In this article, different inspection models are compared in terms of their impact on school improvement and the mechanisms each of these models generates to have such an impact. Our theoretical ...framework was drawn from the programme theories of six countries' school inspection systems (i.e. the Netherlands, England, Sweden, Ireland, the province of Styria in Austria and the Czech Republic). We describe how inspection models differ in the scheduling and frequency of visits (using a differentiated or cyclical approach), the evaluation of process and/or output standards, and the consequences of visits, and how these models lead to school improvement through the setting of expectations, the use of performance feedback and actions of the school's stakeholders. These assumptions were tested by means of a survey of principals in primary and secondary schools in these countries (n = 2239). The data analysis followed a three-step approach: (1) confirmatory factor analyses, (2) path modelling and (3) fitting of multiple-indicator multiple-cause models. The results indicate that Inspectorates of Education that use a differentiated model (in addition to regular visits), in which they evaluate both educational practices and outcomes of schools and publicly report inspection findings of individual schools, are the most effective. These changes seem to be mediated by improvements in the schools' self-evaluations and the schools' stakeholders' awareness of the findings in the public inspection reports. However, differentiated inspections also lead to unintended consequences as principals report on narrowing the curriculum and on discouraging teachers from experimenting with new teaching methods.
Irradiance continuously fluctuates during the day in the field. The speed of the induction response of photosynthesis in high light affects the cumulative carbon gain of the plant and could impact ...growth and yield. The photosynthetic induction response and its relationship with the photosynthetic capacity under steady-state conditions (
P
max
) were evaluated in 37 diverse soybean
Glycine max
(L.) Merr. genotypes. The induction response of leaf photosynthesis showed large variation among the soybean genotypes. After 5 min illumination with strong light, genotype NAM23 had the highest leaf photosynthetic rate of 33.8 µmol CO
2
m
−2
s
−1
, while genotype NAM12 showed the lowest rate at 4.7 µmol CO
2
m
−2
s
−1
. Cumulative CO
2
fixation (CCF) during the first 5 min of high light exposure ranged from 5.5 mmol CO
2
m
−2
for NAM23 to 0.81 mmol CO
2
m
−2
for NAM12. The difference in the induction response among genotypes was consistent throughout the growth season. However, there was no significant correlation between CCF and
P
max
among genotypes suggesting that different mechanisms regulate
P
max
and the induction response. The observed variation in the induction response was mainly attributed to ribulose-1,5-bisphosphate carboxylase/oxygenase (Rubisco) activation, but soybean lines differing in the induction response did not differ in the leaf content of Rubisco activase α- and β-proteins. Future studies will be focused on identifying molecular determinants of the photosynthetic induction response and determining whether this trait could be an important breeding target to achieve improved growth of soybeans in the field.
Objective Spinal cord ischemia (SCI) is a devastating but potentially preventable complication of thoracic endovascular aortic repair (TEVAR). The purpose of this analysis was to determine what ...factors predict SCI after TEVAR. Methods All TEVAR procedures at a single institution were reviewed for patient characteristics, prior aortic repair history, aortic centerline of flow analysis, and procedural characteristics. SCI was defined as any lower extremity neurologic deficit that was not attributable to an intracranial process or peripheral neuropathy. Forty-three patient and procedural variables were evaluated individually for association with SCI. Those with the strongest relationships to SCI ( P < .1) were included in a multivariable logistic regression model, and a stepwise variable elimination algorithm was bootstrapped to derive a best subset of predictors from this model. Results From 2002 to 2013, 741 patients underwent TEVAR for various indications, and 68 (9.2%) developed SCI (permanent: n = 38; 5.1%). Because of the lack of adequate imaging for centerline analysis, 586 patients (any SCI, n = 43; 7.4%) were subsequently analyzed. Patients experiencing SCI after TEVAR were older (SCI, 72 ± 11 years; no SCI, 65 ± 15 years; P < .0001) and had significantly higher rates of multiple cardiovascular risk factors. The stepwise selection procedure identified five variables as the most important predictors of SCI: age (odds ratio OR multiplies by 1.3 per 10 years; 95% confidence interval CI, 0.9-1.8, P = .06), aortic coverage length (OR multiplies by 1.3 per 5 cm; CI, 1.1-1.6; P = .002), chronic obstructive pulmonary disease (OR, 1.9; CI, 0.9-4.1; P = .1), chronic renal insufficiency (creatinine concentration ≥ 1.6 mg/dL; OR, 1.9; CI, 0.8-4.2; P = .1), and hypertension (defined as chart history or medication; OR, 6.4; CI, 2.6-18; P < .0001). A logistic regression model with just these five covariates had excellent discrimination (area under the receiver operating characteristic curve = .83) and calibration ( χ2 = 9.8; P = .28). Conclusions This analysis generated a simple model that reliably predicts SCI after TEVAR. This clinical tool can assist decision-making about when to proceed with TEVAR, guide discussions about intervention risk, and help determine when maneuvers to mitigate SCI risk should be implemented.
