older patients, with significant discordance observed among patients who are “less frail”. Hence, proxy-reported responses should be interpreted with care especially when the abovementioned characteristics are present in an older patient. [ABSTRACT FROM AUTHOR]

Background: Illness-related communication and depressive symptoms within families may play an important role in caregivers' ability to accurately understand patients' symptom burden. We examined the associations between these psychosocial factors and symptom accuracy in patients with glioma and their family caregivers. Methods: Patients and caregivers (n = 67 dyads) completed measures of depressive symptoms (CES-D), illness communication (CICS), and QOL (SF-36). Patients reported on their own cancer-related symptoms (MDASI-BT) while caregivers reported on their perception of the patients' symptoms (i.e., proxy reporting). Paired t-tests and difference scores were used to test for agreement (absolute value of difference scores between patients and caregiver proxy symptom and interference severity reports) and accuracy (caregiver underestimation, overestimation, or accurate estimation of patient symptom and interference severity). Results: Clinically significant disagreement was found for all means scores of the MDASI-BT subscales except for gastrointestinal symptoms and general symptoms. Among caregivers, 22% overestimated overall symptom severity and 32% overestimated overall symptom interference. In addition, 13% of caregivers underestimated overall symptom severity and 21% of caregivers underestimated overall symptom interference. Patient illness communication was associated with agreement of overall symptom severity (r=−0.27, p = 0.03) and affective symptom subscale (r=−0.34, p < 0.01). Caregivers' reporting of illness communication (r=−0.33, p < 0.01) and depressive symptoms (r = 0.46, p < 0.0001) were associated with agreement of symptom interference. Caregiver underestimating symptom severity was associated with lower patient physical QOL (p < 0.01); caregiver underestimating symptom interference was associated with lower patient physical QOL (p < 0.0001) and overestimating symptom interference was associated with lower patient physical QOL (p < 0.05). Patient and caregiver mental QOL was associated with caregiver underestimating (p < 0.05) and overestimating (p < 0.05) symptom severity. Conclusion: The psychosocial context of the family plays an important role in the accuracy of symptom understanding. Inaccurately understanding patients experience is related to poor QOL for both patients and caregivers, pointing to important targets for symptom management interventions that involve family caregivers. [ABSTRACT FROM AUTHOR]

Background: The measurement of internal states of people with an intellectual disability is challenging. Given these difficulties, proxy respondents are sometimes used. However, the literature provides some caution about the validity of the use of proxy respondents. Aims: This review aims to identify the available evidence regarding the use of proxy respondents in the measurement of internal states of people with intellectual disabilities. Method: The Arksey and O'Malley scoping review framework was used for this review, refined with the Joanna Briggs Institute Methodology. Results: Results indicate there are some differences in the findings reported with respect to the efficacy of the use of proxy respondents. These may be due to a number of inconsistencies and weaknesses in examinations of their utility. Conclusions: If proxy‐reports are to be useful in understanding the internal states of people with intellectual disability, researchers need to address the shortcomings revealed by this review. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Cognitive impairment and dementia have rising prevalence and impact the health care utilization and lives of older adults. Receipt of low-value (LV) care and underutilization of high-value (HV) care by individuals with these cognitive disorders may have negative consequences for patient health, health system efficiency, and societal welfare. Evidence on health care value among cognitively impaired individuals is limited; we thus ascertained receipt of LV and HV health care in older adults with normal cognition, cognitive impairment without dementia (CIND), and dementia. STUDY DESIGN: Retrospective cohort study of Health and Retirement Study data linked to Medicare claims (1996-2018). METHODS: We examined the association between cognitive decline and the receipt of 5 LV and 7 HV services vs individuals with no change in cognition. RESULTS: Receipt of LV care ranged from 4% to 13% regardless of cognitive status. Cognitive decline (from unimpaired to either CIND or dementia) was associated with decreased probability of receipt of 1 LV service (colorectal cancer screening at 85 years and older [5-percentage-point reduction; P=.047]) and 3 HV services (glucose-lowering drugs [7-percentage-point reduction; P=.029], statins [32-percentage-point reduction; P=.045], and antiresorptive therapy [61-percentage-point reduction; P=.019]). CONCLUSIONS: LV service receipt is wasteful and may be harmful, but it was not consistently associated with cognitive status. Lack of HV care for those with cognitive impairment could be a missed opportunity to improve well-being or reduce preventable adverse events. Our results suggest opportunities for improving the quality of care received by all older adults, including those with cognitive impairment. [ABSTRACT FROM AUTHOR]

