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Young children’s use of digital technologies has presented challenges for parents, particularly in response to an increased reliance on digital resources during the Covid-19 pandemic. This mixed-methods study explored young children’s digital practices within the context of their families and homes. Although this study was originally planned, the timing of data collection meant that it was uniquely positioned to capture parent perspectives as the pandemic and first lockdown was unfolding in Australia. Data was collected through questionnaire ( N = 101) and semistructured interview ( n = 20) about status and change in children’s digital practices, and parents’ rules and flexibility in governing these experiences. Quantitative findings suggested children’s frequency and duration of digital device use trended upwards during lockdown, and parents were more flexible in their rules about the amount of screen time, as well as when and where children could use digital devices. Qualitative results suggested that, more than a temporary and situational change, for many parents, exposure to new ways of engaging with digital technologies facilitated a shift in their perceptions, leading to greater consideration of quality in their choices for their children. This study highlights the influential role of parents in shaping children’s digital experiences. Understanding their perceptions, as well as children’s current and shifting digital practices in the home, is important for informing efforts and guidance for supporting young children’s safe and effective use of digital technologies.

Background: Contemporary data on stroke epidemiology and the availability of national stroke clinical registries are important for providing evidence to improve practice and support policy decisions. Aims: To update the most current incidence, case-fatality, and mortality rates on stroke and identify national stroke clinical registries worldwide. Methods: We searched multiple databases (based on our existing search strategy) to identify new original papers, published between 1 November 2018 and 15 December 2021, that met ideal criteria for data on stroke incidence and case-fatality, and added these to the studies reported in our last review. To identify national stroke clinical registries, we updated our last search, using PubMed, from 6 February 2015 until 6 January 2022. We also screened reference lists of review papers, citation history of papers, and the gray literature. Mortality codes for International Classification of Diseases (ICD)-9 and ICD-10 were extracted from the World Health Organization (WHO) for each country providing these data. Population denominators were obtained from the United Nations (UN) or WHO (when data were unavailable in the UN database). Crude and adjusted stroke mortality rates were calculated using country-specific population denominators, and the most recent years of mortality data available for each country. Results: Since our last report in 2020, there were two countries (Chile and France) with new incidence studies meeting criteria for ideal population-based studies. New data on case-fatality were found for Chile and Kenya. The most current mortality data were available for the year 2014 (1 country), 2015 (2 countries), 2016 (11 countries), 2017 (10 countries), 2018 (19 countries), 2019 (36 countries), and 2020 (29 countries). Four countries (Libya, Solomon Islands, United Arab Emirates, and Lebanon) reported mortality data for the first time. Since our last report on registries in 2017, we identified seven more national stroke clinical registries, predominantly in high-income countries. These newly identified registries yielded limited information. Conclusions: Up-to-date data on stroke incidence, case-fatality, and mortality continue to provide evidence of disparities and the scale of burden in low- and middle-income countries. Although more national stroke clinical registries were identified, information from these newly identified registries was limited. Highlighting data scarcity or even where a country is ranked might help facilitate more research or greater policy attention in this field.

During summer 2020, the Maricopa County Department of Public Health (MCDPH) responded to a surge in COVID-19 cases. We used internet-based platforms to automate case notifications, prioritized investigation of cases more likely to have onward transmission or severe COVID-19 based on available preinvestigation information, and partnered with Arizona State University (ASU) to scale investigation capacity. We assessed the speed of automated case notifications and accuracy of our investigation prioritization criteria. Timeliness of case notification—the median time between receipt of a case report at MCDPH and first case contact—improved from 11 days to

The stress of family caregiving may affect many health-related variables, including sleep. We evaluated differences in self-reported sleep quality between incident caregivers and matched non-caregiving controls from a national population-based study. Caregivers and controls were identified in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study and matched on seven different demographic and health history factors. Caregivers reported significantly longer sleep onset latency than controls, before and after adjusting for covariates (ps < .05). No differences were found on measures of total sleep time or sleep efficiency. Among caregivers only, employed persons reported less total sleep time and number of care hours was a significant predictor of total sleep time. Dementia caregivers did not differ from other caregivers. This is one of the few population-based studies of sleep quality in family caregivers. Additional research is needed to examine whether sleep disturbance contributes to greater health problems among caregivers.

There is need and opportunity for assessments that support quick and playful – yet also accurate, rigorous and developmentally sensitive – appraisals of early numeracy. Ideally, these should be accessible to those who have opportunity to support children’s learning development and ultimately shift children’s trajectories. The iPad-based Early Years Toolbox (EYT) Early Numeracy assessment was developed and evaluated to determine its validity and reliability, and appropriateness of use by researchers and preschool educators. Results from two studies with 246 children aged 3–5 years indicated the following: construct validity and internal consistency, concurrent validity with established measures, developmental sensitivity, test–retest reliability and highly comparable results whether used by a researcher or an educator. This yields a brief and playful assessment of early numeracy and a potential approach to develop broad-use early years assessments.

This study aimed to examine associations between gross motor skills and executive functions (EF) in a large sample of Australian preschool-aged children. Of 566 children (mean age = 3.2 ± 0.4 years, 51.2% girls), locomotor, object control, and total skill competence were significantly associated with visual spatial working memory and inhibition ( p < 0.05). Total skill competence was associated with shifting and locomotor skills were significantly associated with self-regulation ( p < 0.05). Static balance was significantly associated with inhibition and shifting ( p < 0.05). In boys, an association between object control skills and visual spatial working memory was observed. In girls, an association between static balance and visual spatial working memory, phonological working memory, and shifting was observed. The identification of significant associations between gross motor skills and different EFs is an important contribution to the growing evidence on the relationship between motor skills and EFs in early childhood.

