Agreement between methods of measurement with multiple observations per individual

Limits of agreement provide a straightforward and intuitive approach to agreement between different methods for measuring the same quantity. When pairs of observations using the two methods are independent, i.e., on different subjects, the calculations are very simple and straightforward. Some authors collect repeated data, either as repeated pairs of measurements on the same subject, whose true value of the measured quantity may be changing, or more than one measurement by one or both methods of an unchanging underlying quantity. In this paper we describe methods for analysing such clustered observations, both when the underlying quantity is assumed to be changing and when it is not

Methane emissions from western Siberian wetlands: heterogeneity and sensitivity to climate change

The prediction of methane emissions from high-latitude wetlands is important given concerns about their sensitivity to a warming climate. As a basis for the prediction of wetland methane emissions at regional scales, we coupled the variable infiltration capacity macroscale hydrological model (VIC) with the biosphere–energy-transfer–hydrology terrestrial ecosystem model (BETHY) and a wetland methane emissions model to make large-scale estimates of methane emissions as a function of soil temperature, water table depth, and net primary productivity (NPP), with a parameterization of the sub-grid heterogeneity of the water table depth based on TOPMODEL. We simulated the methane emissions from a 100 km × 100 km region of western Siberia surrounding the Bakchar Bog, for a retrospective baseline period of 1980–1999 and have evaluated their sensitivity to increases in temperature of 0–5 °C and increases in precipitation of 0–15%. The interactions of temperature and precipitation, through their effects on the water table depth, played an important role in determining methane emissions from these wetlands. The balance between these effects varied spatially, and their net effect depended in part on sub-grid topographic heterogeneity. Higher temperatures alone increased methane production in saturated areas, but caused those saturated areas to shrink in extent, resulting in a net reduction in methane emissions. Higher precipitation alone raised water tables and expanded the saturated area, resulting in a net increase in methane emissions. Combining a temperature increase of 3 °C and an increase of 10% in precipitation to represent climate conditions that may pertain in western Siberia at the end of this century resulted in roughly a doubling in annual emissions

A Performance Improvement Project to Improve Hand-off Communication Documentation within the Surgical Services Department

Over 80% of adverse events in healthcare are due to miscommunication. To improve patient safety, The Joint Commission recommended the use of standardized hand-off communication tools in 2012. One acute care hospital in Southeast Florida implemented standardized handoff reports in 2014 with few revisions since that time. The COVID-19 pandemic brought to light additional critical information was needed to keep patients and staff safe, such as laboratory results indicating the need for isolation precautions. The nurses within the surgical services noticed this critical information was not sufficiently included in the handoff report. The lack of this information led to unnecessary staff exposures and delays in treatment. The quality improvement nurse noticed a significant drop in the use of the standardized hand-off report form used during this time. This drop in compliance lead to concerns for patient and staff safety. The purpose of this performance improvement project was to improve the quality of handoff reports as measured by the level of documentation using the standardized handoff report. The project followed the Plan-Do-Check-Act model for performance improvement, monitoring documentation compliance and reporting the results to the leaders and staff. The handoff report form was revised with input from the staff, resulting in improved efficiency. The nurses’ level of satisfaction with the form improved resulting in improved compliance and reducing miscommunications

Mode Bifurcation and Fold Points of Complex Dispersion Curves for the Metamaterial Goubau Line

In this paper the complex dispersion curves of the four lowest-order transverse magnetic modes of a dielectric Goubau line ($\epsilon>0, \mu>0$) are compared with those of a dispersive metamaterial Goubau line. The vastly different dispersion curve structure for the metamaterial Goubau line is characterized by unusual features such as mode bifurcation, complex fold points, both proper and improper complex modes, and merging of complex and real modes

The other side of the story - maternal perceptions of safety advice and information: a qualitative approach

Background: A qualitative study of maternal perceptions of home safety advice. The aim was to gain an understanding of maternal perceptions of and possible barriers to the implementation of home safety advice. Methods: Semi-structured interviews with 37 mothers with a child aged less than 5 years of age; 16 were mothers living in an area of socio-economic disadvantage (with a high rate of childhood unintentional injury), 21 were mothers living in an area of relative affluence (with a low rate of childhood unintentional injury). Thematic analysis was used to analyse the data. Results: Although some mothers living in both areas found talking to a health professional about child home safety was helpful, mothers in both areas tended to find talking to other mothers as being more helpful and they preferred this to talking to a professional. Barriers to obtaining safety advice from professionals exist for mothers living in both areas. Mothers living in the advantaged area describe ‘feeling silly’ and that they should ‘know it already’ when talking to professionals. Mothers living in the disadvantaged area are less likely to access home safety advice due to fear of being perceived as an incompetent mother and the fear of social service involvement. Conclusions: Mothers find home safety advice from other parents more useful and prefer this to advice from professionals. This suggests greater use could be made of appropriately trained parents to deliver safety advice and education. Fear and mistrust can limit access to child safety advice in parents living in disadvantaged areas and this may be a potential explanation for differential unintentional injury rates as those who need the advice and support most may be least likely to access it. Further research should explore how professionals can build trust, gain parents’ confidence and provide child safety advice and education that is targeted appropriately to parents living circumstances and their child safety needs

Accuracy of chest computed tomography in distinguishing cystic pleuropulmonary blastoma from benign congenital lung malformations in children