An accurate assessment of intimate partner violence (IPV) is crucial to guide public policy and intervention. The Conflict Tactic Scales Revised (CTS-2) is one of the most widely used instruments to do so. Despite its good psychometric properties, research on interpartner agreement has pointed to low-to-moderate estimates, which generated some concerns about the validity of the results obtained through single-partner reports. This cross-sectional study introduces indexes that have not previously been used to assess interpartner agreement. Both partners' reports on perpetration and victimization were analyzed in a community sample of 268 different-sex couples. Our results generally pointed to better agreement levels on IPV occurrence than frequency, suggesting that the proxy method (i.e., using a single-partner report) could be a reliable method for assessing IPV occurrence but not its frequency in this population. Findings are discussed as well as the advantages and constraints of different IPV assessment practices. [ABSTRACT FROM AUTHOR]

Aim: To delineate between the concepts of parental presence, participation, and engagement in paediatric hospital care. Design: The concepts' uses in the literature were analysed to determine attributes, influences, and relationships. Methods: Delineations of each concept are established and conceptual definitions are proposed following Morses' methods. Data Sources: MEDLINE (PubMed); CINAHL, PsycINFO, Sociology Source Ultimate (EBSCOhost); Embase, Scopus (Elsevier); Google Scholar. Search dates October 2021, February 2023. Results: Multinational publications dated 1991–2023 revealed these concepts represent a range of parental behaviours, beliefs, and actions, which are not always perceptible to nurses, but which are important in family‐integrated care delivery. Parental presence is the state of a parent being physically and/or emotionally with their child. Parental participation reflects parents' performing caregiving activities with or without nurses. Parental engagement is a parents' state of emotional involvement in their child's health and the ways they act on their child's behalf. Conclusion: These concepts' manifestations are important to parental role attainment but may be inadequately understood and considered by healthcare providers. Implications: Nurses have influence over parents' parental presence, participation, and engagement in their child's care but need support from healthcare institutions to ensure equitable family‐integrated care delivery. Impact: Problem: Lack of clear definition among these concepts results in incomplete and at times inequitable family‐integrated care delivery. Findings: Parental presence is an antecedent to parental participation, and parental presence and participation are elements of parental engagement. The concepts interact to influence one another. Impact: Hospitalized children, their families, nurses, and researchers will benefit through a better understanding of the concepts' attributes, interactions, and implications for enhanced family‐integrated care delivery. [ABSTRACT FROM AUTHOR]

Importance: Parent recall is the primary method for measuring positioning practices such as tummy time in infants. Concerns regarding the accuracy of parent recall have been raised in the literature. To date, no study has examined the agreement of tummy time recall measures with gold-standard methods. Objective: To assess the agreement between parental recall versus direct observation of tummy time in infants, and to explore the impact of prematurity on this relationship. Design: Cross-sectional observational study, spanning 1 yr. Setting: Participants' homes Participants: Thirty-two infant–parent dyads (19 full-term, 13 preterm), with infants ages 3 to 6 mo and caregivers ages older than 18 yr. Outcome and Measures: Home-recorded videos of infant play across 3 days were used as a proxy for direct observation of tummy time and compared with a 12-item parent recall survey. Results: Parent recall had a significant moderate correlation (ρ =.54, p =.002) with direct observation in full-term infants but was not correlated (p =.23) with direct observation in preterm infants. On average, parents of preterm infants overestimated tummy time by 2.5 times per day compared with direct observation. Conclusions and Relevance: For full-term infants, parent recall measures of tummy time exhibit an acceptable level of agreement with direct observation and can be reliably used over shorter periods. Parents of preterm infants may display a bias in recalling tummy time, leading to overestimations. To accurately assess tummy time in this population, a combination of subjective and objective measures should be explored. Plain-Language Summary: Tummy time is an essential movement experience for infants, especially for preterm infants, who are at a higher risk for motor delays. The most common way to track tummy time is through parent reports, or recall, versus a practitioner directly observing tummy time in the home. Despite the widespread use of parent recall to track tummy time, no study has examined the accuracy of parent recall versus direct observation in the home. Accurately assessing tummy time is crucial for improving and supporting health outcomes for infants. This study found that prematurity may affect the accuracy of parent recall for assessing tummy time in young infants. The authors discuss the implications of this finding and provide suggestions to guide the selection of appropriate methods to measure tummy time in clinical practice and research studies. This study found that infant prematurity may affect the accuracy of parent reports, or recall, of tummy time in the home versus a practitioner directly observing infant tummy time. [ABSTRACT FROM AUTHOR]