The study objective was to investigate the effects of childhood residential mobility on older adult physical and mental health. In REasons for Geographic and Racial Differences in Stroke (REGARDS) Study, we used linear regression models to investigate if number of moves during childhood predicted mental and physical health (SF-12 MCS, PCS), adjusting for demographic covariates, childhood socioeconomic status (SES), childhood social support, and adverse childhood experiences (ACEs). We investigated interaction by age, race, childhood SES, and ACEs. People who moved more during childhood had poorer MCS scores, β = −0.10, SE = 0.05, p = 0.03, and poorer PCS scores, β = −0.25, SE = 0.06, p < 0.0001. Effects of moves on PCS were worse for Black people compared to White people ( p = 0.06), those with low childhood SES compared to high childhood SES ( p = 0.02), and high ACEs compared to low ACEs ( p = 0.01). As family instability accompanying residential mobility, family poverty, and adversity disproportionately affect health, Black people may be especially disadvantaged.

NASA human factor design engineers wanted to examine if there would be any differences in testing low-fidelity conceptual designs in a physical environment compared to a virtual environment. An evaluation of two identical environments was conducted with subject matter experts (SMEs). Results indicated that when testing a design concept at this early stage, a high correlation between the two environments exists, meaning SMEs found little to no difference when evaluating a design in either a physical or a virtual environment. There are advantages and limitations to both environments. The virtual world gave the experts a better sense of the microgravity space and the relationships of space and human presence that are difficult to simulate in a 1-g physical environment. However, the interaction between human and mechanics is better enhanced in the physical world compared to the virtual world. These advantages and limitations of each environment are important; thus, at this early design life cycle phase, virtual reality shows great promise as an evaluation environment for testing early design concepts that will cost less, give more options, and increase designer’s time to design.

The tridecapeptide neurotensin has been implicated in the pathogenesis of cardiometabolic disease. Its stable precursor, pro-neurotensin/neuromedin N (pro-NT/NMN), has been associated with composite cardiovascular outcomes including coronary heart disease (CHD) and stroke. The exclusive association of pro-NT/NMN with ischemic stroke has not been evaluated. We conducted a prospective case-cohort study in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. From 2003 to 2007, REGARDS enrolled 30,239 white or black adults aged ⩾ 45 years. Baseline fasting pro-NT/NMN was measured by immunoassay in the analytic sample including 448 incident ischemic stroke cases and 818 random cohort sample participants. A total of 464 ischemic strokes occurred. Risk of stroke was assessed with a Cox proportional-hazards model incorporating demographic covariates and a second adding stroke risk factors. Increased pro-NT/NMN was associated with ischemic stroke in the demographic model overall (hazard ratio (HR) per standard deviation (SD) pro-NT/NMN 1.16, 95% confidence interval (CI) 1.01–1.33) and in men (HR per SD pro-NT/NMN 1.25, 95% CI 1.04–1.50); HRs were attenuated in the risk factor model. Pre-existing diabetes mellitus and CHD were the largest confounders of ischemic stroke risk, each accounting for an estimated 19% of the association of pro-NT/NMN with ischemic stroke observed in the demographic model. There were no significant interactions of race or sex with pro-NT/NMN. Further research on associations of pro-NT/NMN with stroke risk factors such as diabetes mellitus is indicated.

Objectives:We aimed to compare incident family caregivers and matched controls on change in social network variables and satisfaction with social activities. Methods: A total of 479 participants from the Caregiving Transitions Study were included in the analysis, 244 (50.9%) of whom began substantial and sustained caregiving between baseline and follow-up interviews. We assessed associations between incident caregiving and change in social network size, change in monthly social contact, and satisfaction with social activities. Results: Incident caregivers reported lower satisfaction with social activities and greater decline in social network size than controls. Among only the caregivers, dementia caregivers reported greater decline in social network size while caregivers who were spouses, experienced higher strain, and provided more hours of care reported lower satisfaction with social activities. Discussion: Social engagement declined more among incident caregivers than controls. Future studies should aim to understand why subgroups of caregivers reported lower social engagement.

Background Data on stroke epidemiology and availability of hospital-based stroke services around the world are important for guiding policy decisions and healthcare planning. Aims To provide the most current incidence, mortality and case–fatality data on stroke and describe current availability of stroke units around the world by country. Methods We searched multiple databases (based on our existing search strategy) to identify new original manuscripts and review articles published between 1 June 2016 and 31 October 2018 that met the ideal criteria for data on stroke incidence and case–fatality. For data on the availability of hospital-based stroke services, we searched PubMed for all literature published up until 31 June 2018. We further screened reference lists, citation history of manuscripts and gray literature for this information. Mortality codes for International Classification of Diseases-9 and International Classification of Diseases-10 were extracted from the World Health Organization mortality database for each country providing these data. Population denominators were obtained from the World Health Organization, and when these were unavailable within a two-year period of mortality data, population denominators within a two-year period were obtained from the United Nations. Using country-specific population denominators and the most recent years of mortality data available for each country, we calculated both the crude mortality from stroke and mortality adjusted to the World Health Organization world population. Results Since our last report in 2017, there were two countries with new incidence studies, China ( n = 1) and India ( n = 2) that met the ideal criteria. New data on case–fatality were found for Estonia and India. The most current mortality data were available for the year 2015 (39 countries), 2016 (43 countries), and 2017 (7 countries). No new data on mortality were available for six countries. Availability of stroke units was noted for 63 countries, and the proportion of patients treated in stroke units was reported for 35/63 countries. Conclusion Up-to-date data on stroke incidence, case–fatality, and mortality statistics provide evidence of variation among countries and changing magnitudes of burden among high and low–middle income countries. Reporting of hospital-based stroke units remains limited and should be encouraged.