Importance: The ability of computed tomography (CT) to distinguish between benign congenital lung malformations and malignant cystic pleuropulmonary blastomas (PPBs) is unclear. Objective: To assess whether chest CT can detect malignant tumors among postnatally detected lung lesions in children. Design, Setting, and Participants: This retrospective multicenter case-control study used a consortium database of 521 pathologically confirmed primary lung lesions from January 1, 2009, through December 31, 2015, to assess diagnostic accuracy. Preoperative CT scans of children with cystic PPB (cases) were selected and age-matched with CT scans from patients with postnatally detected congenital lung malformations (controls). Statistical analysis was performed from January 18 to September 6, 2020. Preoperative CT scans were interpreted independently by 9 experienced pediatric radiologists in a blinded fashion and analyzed from January 24, 2019, to September 6, 2020. Main Outcomes and Measures: Accuracy, sensitivity, and specificity of CT in correctly identifying children with malignant tumors. Results: Among 477 CT scans identified (282 boys [59%]; median age at CT, 3.6 months [IQR, 1.2-7.2 months]; median age at resection, 6.9 months [IQR, 4.2-12.8 months]), 40 cases were extensively reviewed; 9 cases (23%) had pathologically confirmed cystic PPB. The median age at CT was 7.3 months (IQR, 2.9-22.4 months), and median age at resection was 8.7 months (IQR, 5.0-24.4 months). The sensitivity of CT for detecting PPB was 58%, and the specificity was 83%. High suspicion for malignancy correlated with PPB pathology (odds ratio, 13.5; 95% CI, 2.7-67.3; P = .002). There was poor interrater reliability (κ = 0.36 [range, 0.06-0.64]; P \u3c .001) and no significant difference in specific imaging characteristics between PPB and benign cystic lesions. The overall accuracy rate for distinguishing benign vs malignant lesions was 81%. Conclusions and Relevance: This study suggests that chest CT, the current criterion standard imaging modality to assess the lung parenchyma, may not accurately and reliably distinguish PPB from benign congenital lung malformations in children. In any cystic lung lesion without a prenatal diagnosis, operative management to confirm pathologic diagnosis is warranted

Strength and Comprehensiveness of School Wellness Policies in Southeastern US School Districts

In 2004, Congress passed legislation mandating that all public school districts participating in federal school meal programs develop a school wellness policy (SWP) to direct efforts related to nutrition and physical activity. We examined the extent to which SWPs varied in comprehensiveness and strength in a representative sample of school districts in the southeastern United States, the area of the country with the highest rates of childhood obesity

Drainage Water Storage for Improved Resiliency and Environmental Performance of Agricultural Landscapes

Drained lands, which include some of the most productive lands in the world, can experience both water excess and water deficit within a year. Storing drained water within the landscape could increase the sustainability of water for agriculture, particularly as intense rainfall and prolonged summer drought continue to increase under future climate change. A team of researchers and extension specialists from nine states are currently working towards a vision of transforming the process of designing and implementing agricultural drainage to include storage through the use of controlled drainage, saturated buffers, and drainage water recycling (i.e. capture, storage, and reuse). Field research data from experimental drainage sites from across the U.S. Corn Belt have been brought together in a database to support synthesis and modeling to determine economic and environmental impacts of drainage water storage. Results from this effort will extend the strategies and tools to agricultural producers, the drainage industry, watershed managers, agencies, and policy makers, and educate the next generation of engineers and scientists to design drainage systems that include water storage in the landscape

Acute Effects of Vibrating Insoles on Dynamic Balance and Gait Quality in Individuals With Diabetic Peripheral Neuropathy: A Randomized Crossover Study

OBJECTIVE This study investigated the effects of vibrating insoles on dynamic balance and gait quality during level and stair walking and explored the influence of vibration type and frequency in individuals with diabetic peripheral neuropathy (DPN). RESEARCH DESIGN AND METHODS Twenty-two men with DPN were assessed for gait quality and postural and dynamic balance during walking and stair negotiation using a motion capture system and force plates across seven vibratory insole conditions (Vcs) versus a control (Ctrl) condition (insole without vibration). Vibration was applied during standing and walking tasks, and 15-min rest-stop periods without vibration were interposed between conditions. Repeated measures test conditions were randomized. The primary outcomes were gait speed and dynamic balance. RESULTS Gait speed during walking significantly improved in all Vcs compared with Ctrl (P < 0.005), with Vc2, Vc4, and Vc6 identified as the most effective. Gait speed increased (reflecting faster walking) during stair ascent and descent in Vc2 (Ctrl vs. Vc2 for ascent 0.447 ± 0.180 vs. 0.517 ± 0.127 m/s; P = 0.037 and descent 0.394 ± 0.170 vs. 0.487 ± 0.125 m/s; P = 0.016), Vc4 (Ctrl vs. Vc4 for ascent 0.447 ± 0.180 vs. 0.482 ± 0.197 m/s; P = 0.047 and descent 0.394 ± 0.170 vs. 0.438 ± 0.181 m/s; P = 0.017), and Vc6 (Ctrl vs. Vc6 for ascent 0.447 ± 0.180 vs. 0.506 ± 0.179 m/s; P = 0.043 and descent 0.394 ± 0.170 vs. 0.463 ± 0.159 m/s; P = 0.026). Postural balance improved during quiet standing with eyes closed in Vc2, Vc4, Vc6, and Vc7 (P < 0.005). CONCLUSIONS Vibrating insoles are an effective acute strategy for improving postural balance and gait quality during level walking and stair descent in individuals with DPN. These benefits are particularly evident when the entire plantar foot surface is stimulated