1. Previous studies of the Medium Ground Finch, Geospiza fortis, have documented that selection is most severe under drought conditions, which generally favour beaks that are comparatively deep and ...narrow. Deep beaks are presumed to enhance a bird's ability to crack hard seeds, and narrow beaks have been proposed to enhance a bird's efficiency in manipulating seeds. 2. In the present study, we make the first direct measurements of bite force in Darwin's finches. We used 147 G. fortis from Isla Santa Cruz, Galápagos, to document the influence of beak, head and body dimensions on bite force. 3. Among the various beak dimensions, depth, width and shape were all significant predictors of bite force. Among the various head dimensions, width was the best predictor of bite force. Generally low predictive values of multiple regression models including all morphological variables, as well as positive allometric scaling of bite force on head width, suggest an important additional role for variation in muscle architecture or jaw biomechanics in bite force generation.
Spinal cord ischemia (SCI) is a dreaded complication of thoracic endovascular aortic repair (TEVAR). There are limited national data describing the incidence and influence of in-hospital SCI recovery ...on survival. Moreover, no robust preoperative SCI risk assessment models currently exist. The purpose of this analysis was to analyze the Vascular Quality Initiative to determine the national incidence, survival association, and preoperative predictors of SCI after TEVAR.
All Vascular Quality Initiative TEVAR procedures (June 2014-June 2019) were reviewed. The primary end point was development of in-hospital SCI, defined as any new neurologic deficit or paralysis not attributable to intracranial disease. Secondary end points were disease-specific SCI rates and long-term out-of-hospital survival. Functional outcomes (transient vs permanent SCI) were independently determined by treating physicians. Kaplan-Meier analysis and Cox proportional hazards methodology were used to assess the association of SCI with survival. A logistic regression model of candidate preoperative SCI predictors was created, and bootstrapped backward elimination (retaining predictors with ≥50% selection frequency) was used for model reduction. Model fit and performance statistics were validated by adjustment for Efron's optimism.
The overall rate of SCI was 3.7% (n = 422/11,473; transient, 1.6% n = 179; permanent, 2.1% n = 243). Patients who developed any SCI had significantly lower Kaplan-Meier survival estimate compared with those without SCI (1-year survival: SCI, 65%; no SCI, 87%; P < .0001), and patients with permanent SCI had notably worse survival than patients with transient SCI (1-year survival: permanent SCI, 54%; transient SCI, 80%; P < .0001). Disease-specific incidence of any SCI was as follows: aneurysm, 3.4%; dissection, 5.3%; aneurysm from dissection, 4.1%; trauma, 1.1%; penetrating ulceration, 2.4%; intramural hematoma, 5.7%; penetrating ulceration and intramural hematoma, 4.3%; and aortic thrombus, 4.8%. Several factors were selected on multivariable analysis as the most robust preoperative predictors of any SCI, including distal landing zone 5 to zone 10, nonelective case, creatinine concentration >1.38 mg/dL, smoking history, American Society of Anesthesiologists class, adjunctive procedure, nonwhite race, and preoperative hypertension (area under the curve = 0.72; Nagelkerke R2 = 0.06).
SCI is a devastating complication after TEVAR that is associated with worse overall survival, particularly when no functional recovery occurs by hospital discharge. Disease-specific, real-world benchmarks for SCI rates are provided that may inform quality initiatives focused on reducing this complication. Importantly, this analysis is the first description of a preoperative prediction model derived from national data for determining SCI risk after TEVAR. These predictors should be used to identify high-risk patients to balance the risk of SCI and its associated increased short-term mortality with the risk of the underlying disease. Furthermore, all available adjunctive measures should be implemented in these high-risk patients to reduce risk of SCI.