Self-regulation is crucial for children’s development and learning. Almost by convention, it is assumed that self-regulation is a relatively stable skill, and little is known about its dynamic nature and context dependency. Traditional measurement approaches such as single direct assessments and adult reports are not well suited to address questions around variations of self-regulation within individuals and influences from social-contextual factors. Measures relying on child observations are uniquely positioned to address these questions and to advance the field by shedding light on self-regulatory variability and incremental growth. In this paper, we review traditional measurement approaches (direct assessments and adult reports) and recently developed observational measures. We discuss which questions observational measures are best suited to address and why traditional measurement approaches fall short. Finally, we share lessons learned based on our experiences using child observations in educational settings and discuss how measurement approaches should be carefully aligned to the research questions.

Observational epidemiological studies have the dual goals of measuring disease burden and assessing the association between exposures and outcomes. This report focuses on the first of these goals and provides an overview of design considerations of commonly used approaches, specifically community surveillance studies, cross-sectional studies, and longitudinal cohort studies. Each of these designs has strengths and weaknesses, with no study design being superior in all cases. Rather, these designs are complementary to achieve a better understanding of the burden of stroke.

Background Current information on mortality attributed to stroke among different countries is important for policy development and monitoring prevention strategies. Unfortunately, mortality data reported to the World Health Organization by different countries are inconsistent. Aims and/or hypothesis To update the repository of the most recent country-specific data on mortality from stroke for countries that provide data using a broad code for “cerebrovascular disease.” Methods Data on mortality from stroke were obtained from the World Health Organization mortality database. We searched for countries that provided data, since 1999, on a combined category of “cerebrovascular disease” (code 1609) that incorporated International Classification of Diseases (10th edition) codes I60–I69. Using population denominators provided by the World Health Organization for the same year when available, or alternatively estimates obtained from the United Nations, we calculated crude mortality from “cerebrovascular disease” and mortality adjusted to the World Health Organization world population. We used the most recent year reported to the World Health Organization, as well as comparing changes over time. Results Since 1999, seven countries have provided these mortality data. Among these countries, crude mortality was greatest in the Russian Federation (in 2011), Ukraine (2012), and Belarus (2011) and was greater in women than men in these countries. Crude mortality was positively correlated with the proportion of the population aged ≥65 years but not with time. Age-adjusted mortality was greatest in the Russian Federation and Turkmenistan, and greater in men than women. Over time, mortality declined, with the greatest decline per annum evident in Kazakhstan (8.7%) and the Russian Federation (7.0%). Conclusions Among countries that provided data to the World Health Organization using a broad category of “cerebrovascular disease,” there was a decline in mortality in two of the countries that previously had some of the largest mortality rates for stroke.

Background Up to date data on incidence, mortality, and case-fatality for stroke are important for setting the agenda for prevention and healthcare. Aims and/or hypothesis We aim to update the most current incidence and mortality data on stroke available by country, and to expand the scope to case-fatality and explore how registry data might be complementary. Methods Data were compiled using two approaches: (1) an updated literature review building from our previous review and (2) direct acquisition and analysis of stroke events in the World Health Organization (WHO) mortality database for each country providing these data. To assess new and/or updated data on incidence, we searched multiple databases to identify new original papers and review articles that met ideal criteria for stroke incidence studies and were published between 15 May 2013 and 31 May 2016. For data on case-fatality, we searched between 1980 and 31 May 2016. We further screened reference lists and citation history of papers to identify other studies not obtained from these sources. Mortality codes for ICD-8, ICD-9, and ICD-10 were extracted. Using population denominators provided for each country, we calculated both the crude mortality from stroke and mortality adjusted to the WHO world population. We used only the most recent year reported to the WHO for which both population and mortality data were available. Results Fifty-one countries had data on stroke incidence, some with data over many time periods, and some with data in more than one region. Since our last review, there were new incidence studies from 12 countries, with four meeting pre-determined quality criteria. In these four studies, the incidence of stroke, adjusted to the WHO World standard population, ranged from 76 per 100,000 population per year in Australia (2009–10) up to 119 per 100,000 population per year in New Zealand (2011–12), with the latter being in those aged at least 15 years. Only in Martinique (2011–12) was the incidence of stroke greater in women than men. In countries either lacking or with old data on stroke incidence, eight had national clinical registries of hospital based data. Of the 128 countries reporting mortality data to the WHO, crude mortality was greatest in Kazhakstan (in 2003), Bulgaria, and Greece. Crude mortality and crude incidence of stroke were both positively correlated with the proportion of the population aged ≥ 65 years, but not with time. Data on case-fatality were available in 42 studies in 22 countries, with large variations between regions. Conclusions In this updated review, we describe the current data on stroke incidence, case-fatality and mortality in different countries, and highlight the growing trend for national clinical registries to provide estimates in lieu of community-based incidence studies.

Inherent in applied developmental sciences is the threat to validity and generalizability due to missing data as a result of participant drop-out. The current paper provides an overview of how attrition should be reported, which tests can examine the potential of bias due to attrition (e.g., t-tests, logistic regression, Little's MCAR test, sensitivity analysis), and how it is best corrected through modern missing data analyses. To amend this discussion of best practices in managing and reporting attrition, an assessment of how developmental sciences currently handle attrition was conducted. Longitudinal studies ( n = 541) published from 2009–2012 in major developmental journals were reviewed for attrition reporting practices and how authors handled missing data based on recommendations in the Publication Manual of the American Psychological Association (APA, 2010). Results suggest attrition reporting is not following APA recommendations, quality of reporting did not improve since the APA publication, and a low proportion of authors provided sufficient information to convey that data properly met the MAR assumption. An example based on simulated data demonstrates bias that may result from various missing data mechanisms in longitudinal data, the utility of auxiliary variables for the MAR assumption, and the need for viewing missingness along a continuum from MAR to MNAR.