Resident training programs in the US use the Orthopaedic In-Training Examination (OITE) developed by the American Academy of Orthopaedic Surgeons (AAOS) to assess the current knowledge of their residents and to identify the residents at risk of failing the Amerian Board of Orthopaedic Surgery (ABOS) examination. Optimal strategies for OITE preparation are constantly being explored. There may be a role for Large Language Models (LLMs) in orthopaedic resident education. ChatGPT, an LLM launched in late 2022 has demonstrated the ability to produce accurate, detailed answers, potentially enabling it to aid in medical education and clinical decision-making. The purpose of this study is to evaluate the performance of ChatGPT on Orthopaedic In-Training Examinations using Self-Assessment Exams from the AAOS database and approved literature as a proxy for the Orthopaedic Board Examination. 301 SAE questions from the AAOS database and associated AAOS literature were input into ChatGPT's interface in a question and multiple-choice format and the answers were then analyzed to determine which answer choice was selected. A new chat was used for every question. All answers were recorded, categorized, and compared to the answer given by the OITE and SAE exams, noting whether the answer was right or wrong. Of the 301 questions asked, ChatGPT was able to correctly answer 183 (60.8%) of them. The subjects with the highest percentage of correct questions were basic science (81%), oncology (72.7%, shoulder and elbow (71.9%), and sports (71.4%). The questions were further subdivided into 3 groups: those about management, diagnosis, or knowledge recall. There were 86 management questions and 47 were correct (54.7%), 45 diagnosis questions with 32 correct (71.7%), and 168 knowledge recall questions with 102 correct (60.7%). ChatGPT has the potential to provide orthopedic educators and trainees with accurate clinical conclusions for the majority of board-style questions, although its reasoning should be carefully analyzed for accuracy and clinical validity. As such, its usefulness in a clinical educational context is currently limited but rapidly evolving. ChatGPT can access a multitude of medical data and may help provide accurate answers to clinical questions. [ABSTRACT FROM AUTHOR]

Background. In Italy, the law n. 219/2017 regarding informed consent states that "Communication time between doctor and patient constitutes treatment time". Legal guardian is designated as a proxy to consent on the child's behalf. The issue of proxy informed consent should be approached with a model for parent-child decision-making that is participatory, collaborative, respects and supports the autonomy of child by recognizing their evolving capacities. We aim to assess the informed consent related to healthcare decisions for medically fragile child, using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T). Materials and Methods. An observational study has been conducted at a Child Neuropsychiatry Service, administering a semi-structured interview with customized questionnaire to examine their capacities in four areas of the MacCAT-T. Results were evaluated with the Pearson correlation coefficient for the cognitive and adaptive levels of the Wechsler-Intelligence-Scale-for-Children (WISC-IV) and the Vineland-Adaptive-Behavior-Scales-II (VABS-II). Conclusions. The MacCAT-T domains Understanding, Appreciation, Reasoning, Expressing a Choice were correlated with the cognitive and adaptive levels of the WISC-IV and the VABS-II. Understanding, Appreciation and Expressing a choice have positive correlation with the Communication and Socialization scores of VABS-II; Reasoning has positive correlation with the Working-Memory-Index scores of the WISC-IV. The study enabled to assess the informed consent processes in vulnerable children and although demonstrating how they participate in their care process in a mostly unconscious way, making the frail children more involved in their own care process was possible. Future studies should assess the impact of incorporating MacCAT-T into standard informed consent in other settings. [ABSTRACT FROM AUTHOR]

Abstract“The use of health care claims datasets often encounters criticism due to the pervasive issues of omitted variables and inaccuracies or mis-measurements in available confounders. Ultimately, the treatment effects estimated using such data sources may be subject to residual confounding. Digital electronic administrative records routinely collect a large volume of health-related information; and many of which are usually not considered in conventional pharmacoepidemiological studies. A high-dimensional propensity score (hdPS) algorithm was proposed that uses such information as surrogates or proxies for mismeasured and unobserved confounders in an effort to reduce residual confounding bias. Since then, many machine learning and semi-parametric extensions of this algorithm have been proposed to better exploit the wealth of high-dimensional proxy information. In this tutorial, we will (i) demonstrate logic, steps and implementation guidelines of hdPS using an open data source as an example (using reproducible R codes), (ii) familiarize readers with the key difference between propensity score versus hdPS, as well as the requisite sensitivity analyses, (iii) explain the rationale for using the machine learning and double robust extensions of hdPS, and (iv) discuss advantages, controversies, and hdPS reporting guidelines while writing amanuscript. [ABSTRACT FROM AUTHOR]