Abstract Supernova (SN) SN H0pe is a gravitationally lensed, triply imaged, Type Ia SN (SN Ia) discovered in James Webb Space Telescope imaging of the PLCK G165.7+67.0 cluster of galaxies. ...Well-observed multiply imaged SNe provide a rare opportunity to constrain the Hubble constant ( H 0 ), by measuring the relative time delay between the images and modeling the foreground mass distribution. SN H0pe is located at z = 1.783 and is the first SN Ia with sufficient light-curve sampling and long enough time delays for an H 0 inference. Here we present photometric time-delay measurements and SN properties of SN H0pe. Using JWST/NIRCam photometry, we measure time delays of Δ t ab = − 116.6 − 9.3 + 10.8 observer-frame days and Δ t cb = − 48.6 − 4.0 + 3.6 observer-frame days relative to the last image to arrive (image 2b; all uncertainties are 1 σ ), which corresponds to a ∼5.6% uncertainty contribution for H 0 assuming 70 km s −1 Mpc −1 . We also constrain the absolute magnification of each image to μ a = 4.3 − 1.8 + 1.6 , μ b = 7.6 − 2.6 + 3.6 , μ c = 6.4 − 1.5 + 1.6 by comparing the observed peak near-IR magnitude of SN H0pe to the nonlensed population of SNe Ia.
We present a robust practical scheme for measuring the topological invariants of non-interacting tight-binding models realized in arrays of coupled photonic cavities. More specifically, we aim to ...focus on the implementation of a single unit cell with tunable twisted boundary conditions in order to access the bulk topological properties of much larger systems experimentally. We illustrate our method in a two-dimensional integer quantum Hall model, demonstrating that the associated topological invariants can be measured to a high degree of accuracy despite the driven-dissipative bosonic nature of the system, and discuss the robustness of our scheme against various sources of disorder.
Acute-phase proteins, which respond to systemic proinflammatory cytokines such as interleuken-6, are elevated in cardiovascular disease and are predictive markers of future ischemic events, even over ...decades. This suggests a role for proinflammatory cytokines and/or acute phase proteins in early lesion development. To explore this issue, we fed C57Bl/6 and nonobese diabetic male mice high-fat (20% total fat, 1.5% cholesterol) diets and ApoE-deficient male mice both high-fat and normal chow diets for 6 to 21 weeks, injecting them weekly with either 5000 U recombinant interleukin-6 (rIL-6) or saline buffer. Blood was collected when animals were euthanized and assayed for cytokines, acute-phase proteins, and cholesterol. Across all mice, IL-6 injection resulted in significant increases in proinflammatory cytokines (IL-6, 4.6-fold; IL-1beta, 1.6-fold; and tissue necrosis factor-alpha, 1.7-fold) and fibrinogen (1.2-fold) and with decreased concentrations of albumin (0.9-fold) in plasma. Total cholesterol levels were unchanged between rIL-6-treated and nontreated groups. Serial sections through the aortic sinus were stained with oil red O to detect fatty streaks, and area of the lesions was determined by image analysis. Although no fatty streaks were detected in the nonobese diabetic mice with or without rIL-6 treatment, rIL-6 treatment increased lesion size in C57Bl/6 and ApoE-deficient mice 1.9- to 5.1-fold over lesions in saline-treated animals. These results suggest that under the appropriate circumstances changes in circulating proinflammatory cytokines and acute-phase proteins may be more than just markers of atherosclerosis but actual participants in early lesion development.
Thoracic endovascular aortic repair (TEVAR) has become a mainstay of therapy for acute and chronic type B aortic dissection (TBAD). Dynamic aortic morphologic changes, untreated dissected aorta, and ...persistent false lumen perfusion have significant consequences for reintervention after TEVAR for TBAD. However, few reports contrast differences in secondary aortic intervention (SAI) after TEVAR for TBAD or describe their influence on mortality. This analysis examined incidence, timing, and types of SAI after TEVAR for acute and chronic TBAD and determined their impact on survival.
All TEVAR procedures for acute and chronic TBAD (2005-2016) were retrospectively reviewed. Patients with staged (<30 days) or concomitant ascending aortic arch repair or replacement were excluded. Acuity was defined by symptom onset (0-30 days, acute; >30 days, chronic). SAI procedures were grouped into open (intended treatment zone or remote aortic site), major endovascular (TEVAR extension or endograft implanted at noncontiguous site), and minor endovascular (side branch or false lumen embolization) categories. Kaplan-Meier methodology was used to estimate freedom from SAI and survival. Cox proportional hazards were used to identify SAI predictors.