Several methods of assessing executive function (EF), self-regulation, language development, and social development in young children have been developed over previous decades. Yet new technologies make available methods of assessment not previously considered. In resolving conceptual and pragmatic limitations of existing tools, the Early Years Toolbox (EYT) offers substantial advantages for early assessment of language, EF, self-regulation, and social development. In the current study, results of our large-scale administration of this toolbox to 1,764 preschool and early primary school students indicated very good reliability, convergent validity with existing measures, and developmental sensitivity. Results were also suggestive of better capture of children’s emerging abilities relative to comparison measures. Preliminary norms are presented, showing a clear developmental trajectory across half-year age groups. The accessibility of the EYT, as well as its advantages over existing measures, offers considerably enhanced opportunities for objective measurement of young children’s abilities to enable research and educational applications.

Background Black individuals are at greater risk of stroke and vitamin D deficiency than white individuals. Epidemiologic studies have shown that low 25-hydroxyvitamin D concentrations are associated with increased risk of stroke, but these studies had limited representation of black individuals. Methods We examined the association of 25-hydroxyvitamin D with incident stroke in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a cohort of black and white adults ≥45 years of age. Using a case–cohort study design, plasma 25-hydroxyvitamin D was measured in 610 participants who developed incident stroke (cases) and in 937 stroke-free individuals from a stratified cohort random sample of REGARDS participants (comparison cohort). Results In multivariable models adjusted for socio-demographic factors, co-morbidities and laboratory values including parathyroid hormone, lower 25-hydroxyvitamin D concentrations were associated with higher risk of stroke (25-hydroxyvitamin D >30 ng/mL reference; 25-hydroxyvitamin D concentrations 20–30 ng/mL, hazard ratio 1.33, 95% confidence interval (95% CI) 0.89,1.96; 25-hydroxyvitamin D interaction = 0.82). The associations were qualitatively unchanged when restricted to ischemic or hemorrhagic stroke subtypes or when using race-specific cut-offs for 25-hydroxyvitamin D categories. Conclusions Vitamin D deficiency is a risk factor for incident stroke and the strength of this association does not appear to differ by race.

Video analysis of situational factors associated with head impacts and concussion has been completed in several sports, however has yet to be completed in cricket. This study aimed to identify situational factors associated with concussion in elite Australian male and female cricket. Match video of head impacts were coded for player position, impacting object, source of ball, location of impact, and where the ball went after impact. Head impacts were then categorised as either concussion or no concussion based on clinical diagnosis. Data for 197 head impacts included 35 (18%) which were diagnosed as concussion. Head impacts typically occurred to an on-strike batter facing a pace bowler (84%). If the ball stopped or rebounded towards the source, 21% were diagnosed as concussion (13% if the ball deflected away from the source). If impact was to an unprotected head, 38% were diagnosed as concussion (16% if impact was to a helmet). If impact was to the back of the helmet or head, 40% were diagnosed as concussion (11–21% for other areas of the head or helmet). The combination of situational factors most consistent with concussion were impact from ball that hit the back of helmet or head and stopped or rebounded towards the source (PPV 80%, p = 0.002). Consideration of the situational factors of a head impact may improve the speed and accuracy of clinical decision making on whether to remove a player from the field for further assessment, particularly if clinical signs are unclear. Video may be used as a tool to support this process. Improved impact attenuation of cricket helmets, particularly at the back, may reduce the risk of concussion.

Background: With patients living a decade or longer post-procedure, long-term data are needed to assess the durability of carotid artery stenting versus carotid endarterectomy. Identifying characteristics of those consenting or declining to continue in long-term follow-up may suggest strategies to improve retention in clinical trials. Purpose: This report describes differences between patients choosing or declining to continue follow-up for up to 10 years in the Carotid Revascularization Endarterectomy versus Stenting Trial. Methods: Following completion of the primary outcome, patients who were in active Carotid Revascularization Endarterectomy versus Stenting Trial follow-up were asked to continue beyond their original 4-year commitment for a maximum of 10 years. The characteristics of those who consented were compared with those who declined. Univariate and multivariable logistic regression were used for analysis, and backwards stepwise logistic regression (the most parsimonious model) was used to determine the factors associated with continuation. Results: Of the 1921 active Carotid Revascularization Endarterectomy versus Stenting Trial participants for whom consent to extend follow-up was requested, 1695 (88%; mean age: 68.4) consented; 226 (12%; mean age: 69.6) declined. Of those who did not consent versus those who consented, 66% versus 48% were symptomatic at baseline (p Conclusion: Symptomatic status, increasing age, randomized at lower volume centers, and longer time in follow-up were associated with reduced odds of consenting to long-term follow-up. Identifying factors associated with reduced willingness to extend participation long-term can suggest targeted strategies to improve retention in future clinical trials.

Although researchers agree that the first 5 years of life are critical for children’s developing executive functions (EFs), further advances are hindered by a lack of consensus on the design and selection of developmentally appropriate EF tasks for young children. Given this debate, well-established adult measures of EF routinely have been adapted for young children. Given young children’s comparatively limited cognitive capacities, however, such adaptations do not guarantee that the task’s critical EF demands are retained. To investigate this possibility, the current study examined the characteristics that optimize measurement of young children’s EFs—specifically, their inhibitory control—using the go/no-go (GNG) task as an exemplar. Sixty preschoolers completed six GNG tasks differing in stimulus animation, presentation time, and response location. Comparison EF tasks were administered to examine concurrent validity of GNG variants. Results indicated effects of stimulus presentation time and response location, with animation further enhancing task validity and reliability. This suggests that current GNG tasks deflate estimates of young children’s ability to inhibit, with implications for future design and selection of developmentally appropriate EF tasks.