During the design, it is important to evaluate the user experience of representative users in many human product interactions. But, in some cases, it is difficult or even impossible to recruit representative users because they have disabilities that do not allow them to take part in such investigations. Thus, alternative populations are widely studied. The most common way to replace real blind people is to use sighted but blindfolded users when studying design solutions. To test whether such alternative or proxy users can be used to represent blind people in social interactions, we examined the communication quality of 20 blind-sighted pairs and 20 blindfolded-sighted pairs in two different experiments. A prototype named E-Gaze glasses was evaluated as the testing tool. Results clearly show that the blindfolded participants achieved significantly higher communication quality than the blind participants. In qualitative data analysis, the blindfolded participants also reported their user experience of being blindfolded in conversations. Our qualitative results strengthen the conclusion that blindfolded users' behaviour is different from real blind users' behaviour. We recommend that blind users should not be substituted for blindfolded users in human product evaluations when communication quality is measured. [ABSTRACT FROM AUTHOR]

Purpose: Caregiver burden (CB) is typically self-assessed by caregivers. However, an emerging concept is assessment of CB by the recipients of care, i.e., the patient. The specific objectives are (1) to assess the level of agreement between care recipients' and caregivers' view on CB, across financial, physical, emotional, and social domains; (2) to explore two care recipient perspectives: their self-perceived burden (CR-SPB), and their interpretation of the caregiver's view (Proxy-CB). Methods: Data were collected from 504 caregiver-care recipient dyads in the U.S. using an online Qualtrics panel. The survey assessed caregiver burden using CarerQol and newly developed items. The level of agreement between responses was quantified using weighted kappa (κ) coefficients for individual items and intraclass correlation coefficients (ICC) for index/summary scores. Results: The average age of caregivers was 49.2 years, and 62.7 years for care recipients. Dyads most commonly consisted of spouses/partners (34.5%); 68.3% lived together. Proxy-CB aligned more closely with caregiver's view, with moderate to substantial agreement across CB domains (from κ = 0.48 for emotional to κ = 0.66 for financial). In the same perspective, the CarerQol-7D Index showed moderate agreement (ICC = 0.58) and the summary score of CB items substantial agreement (ICC = 0.76). Care recipients generally overestimated CB in the Proxy-CB perspective, while they underestimated it in the CR-SPB perspective. Conclusion: Results demonstrate there is a difference between perspectives. Strong agreement in Proxy-CB perspective suggests that care recipients can potentially substitute for caregivers depending on the domain. CR-SPB agrees less with caregivers and may provide complementary information. [ABSTRACT FROM AUTHOR]

The article focuses on the unpreparedness of surrogate decision-makers, especially from marginalized communities, for making critical medical decisions and highlights the need for better advance care planning and support.

The conditional proxy broadcast ReEncryption mechanism enables the user to periodically re-encrypt the cipher-text. When a sender generates the key, ReEncryption id, which reuses for the encrypted data or the ciphertext. Two methods that only allow one recipient at a time are proxy ReEncryption and identity-based proxy ReEncryption. If there are multiple receivers, these systems need to be called numerous times, which is a significant drawback. To overcome this problem of a single receiver, proposed a new scheme, blockchain-based broadcast proxy ReEncryption (BBPRE), which allows the system to handle multiple receivers at a time. This BBPRE works similar to the proxy ReEncryption and identity-based proxy ReEncryption but allows multiple receivers and adds the time property. In this broadcast proxy ReEncryption, a sender/user can able to send ciphertext or encrypted to multiple receivers at a time, and all the receivers also have an encryption key provided by the sender/user.The receivers can able to re-encrypt this encrypted data or the ciphertext. It provides security to the user files during sending and sharing through electronic mail. The time stamp authority creates a public key, each period that has the most recent timestamp for every user. [ABSTRACT FROM AUTHOR]