TEVAR for TBAD was performed in 258 patients (acute, 49% n = 128; chronic, 51% n = 130). Mean follow-up was 17 ± 22 months with an overall SAI rate of 27% (n = 70; acute, 22% 28; chronic, 32% 42; odds ratio, 1.7; 95% confidence interval, 0.9-2.9; P = .07. Median time to SAI was significantly less after acute than after chronic dissection (0.7 0-12 vs 7 0-91 months; P < .001); however, freedom from SAI was not different (1-year: acute, 67% ± 4%, vs chronic, 68% ± 5%; 3-year: acute, 65% ± 7%, vs chronic, 52% ± 8%; P = .7). Types of SAI were similar (acute vs chronic: open, 61% vs 55% P = .6; major endovascular, 36% vs 38% P = .8; minor endovascular, 21% vs 21% P = 1). The open conversion rate (either partial or total endograft explantation: acute, 10% 13/128; chronic, 15% 20/130; P = .2) and incidence of retrograde dissection (acute, 6% 7/128; chronic, 4% 5/130; P = .5) were similar. There was no difference in survival for SAI patients (5-year: acute + SAI, 55% ± 9%, vs acute without SAI, 67% ± 8% P = .3; 5-year: chronic + SAI, 72% ± 6%, vs chronic without SAI, 72% ± 7% P = .7). Factors associated with SAI included younger age, acute dissection with larger maximal aortic diameter at presentation, Marfan syndrome, and use of arch vessel adjunctive procedures with the index TEVAR. Indication for the index TEVAR (aneurysm, malperfusion, rupture, and pain or hypertension) or remote preoperative history of proximal arch procedure was not predictive of SAI.
SAI after TEVAR for TBAD is common. Acute TBAD has a higher proportion of early SAI; however, chronic TBAD appears to have ongoing risk of remediation after the first postoperative year. SAI types are similar between groups, and the occurrence of aorta-related reintervention does not affect survival. Patients' features and anatomy predict need for SAI. These data should be taken into consideration for selection of patients, device design, and surveillance strategies after TEVAR for TBAD.
Abstract Objective The Kidney Disease Outcome Quality Initiative and Fistula First Breakthrough Initiative call for the indiscriminate creation of arteriovenous fistulas (AVFs) over arteriovenous ...grafts (AVGs) without providing patient-specific criteria for vascular access selection. Although the U.S. AVF rate has increased dramatically, several reports have found that this singular focus on increasing AVFs has resulted in increased AVF nonmaturation/early failure and a high prevalence of catheter dependence. The objective of this study was to determine the appropriateness of vascular access procedures in clinical scenarios constructed with combinations of relevant factors potentially influencing outcomes. Methods The RAND/UCLA Appropriateness Method was used. Accordingly, a comprehensive literature search was performed and a synthesis of results compiled. The RAND/UCLA Appropriateness Method was applied to 2088 AVF and 1728 AVG clinical scenarios with varying patient characteristics. Eleven international vascular access experts rated the appropriateness of each scenario in two rounds. On the basis of the distribution of the panelists' scores, each scenario was determined to be appropriate, inappropriate, or indeterminate. Results Panelists achieved agreement in 2964 (77.7%) scenarios; 860 (41%) AVF and 588 (34%) AVG scenarios were scored appropriate, 686 (33%) AVF and 480 (28%) AVG scenarios were scored inappropriate, and 542 (26%) AVF and 660 (38%) AVG scenarios were indeterminate. Younger age, larger outflow vein diameter, normal or obese body mass index (vs morbidly obese), larger inflow artery diameter, and higher patient functional status were associated with appropriateness of AVF creation. Older age, dialysis dependence, and smaller vein size were associated with appropriateness of AVG creation. Gender, diabetes, and coronary artery disease were not associated with AVF or AVG appropriateness. Dialysis status was not associated with AVF appropriateness. Body mass index and functional status were not associated with AVG appropriateness. To simulate the surgeon's decision-making, scenarios were combined to create situations with the same patient characteristics and both AVF and AVG options for access. Of these 864 clinical situations, 311 (36%) were rated appropriate for AVG but inappropriate or indeterminate for AVF. Conclusions The results of this study indicate that patient-specific situations exist wherein AVG is as appropriate as or more appropriate than AVF. These results provide patient-specific recommendations for clinicians to optimize vascular access selection criteria, to standardize care, and to inform payers and policy. Indeterminate scenarios will guide future research.
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