Evidence for an indigenous Interpersonal Relatedness (IR) personality trait that is distinct from the Big Five personality taxonomy has been demonstrated in Chinese culture; however, research has not yet established whether this construct is specific to the Chinese culture or whether it is more universal. The current research extended this personality construct to a workplace context and examined the relevance of the Workplace IR trait within Taiwanese ( n = 573) and U.S. ( n = 155) employees. Results indicated that in both cultural groups the Workplace IR construct emerged and was not subsumed within the workplace Big Five domains; however, the content of the Workplace IR construct varied slightly between Taiwanese and U.S. employees. These findings suggest that this purported indigenous Chinese personality trait has potential relevance for working adults in Western as well as Eastern cultures.

Numerous studies finding a relationship between children's television viewing and obesity have led many to argue that advertising “unhealthy” food products causes children to adopt eating habits that lead to obesity. This longitudinal analysis of the relationship between television viewing and childhood obesity finds a positive effect in children aged seven years and older but not in younger children. Adding controls for the household environment created by the children's parents reduces the size of this effect. If advertising is the causal mechanism for the relationship, watching programming on television should have a greater effect than watching similar programming on video or DVDs. We find no significant difference in the effects of viewing commercial versus noncommercial television. Moreover, we generally find no significant differences between watching programming for the same intended audience on television or on video. These results suggest that restrictions on advertising may play a limited role in the battle against childhood obesity. Research is needed on the determinants of children's television viewing and how those factors may influence dietary choices.

The historical development of deceased organ donation, transplantation, and organ procurement organizations is reviewed. The concept of transplantation, taking parts from one animal or person and putting them into another animal or person, is ancient. The development of organ transplantation brought on the need for a source of organs. Although many early kidney transplants used kidneys from living donors, these donors could not satisfy the ever-growing need for organs, and extrarenal organs were recovered only from deceased donors. This need for organs to satisfy the great demand led to specialized organizations to identify deceased donors, manage them until recovery occurred, and to notify transplant centers that organs were available for their patients. The functions of these organ procurement organizations expanded to include other required functions such as education, accounting, and compliance with state and federal requirements. Because of the shortage of organs relative to the demand, lack of a unified organ allocation system, the perception that organs are a national resource and should be governed by national regulations, and to improve results of organ procurement organizations and transplant centers, the federal government has regulated virtually all phases of organ procurement and transplantation.

Established in 1957, the University of Florida Department of Surgery has a solid foundation on which current faculty are driven to build a stronger tomorrow. The department is focused on promoting patient-centered care, expanding its research portfolio to improve techniques and outcomes, and training the surgical leaders of tomorrow. It fosters an environment where faculty, residents, students, and staff challenge long-held traditions with the goal of improving the health of our patients, the quality of our care, and the vitality of our work environment.

Measurement in early childhood is an increasingly large-scale endeavor addressing purposes of accountability, program improvement, child outcomes, and intervention decision making for individual children. The Early Communication Indicator (ECI) is a measure relevant to intervention decision making for infants and toddlers, including response to intervention approaches. The widespread use of the ECI is growing in multiple programs and states. Local program staff members collect ECI data and, with their program directors, manage their own system of ECI measurement. Program-level implementations represent independent ECI measurement replications, and the success of each potentially influences the quality of data produced and, ultimately, the validity of the inferences made thereof. The purpose of this research was to examine program-level influences on child-level ECI total communication growth and 36-month outcomes in a large sample of children, including those with individual family service plans served by multiple Early Head Start programs in two states. Results indicated variation in programs’ sociodemographic composition, ECI implementation quality, ECI total communication growth, and 36-month outcomes. Program-level sociodemographic composition was found not to be an influence on ECI growth or 36-month outcomes, whereas state location and implementation quality were. Implications are discussed.

Various military and commercial entities, as well as the National Aeronautics and Space Administration (NASA), have conducted space-cabin confinement studies. However, after an extensive literature search, only one study was found using a simulated lunar rover (LUNEX II), under laboratory conditions, with a crew of two for an 18-day lunar mission. Forty-three years later, NASA human-factors engineers conducted a similar study using the Lunar Electric Rover (LER) in a dynamic real-world lunar simulation at the Black Point Lava Flow in Arizona. The objective of the study was to obtain human-in-the-loop performance data on the vehicle's interior volume with respect to human-system interfaces, crew accommodations, and habitation over a 14-day mission. Though part of a larger study including 212 overall operational elements, this paper will discuss only the performance of fifty different daily habitational elements within the confines of the vehicle carried out by two male subjects. Objective timing data and subjective questionnaire data were collected. Results indicate, much like the LUNEX II study, the LER field study suggest that a crew of two was able to maintain a satisfactory performance of tasks throughout the 14-day field trail within a relative small vehicle volume.

A natural component to driving any type of vehicle, whether Earth-based or space-based, is visibility. In its simplest form, visibility is a measure of the distance at which an object can be seen. The National Aeronautics and Space Administration (NASA) have human factors guidelines for the Space Shuttle and the International Space Station (ISS) windows, in terms of ergonomics and safety. However, there is little research with respect to lunar vehicles. The goal of the current study was to obtain preliminary human-in-the-loop data on window placement and configuration for the small pressurized rover (SPR). Nine participants evaluated multiple areas along the vehicle's front “nose”, while actively maneuvering through several lunar driving simulations. Subjective data was collected on areas of necessity, frequency of views, and placement/configuration of windows. Results indicated a desire for large field-of-view windows spanning the front of the vehicle with slightly reduced window areas for the lower front, lower corners, and side views.