Background and Objectives Proxy respondents are an important tool in survey research, especially among people with cognitive impairment. However, proxy respondents may be unable to accurately answer subjective survey instruments for cognitively impaired persons. This study investigates the mediating effect of proxy status on the relationship between cognitive impairment and subjectively rated health. Research Design and Methods Respondents from the 2018 wave of the Health and Retirement Study (N  = 17,146) were included, and the Baron and Kenny method assessed the potential mediating role of having a proxy on subjectively rated health. Subjectively rated health and proxy status were dichotomously coded, and relationships between cognitive impairment, proxy status, and subjectively rated health were assessed using logistic regression. Results Findings indicate that cognitive impairment is inversely associated with subjectively rated health, and it is directly associated with having a proxy. They also indicate that having a proxy is inversely related to subjectively rated health. When including proxy status and cognitive impairment in the same model, cognitive impairment no longer predicted subjectively rated health. This indicates that proxy status perfectly mediated the relationship between cognitive impairment and subjectively rated health. Discussion and Implications Measuring the experiences of people with cognitive impairment is challenging in survey research due to the limiting features of cognitive impairment. Although having a proxy respondent helps address attrition-related measurement challenges in survey research, findings indicate that proxies report worse subjectively rated health for people with cognitive impairment compared to individuals with comparable levels of cognitive impairment without a proxy. Future research may benefit from exploring optimal proxy-respondent characteristics. [ABSTRACT FROM AUTHOR]

Background Pediatric, adolescent, and young adult patients with cancer and their caregivers are at high risk of financial toxicity, and few evidence-based oncology financial and legal navigation programs exist to address it. We tested the feasibility, acceptability, and preliminary effectiveness of Financial and Insurance Navigation Assistance, a novel interdisciplinary financial and legal navigation intervention for pediatric, adolescent and young adult patients and their caregivers. Methods We used a single-arm feasibility and acceptability trial design in a pediatric hematology and oncology clinic and collected preintervention and postintervention surveys to assess changes in financial toxicity (3 domains: psychological response/Comprehensive Score for Financial Toxicity [COST], material conditions, and coping behaviors); health-related quality of life (Patient-Reported Outcomes Measurement Information System Physical and Mental Health, Anxiety, Depression, and Parent Proxy scales); and perceived feasibility, acceptability, and appropriateness. Results In total, 45 participants received financial navigation, 6 received legal navigation, and 10 received both. Among 15 adult patients, significant improvements in FACIT-COST (P  = .041) and physical health (P  = .036) were noted. Among 46 caregivers, significant improvements were noted for FACIT-COST (P  < .001), the total financial toxicity score (P  = .001), and the parent proxy global health score (P  = .0037). We were able to secure roughly $335 323 in financial benefits for 48 participants. The intervention was rated highly for feasibility, acceptability, and appropriateness. Conclusions Integrating financial and legal navigation through Financial and Insurance Navigation Assistance was feasible and acceptable and underscores the benefit of a multidisciplinary approach to addressing financial toxicity. ClinicalTrials.gov registration NCT05876325 [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) is the second most common age-related neurodegenerative disease after Alzheimer's disease. Cognitive impairments are frequent non-motor symptoms in PD and have a significant impact on everyday life and well-being. Still, rehabilitation services for people with PD predominantly target motor symptoms. Drawing on data from a national Danish survey, this study aimed to determine significant differences among people living with PD with or without perceived cognitive impairments regarding (1) contact with different healthcare professionals, and (2) unmet needs for rehabilitation services. Data were analyzed based on whether the person with PD perceived cognitive impairments or not. Statistically significant differences between results for PD patients with and without cognitive impairments were calculated. Data on 6711 individuals with PD were included in the study. Respondents' mean age was 73.5 years, and 31% of them were experiencing cognitive impairments. Significantly more people with PD and cognitive impairments were in contact with almost all professionals compared to those without cognitive impairments. However, individuals experiencing cognitive impairments were less often in contact with the professions most experienced in cognitive rehabilitation. [ABSTRACT FROM AUTHOR]

In intraoperative brain cancer procedures, real-time diagnosis is essential for ensuring safe and effective care. The prevailing workflow, which relies on histological staining with hematoxylin and eosin (H&E) for tissue processing, is resource-intensive, time-consuming, and requires considerable labor. Recently, an innovative approach combining stimulated Raman histology (SRH) and deep convolutional neural networks (CNN) has emerged, creating a new avenue for real-time cancer diagnosis during surgery. While this approach exhibits potential, there exists an opportunity for refinement in the domain of feature extraction. In this study, we employ coherent Raman scattering imaging method and a self-supervised deep learning model (VQVAE2) to enhance the speed of SRH image acquisition and feature representation, thereby enhancing the capability of automated real-time bedside diagnosis. Specifically, we propose the VQSRS network, which integrates vector quantization with a proxy task based on patch annotation for analysis of brain tumor subtypes. Training on images collected from the SRS microscopy system, our VQSRS demonstrates a significant speed enhancement over traditional techniques (e.g., 20–30 min). Comparative studies in dimensionality reduction clustering confirm the diagnostic capacity of VQSRS rivals that of CNN. By learning a hierarchical structure of recognizable histological features, VQSRS classifies major tissue pathological categories in brain tumors. Additionally, an external semantic segmentation method is applied for identifying tumor-infiltrated regions in SRH images. Collectively, these findings indicate that this automated real-time prediction technique holds the potential to streamline intraoperative cancer diagnosis, providing assistance to pathologists in simplifying the process. [ABSTRACT FROM AUTHOR]

The article presents a study which described the prevalence of acute decline in ability to perform activities of daily living (ADL) in older adults presenting to the emergency department (ED) with suspected pneumonia. Topics discussed include demographic characteristics of older ED patients with suspected pneumonia, and limitations of the study, and the need of emergency physicians to evaluate for acute decline during their treatment and disposition decisions.

The Slovenian climate has undergone significant fluctuations, and an understanding of the past climate is necessary to improve models and recognise long-term patterns. The cryosphere environment, such as ice core samples, provides valuable palaeoclimate data. Palynology and dendroclimatology are also effective ways to study long-term changes in vegetation and reconstruct past climates using pollen and tree proxies. Sediment cores from various locations in Slovenia have been studied to understand past environmental changes. Borehole temperature profiles as well as historical records were also used to reconstruct past climate conditions. Studies have shown specific periods when climatic changes likely played a major role, but a complete timeline of the Slovenian climate throughout the Holocene has not yet been fully developed. [ABSTRACT FROM AUTHOR]

This study aims to investigate whether individual beliefs about the fairness of society can account for differences in life satisfaction. Fairness here encompasses both procedural and distributive justice. The paper uses fifth-round individual-level data from the European Social Survey (ESS). The round in question contains information that can be used as a proxy for procedural justice, in the form of individual assessment of how the courts operate in their country. It also contains variables that will serve as a proxy for distributive justice. To that end we use survey information on individual assessment of whether pay is appropriate as well as a variable measuring the gap between received and expected pay. The latter is constructed using pay information and individuals' personal demographic and productive features, as well as information on the characteristics of their workplace. The hypothesis that life satisfaction is impacted by perceived unfairness cannot be rejected. Furthermore, we find that dissatisfaction with pay increases when individuals have a negative view of procedural justice. [ABSTRACT FROM AUTHOR]

This article explores the concept of stakeholder engagement in corporate governance. It discusses the different types of stakeholders and engagement methods used by large corporations, as well as governance practices related to stakeholder engagement. The research findings suggest that while companies engage with stakeholders in various ways, true empowerment of stakeholders beyond shareholders is still limited. The article concludes by discussing potential reforms and best practices for stakeholder engagement, including increased disclosure and executive compensation tied to environmental, social, and governance (ESG) matters. The text provides a comprehensive overview of stakeholder engagement in corporate governance and highlights the importance of considering diverse perspectives and empowering stakeholders in decision-making processes. [Extracted from the article]