To effectively explore the lunar surface, astronauts will need a transportation vehicle which can traverse all types of terrain. Currently, the National Aeronautics and Space Administration's (NASA) is investigating two lunar rover configurations to meet such a requirement. Under the Lunar Electric Rover (LER) project, a comparison study between the unpressurized rover (UPR) and the small pressurized rover (SPR) was conducted at the Black Point Lava Flow in Arizona. The objective of the study was to obtain human-in-the-loop performance data on the vehicles with respect to human-machine interfaces, vehicle impacts on crew productivity, and scientific observations. Four male participants took part in four, one-day field tests using the exact same terrain and scientific sites for an accurate comparison between vehicle configurations. Subjective data was collected using several human factors performance measures. Results indicate either vehicle configuration was generally acceptable for a lunar mission; however, the SPR configuration was preferred over the UPR configuration priminarly for the SPR's ability to cause less fatigue and enabling greater crew productivity.

Adenoid cystic carcinoma is a rare malignant tumor that is well known for its deceptively encouraging 5-year survival rate and its dismal survival rate at longer intervals. Controversy exists as to the benefit of regularly following asymptomatic patients to look for distant metastases because even if one is found, the options for further management are limited. When a metastasis is limited to the lung in an asymptomatic patient with no locoregional recurrence, metastasectomy might provide some long-term benefit, although we cannot know for certain. We encountered such a case, and we opted for surgical resection rather than a conservative approach. There is a need for multicenter trials so that the management of such patients, be it active or conservative, can be evidence-based.

Purpose To standardize intravenous (IV) medication concentrations and dosage units across adult hospitals in San Diego County. Methods The San Diego Patient Safety Consortium Task Force comprised representatives from 17 adult hospitals. The first step was a survey of concentration standards and dosage units for the most common and highest-risk IV medications in use at all sites. Survey results were compared with manufacturers' recommendations and reference materials. A Delphi decision-making process was used to determine final drug concentration and dosage units for each drug. Results Survey results showed more than 85 concentrations used for 34 drugs. Nine of these were high-risk medications, for which 27 different concentrations were identified. With the exception of magnesium sulfate for nonobstetric use, a single concentration was developed for each medication, resulting in a greater than 94% reduction in variation from concentration standards. A single concentration standard was developed for each high-risk medication, resulting in a 77% reduction in variation. A single dosage unit standard was developed for all medications reviewed, resulting in a 100% reduction in variation. Of the 17 hospitals, 15 were assessed for adoption of the standards. Of these 15 hospitals, adoption of concentrations standards ranged from 72.2% to 100% and adoption of dosage units ranged from 84.8% to 100%. Conclusion County-wide standardization of high-risk IV drug concentrations and dosage units reduces variability in IV therapy, which can help promote safer and more consistent practices in IV medication administration. It is expected that standardization will decrease the potential for medication errors within hospitals and on patient transfer to other health care facilities.

Issues of moving through hatchways and related design problems of hatch size and shape were investigated for the Altair lunar habitat. To insure proper usability and safety, the goal of the current study was to understand the critical dimensions necessary for proper translation through the hatch by manipulating size (height, width, step over height, and overall height) and shape (rectangular and circular). A single participant donning a pressurized rear-entry integrated (REI) Extravehicular Activity (EVA) suit was timed and video recorded as participant accomplished various translations through a mockup hatch. Objective performance measures consisted of time and contact data with the hatch, while subjective data was obtained using the Cooper-Harper Qualities Ratings, Corlett and Bishop Discomfort Scale, a Physical Effort scale, and a functionality questionnaire. Correlation analysis discovered a significant relationship between the hatch dimension of height and all of the performance measures, as well as, step over and overall height with some of the dependent scores.

Context Information about the relationship between family disagreement and donation decisions may facilitate development of strategies to help families resolve conflict and possibly increase donation consent rates. Objective To assess how family interactions influence next-of-kin decisions about organ donation. Design Semistructured survey. Setting and Participants Next of kin of potential donors (147 donors, 138 non-donors) from 1 organ procurement organization participated in a semistructured telephone interview, answering questions about the presence and influence of others during decision making related to organ donation. Results When others were actively involved in the donation decision (68%), disagreement about the donation decision occurred in 32% of cases. Compared with families initially in agreement, families not in agreement were less likely to donate ( P Conclusions Family disagreement occurred in one-third of donation approaches when other family members were present. Such disagreement is most likely to contribute to donation refusal when the deceased's donation intentions are unknown. Recognizing and assessing the nature of family disagreement may increase donation consent.

Learning networks, such as a community of practice, can be an important way for planners to gain access to, and power in, new professional knowledge domains. In this manuscript, the authors develop, implement, and evaluate a community of practice model for planning education and practice in energy and sustainability planning. The authors find that although this active, learner-centered method helps enable flexible, self-directed study for those learning new content, there is a strong need for leadership in heterogeneous learning networks to help participants overcome problems created by social position and structuration within the network. New knowledge formation within learning networks ultimately challenges some of the planning profession's fundamental assumptions about the validity of “moving knowledge into practice” in contexts with uncertainty.

Signed donor cards clearly demonstrate the donor's intention to donate organs after death. In many states, this donation cannot be rescinded by the next of kin, and organs can be recovered from the donor even if the family objects. The family usually does not object if the donor has signed an organ donor card, especially if the donor had discussed the issue with the family. In some situations, however, the family objects to donation despite the signed organ donor card. If the organ procurement organization pursues donation, adverse publicity and even legal action are possible. It can be a challenge for organ procurement personnel to deal with families who object to donation in the face of a signed organ donor card in a manner that will lead to successful organ recovery without adverse consequences. This article describes 4 cases where the donor had a signed organ donor card but the family initially objected to donation. Ultimately organs were recovered from 3 of these donors.