Reconstruction of the marine inorganic carbon system relies on proxy signal carriers, such as element/calcium (El/Ca) ratios in foraminiferal shells. Concentrations of boron, lithium, strontium, and sulfur have been shown to vary with carbonate system parameters, but when comparing individual proxy reconstructions based on these elements, they are rarely in complete agreement. This is likely caused by the simultaneous effects of multiple environmental factors on element incorporation. Culture experiments with benthic foraminifera have revealed that the shell's S/Ca reflects the carbon chemistry and can potentially be used as a proxy for seawater [CO32− ${{\text{CO}}_{3}}^{2-}$]. Aiming to investigate the application potential of sulfur incorporation for carbonate speciation reconstruction, we present S/Ca ratios in five planktonic foraminiferal species, namely Globigerina bulloides, Globigerinoides ruber albus, Globigerinoides ruber ruber, Trilobatus sacculifer, and Neogloboquadrina incompta from core‐top sediments in regions with contrasting [CO32− ${{\text{CO}}_{3}}^{2-}$], [HCO3− ${{\text{HCO}}_{3}}^{-}$], temperature, and salinity. Analyses of B/Ca and Mg/Ca ratios are included here since these elements have been shown to depend to a certain degree on carbon system parameters (e.g., calcite saturation state and pH, respectively) as well. Moreover, foraminiferal Mg/Ca values covary with S/Ca values and thereby might compromise its proxy application. In contrast to previously published results, this new data set shows a positive correlation between the incorporation of sulfur in the foraminifer's shell and seawater [CO32− ${{\text{CO}}_{3}}^{2-}$]. As the incorporation of sulfur and magnesium are positively correlated, S/Mg values of the same foraminifera may be used to improve inorganic carbon system reconstructions. Plain Language Summary: Ions incorporated in the shells of foraminifera, a group of unicellular calcifying organisms, provide crucial insight into past changes in the ocean's carbon chemistry. Inorganic carbon chemistry includes six parameters: [CO2], [HCO3− ${{\text{HCO}}_{3}}^{-}$], [CO32− ${{\text{CO}}_{3}}^{2-}$], pH, dissolved inorganic carbon concentration, and total alkalinity; and previous studies have shown that the incorporation of sulfur, magnesium, and boron depend on one or more of these parameters. We analyzed sulfur, magnesium, and boron concentrations in planktonic foraminifera from regions with various carbon chemistry conditions to investigate the application potential of these elements in reconstructing parameters of carbon chemistry. Results of this field study indicate that [HCO3− ${{\text{HCO}}_{3}}^{-}$] may also have a strong influence on the incorporation of magnesium in addition to the previously reported temperature, salinity, and pH control, and the sulfur concentrations in foraminifera are likely affected by more than one parameter of the carbon chemistry. A significant positive correlation between sulfur and magnesium concentrations hints at shared parameters controlling their incorporations. Therefore, taking the ratio of sulfur and magnesium concentrations may correct the parameters that influence the incorporation of both elements. Here, we suggest investigating the potential of combining multiple elements in future work for better constraining the marine inorganic carbon chemistry. Key Points: S/Ca in the planktonic foraminifera, Globigerina bulloides, Globigerinoidesruber, Trilobatus sacculifer, and Neogloboquadrina incompta show a positive correlation with [CO32− ${{\text{CO}}_{3}}^{2-}$]Seawater [HCO3− ${{\text{HCO}}_{3}}^{-}$] may have a stronger influence on the incorporation of magnesium in the foraminifera's shells than salinityA multi‐element approach may correct for the influence of multiple controls on the incorporation of elements [ABSTRACT FROM AUTHOR]

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Archaeal isoprenoid glycerol dibiphytanyl glycerol tetraethers (GDGTs) preserved in sediments are popular tools for the reconstruction of past temperature in the global ocean. Whereas the most common GDGTs have been well studied through environmental and culture studies, their hydroxylated version (OH-GDGTs) is just emerging as a new proxy. Some empirical evidence suggests that the distribution of OH-GDGTs may capture sea surface temperature variability. However, the effects of additional environmental factors on OH-GDGT distributions have not been rigorously tested, and evidence suggests that salinity, sea ice, seasonality, terrestrial input, and water depth may be additional factors in some settings. In this study, we analyzed the distribution of OH-GDGTs in modern and Holocene marine sediment from the North Iceland Shelf. By statistically comparing the biomarker datasets against a collection of modern instrumental and paleoceanographic records, we separated which environmental variables may be controlling OH-GDGT-derived proxies around Iceland. In contrast to prevailing theory, we found that nitrate concentrations and water-column stratification are best correlated to OH-GDGT distributions, and not temperature. These results hold important implications for the application of OH-GDGT proxies in high-latitude oceans, particularly in highly stratified locations, as well as for future studies on the biological sources and functionality of these lipids. Given the current complexity of proxy interpretation, we urge caution in the current application of OH-GDGTs as a tool in paleotemperature reconstructions.

Skeleton bones, distinguished by trabecular and cortical bone tissue content, exhibit varied growth and composition, in response to modified dietary calcium and phosphorus levels. The study investigated how gilts adapt their individual bone and bone region mineralisation kinetics in response to changing intake of Ca and P. A total of 24 gilts were fed according to a two-phase (Depletion (D) 60–95 and Repletion (R) 95–140 kg BW, respectively). During the D phase, gilts were fed either 60% (D60) or 100% (D100) of the estimated P requirement. Subsequently, during the R phase, half of the gilts from each D diet were fed either 100% (R100) or 160% (R160) of the estimated P requirement according to a 2 × 2 factorial arrangement. Bone mineral content (BMC) was assessed in the whole body, individual bones (femur and lumbar spine L2–L4), and bone regions (head, front legs, trunk, pelvis, femur, and hind legs) every 2 weeks using dual-energy X-ray absorptiometry (DXA). At 95 kg BW, gilts fed D60 showed reduced BMC and BMC/BW ratio in all studied sites compared to those fed D100 (P