The current understanding of reference pricing requires broadening to reflect contemporary advertising practices and shopping behavior. A content analysis of 13,594 newspaper retail advertisements reveals that it is uncommon for reference pricing to be used alone in advertisements: 87.2% of the advertisements featuring reference pricing also include limited-time availability (i.e., “Three days only!”) or sale announcements in the headline or copy. Using dual-process theories of persuasion as a conceptual framework, the authors conduct three field experiments that compare the conditions under which the use of limited-time availability and sale announcements in advertisements that feature reference prices affects consumer price perceptions and store shopping intentions. The findings yield three insights for reference price advertising. First, reference pricing results in favorable price perceptions and store shopping intentions only when consumers are shopping for a product. Second, when consumers are shopping for a product, reference pricing paired with limited-time availability results in more favorable price perceptions and store shopping intentions than the use of either technique alone. Third, the use of sale announcements and limited-time availability in reference price advertisements has a favorable effect on price perceptions and store shopping intentions when consumers are not shopping for a product.

Hilar cholangiocarcinoma remains a difficult challenge for the surgeon. Achieving negative surgical margins when resecting this relatively uncommon tumor is technically demanding as a result of the close proximity of the bile duct bifurcation to the vascular inflow of the liver. A recent advance in surgical treatment is the addition of portal vein resection to the procedure. Resection of the portal vein increases the number of patients offered a potentially curative approach but is technically more difficult and may increase the risk of the procedure. This study reviews the results of portal vein resection for hilar cholangiocarcinoma. Between 1998 and 2005, 60 patients underwent potentially curative resections of hilar cholangiocarcinoma. Mean patient age was 64 ± 12 years (range, 24–85 years). Liver resections performed along with biliary resection included 49 trisegmentectomies (37 right, 12 left) and 10 lobectomies (8 left, 2 right). One patient had only the bile duct resected. Four patients also had simultaneous pancreaticoduodenectomy performed. Twenty-six patients required portal vein resection and reconstruction to achieve negative margins, 3 of which also required reconstruction of the hepatic artery. Operative mortality was 8 per cent with an overall complication rate of 40 per cent. Patients who underwent portal vein resection had an operative mortality of 4 per cent, which was not different from the 12 per cent mortality in patients who did not undergo portal vein resection (P = 0.39). There was no difference in actuarial patient survival between patients who underwent portal vein resection and those who did not (5-year survival 39 per cent vs. 41 per cent, P = not significant). Negative margins were achieved in 80 per cent of cases and were associated with improved survival (P < 0.01). Five-year actuarial survival in patients undergoing resection with negative margins was 45 per cent. There was no difference in margin status or long-term survival between those patients who underwent portal vein resection and those who did not. Only negative margin status was associated with improved survival by multivariate analysis. Portal vein resection for hilar cholangiocarcinoma is safe and allows a chance for long-term survival in otherwise unresectable patients.

Tobacco use adversely affects transplant outcomes such as graft survival, patient survival, and other conditions that alter transplant patient longevity. Especially concerning is tobacco's relationship to cardiovascular disease, the number 1 cause of death in kidney transplant recipients. Many authors conclude that tobacco interventions ought to be provided to patients and sometimes lament that there are no tobacco dependence interventions designed for kidney transplant recipients. European Best Practice Guidelines for Renal Transplantation also support tobacco dependence interventions. The purpose of this article is to describe one institution's experience in implementing the clinical practice guideline for treating tobacco use and dependence within a kidney and pancreas transplant program.

Background This study assesses the ability of the short form 36 (SF-36), a validated health status survey, to measure the health of patients with epistaxis due to hereditary hemorrhagic telangiectasia (HHT). Methods Thirty-eight patients completed the SF-36 and symptom-specific questionnaires. They were asked to rate their epistaxis as severe, moderate, or mild. The SF-36 data are compared with a reference population and analyzed with respect to the subgroups. Results The scores for each dimension of health were significantly reduced (p < 0.05) when compared with the reference population for all dimensions except pain. When compared with the patients’ ratings of severity, a significant correlation was detected in five dimensions (p < 0.05). Conclusion The SF-36 reflects the reduced health status of patients with epistaxis due to HHT. Changes in the SF-36 score could be used as an outcome measure in assessing efficacy of treatment of this condition.

Background Epistaxis is the most common symptom in patients with hereditary hemorrhagic telangiectasia. Different treatment options have been described but with little reference to their effect on quality of life or disease severity. Methods This study prospectively investigated the effect of nasal closure, argon laser, and a combination of septodermoplasty and argon laser treatments on quality-of-life scores and disease severity ratings in a group of 29 patients with moderate to severe epistaxis referred to a tertiary referral center. Results The only group of patients who showed a significant improvement (p < 0.05) in quality of life were those who underwent nasal closure. In addition, the nasal closure patients were the only group in which there was a complete cessation of bleeding. Conclusion Nasal closure should be offered to patients with moderate to severe epistaxis secondary to hereditary hemorrhagic telangiectasia that has proved unresponsive to other treatment.

Background Patients with peripheral arterial disease (PAD) are at increased risk for stroke, myocardial infarction (MI) and cardiovascular death. Prior studies have focused on the prevalence of PAD, but the rate of ischaemic outcomes among a diverse group of patients with PAD has received less attention. In addition, the assessment of ischaemic outcomes with the use of a survey in place of casenote review, to our knowledge, has not been defined. The purpose of this pilot study was to develop an ischaemic outcomes survey that could be used in place of the labour-intensive casenote review, for data collection as part of a large epidemiological study. Methods A data abstraction form was used as a guide in blinded casenote reviews to compare the patient's reported medical history to casenote documented ischaemic events. The proportion agreement and Cohen's kappa were used to measure the agreement and the statistical significance of this agreement between the questionnaire and casenote review items. Fifty-one patients with a history of PAD were consented and interviewed using a 23-item questionnaire that focused on the ischaemic events of unstable angina, MI, cerebral vascular accident, transient ischaemic attacks, lower extremity revascularisation, or lower extremity amputation. Results Of the 23 patient survey items, proportion agreement was ≥ 70% on more than half of the items with kappa statistics that were fair-to-moderate. For ischaemic outcomes such as lower extremity bypass surgery, there were no yes responses from the patient or within the medical record, which reflects the low prevalence of this outcome. Conclusions Overall, the ischaemic outcomes questionnaire was a valid research tool. It yielded statistically significant kappa values on several items. Although additional work is needed, the present survey provides a good framework on which to develop the final questionnaire, which will be used in a large prospective cohort study to capture ischaemic events in patients with PAD.

The author outlines the important role that the Federal Trade Commission's unfairness authority plays in fashioning consumer protection policy. First, the author discusses the history of the commission's use of its unfairness authority, focusing on the lessons that the commission learned from its early experiences. Second, the author discusses the three elements of modern unfairness: The injury must be (1) substantial, (2) without offsetting benefits, and (3) one that consumers cannot reasonably avoid. He also discusses the subsidiary role of public policy. Finally, the author uses specific examples to discuss how the commission has appropriately used modern unfairness policy to address difficult problems.

To help alleviate the organ shortage, transplant centers are using organs from expanded-criteria donors, who were considered unsuitable just a few years ago, such as non-heart-beating donors. In 1998, we made a concerted effort to increase the number of non-heart-beating donors recovered by our organ procurement organization. In this paper, we discuss the steps in establishing this program, including transplant center support, estimating the number of potential non-heart-beating donors, organ procurement support, protocol development, hospital development, education, putting the protocol into practice, follow-up, and effect of the program on organ procurement. With the establishment of this program, the number of non-heart-beating donors increased from 2% to 5% per year to over 10% for the past 2 years. From these donors, 61 of 82 recovered kidneys were transplanted into 58 patients, and 18 of 20 recovered livers were transplanted. A non-heart-beating donor program can significantly add to the number of o...

Involvement of the inferior vena cava (IVC) by hepatic tumors, although uncommon, is considered to be unresectable by standard surgical techniques. Recent advances in hepatic surgery have made combined hepatic and vena caval resection possible. The purpose of this study is to describe the surgical techniques and early results of combined resection of the liver and IVC. From 1997 to 2000, 11 patients underwent resection of the IVC along with four to seven liver segments. Resections were carried out for hepatocellular carcinoma (four); colorectal metastases (four); and hepatoblastoma, gastrointestinal stromal tumor metastases, and squamous cell carcinoma in one patient each. Ex vivo procedures were performed twice, and total vascular isolation was used in the nine other cases. The IVC was reconstructed with ringed Gore-Tex tube graft (five), primarily (five), or with Gore-Tex patches (one). There were two early deaths: one from liver failure at 3 weeks and one from sepsis secondary to a perforated segment of small bowel 4 months postresection. One patient with a gastrointestinal stromal tumor died at 32 months of recurrent tumor and one patient with hepatocellular carcinoma is alive with recurrent tumor at 16 months. The remaining patients are alive and disease free with follow-up ranging from 3 to 40 months without evidence of IVC occlusion. Combined resection of the liver and IVC is a formidable undertaking with substantial surgical risk. However, this aggressive surgical approach offers a chance for cure in patients with tumors involving the IVC that would otherwise have a dismal prognosis.

Some members of the public living near landfills perceive the sites as a source of nuisance flies and their associated diseases. Both these factors contribute to frequent complaints to Environmental Health Officers about landfill operations. Fly monitoring using sticky targets was done at a working landfill site in the West Midlands in order to identify the key species of flies present at the site, and to establish whether these flies were similar to those occurring in the surrounding area. Targets were positioned in concentric rings, radiating away from the working face into the surrounding residential area. The abundance of the flies, both in and around the landfill site was monitored over a 6-week period commencing 16 August 1999. The key families of flies present on targets on the landfill site were Muscidae, principally Musca domestica L.(common house fly), Calliphoridae, (primarily ‘blue’ and ‘green’ bottles), and Sarcophagidae (flesh flies). In contrast, the families of flies found on targets immediately outside the working landfill site and in the nearby surrounding area, were largely vegetation-feeding or parasitic flies, together with other non-fly insects. The overall abundance of all flies increased significantly during the monitoring period.

The purpose of this paper is to place the U.S. militia movement into proper historical context through the use of a comparative method. Militias in the United States are often depicted as dangerous and extreme right-wing groups that warrant significant monitoring and control. The sense of danger associated with the militias is perhaps exacerbated by the tendency to think of these groups as an unprecedented social phenomenon. Early reports of U.S. militias in news reports tended to neglect the historical forerunners of this movement, and this omission promoted the view that militias are unique developments. Expanding upon work by Durham (1996), this article seeks to deepen our historical appreciation of U.S. militias. Beginning with the observation that comparative studies of the militia movement have been hampered by a failure to systematically define the subject of study, we employ five analytic categories — ideology, motivation, mobilization, organization, and ritual — in an effort to describe U.S. militias. Having outlined these categories and applied them to U.S. militias, we then compare and contrast the militias with right-wing forerunners in the United States such as the Silver Shirts, KKK, and Know Nothing Party. We conclude with several suggestions for advancing comparative investigations into the U.S. militia movement.

The prevalent legal view with regard to trademark infringement is that consumers who exercise a low (high) degree of care when evaluating goods will be less (more) likely to notice differences among brands and thus conclude they are of (dis)similar origin. The authors argue on the basis of the involvement literature and demonstrate through two field experiments that the effect of degree of care on likelihood of brand source confusion varies by the type of similarity (similar sound versus similar meaning) among brand names. The authors discuss implications for trademark infringement litigation and company brand name evaluation in light of these findings.