The isotopic and elemental composition of the fossil shells of foraminifera are often used for reconstructing past environments and climates. These so-called proxy relations are based on the effect of environmental conditions (e.g. seawater temperature, pH) on the isotopic ratio (e.g. δ11B or δ18O) or partitioning of elements (commonly expressed as El/Ca or DEl) during calcification. Whereas many studies focused on proxy-calibrations of divalent cations, incorporation of monovalent cations are less well constrained. Here we calibrate shell potassium content (K/Cacc) as a function of 1) seawater K+ concentration, 2) the ratio of potassium and calcium in seawater (K/Casw) and 3) temperature. Moreover, we analyze Na+ incorporation into the calcite as a function of seawater K+ and Ca2+ concentrations. First, we cultured specimens of the larger benthic foraminifer Amphistegina lessonii at four different seawater [Ca2+] and constant [K+], resulting in a range of K/Casw. Secondly, we cultured specimens of the same species at four different [Ca2+]sw and [K+]sw while keeping the ratio between these two ions constant. Finally, we tested the effect of temperature (from 18 to 28°C) on K-incorporation in this species. Measured K/Cacc values are not notably affected by [Ca2+]sw, while seawater [K+] positively influences potassium incorporation, resulting in a positive correlation between seawater K/Ca values and K/Cacc. Although the [Na+] in the culture media was constant throughout both experiments, incorporated Na responded positively to decreasing [Ca2+]sw, resulting in a positive correlation between sea water Na/Ca and Na/Cacc. The difference in the controls on K- and Na-incorporation suggests that the (biological) control on these ions differs. Part of the observed variability in element partitioning may be explained by differences in chemical speciation and crystallographic coordination in the calcite lattice.

Central Valley Spring-run Chinook (CVSC) are listed as threatened under the California and federal Endangered Species Acts, but how ocean fisheries affect CVSC is not routinely monitored or managed , largely because of data limitations. Most tag data for CVSC are from a hatchery program that may not sufficiently represent natural-origin fish in ocean and inland fishery recovery data. However, a discontinued tagging program for Butte Creek Wild Spring-run Chinook (BCWSC) provides for estimation of fishery impacts and maturation schedules for a limited set of years, which we compared with estimates for hatchery-origin fish for common years, while extending the hatchery-origin estimates over a wider time-frame. Additional scale-age data from BCWSC allow inferences about more recent maturation rates, conditional on harvest-rate estimates borrowed from other stocks. Overall, CVSC appear to experience low age-3 ocean fishery impact rates, but age-4 impact rates can be comparable to ocean harvest rates estimated for Sacramento River Fall Chinook. Tagging data from the years available indicate that ocean fisheries may reduce spawning run sizes  (all ages combined) by 40% to 60% during periods of high fishing effort. Effects of ocean fishing on spawner abundance are weaker in years of reduced fishing or for cohorts displaying earlier maturation. It appears that maturation rates of hatchery-origin CVSC may have increased (i.e., earlier maturation) over the full time-period examined, and there may be indications of increasing maturation rates for BCWSC as well.

A web application is prone to security threats due to its open nature. The security of these platforms is imperative for organizations of all sizes because they store sensitive information. Consequently, exploiting web application vulnerabilities could result in large-scale data breaches and significant brand and financial damages. SQL injection (SQLi) represents a popular attack vector that malicious actors use to compromise website security. Web application firewalls (WAFs) play a primary role in preventing such malicious attack typologies. In the recent literature, several advances have been proposed in the field of WAF enhancement to prevent SQLi exploitation. However, many of them test the effectiveness of a WAF without releasing a patch to fix security flaws if a WAF is bypassed. In other cases, the patch is distributed exclusively according to the syntax specified by the WAF tested. This paper introduces a framework that leverages PROxy Grammar to Enhance web application firewalls for SQL Injection prevention (PROGESI). The proposed solution can act as an intermediary layer between the targeted web server and the incoming application level requests. Specifically, PROGESI can be used individually or in combination with a WAF and includes a series of rules that patch SQLi vulnerabilities exposed by a specific web server. Furthermore, it can identify and mitigate SQLi attempts, also when attackers use mutation techniques, since the rules used encompass generalization mechanisms. The experiments performed revealed two strengths of PROGESI: (i) the ability to identify SQLi even in the presence of server-side defense mechanisms, which increases as the generalization rate implemented by the rule generation algorithm increases; (ii) impressive detection performance even for low generalization rate values, which is higher than that achieved by competitors using a state-of-the-art SQLi dataset.