Equilibrium sediment transport is the condition of zero net entrainment and deposition by sediment‐transporting flow (i.e. grade or regime). Here criteria for equilibrium sediment transport, or those ...used as proxies for equilibrium (for example, onset of erosion, onset of particle setting or suppression of turbulence) for dilute, suspended‐load‐dominated, turbidity currents, are tested against laboratory and natural data. The examined criteria are restricted to those describing flow over a bed of loose particulate material involving non‐cohesive sediment. Models include both monodisperse and polydisperse formulations that represent sediment non‐uniformity by using a single characteristic grain size or discretization of the grain‐size distribution, respectively. Analysis shows that a polydisperse‐type flux‐balance model, that equates erosional and depositional fluxes and where erosion is related to the power used to lift sediment mass from the bed (the ‘Flow‐Power Flux‐Balance’ model) provides predictions most consistent with observational data. Other equilibrium models tested, monodisperse or polydisperse, fail to predict realistic bed slopes and/or flow durations for concentrations, velocities and depths within limits for natural flows. Results of the Flow‐Power Flux‐Balance model are used to quantify sediment transport fields, equilibrium Shields numbers and slopes for turbidity currents of variable flow and particle properties.
The widespread conflation between having a sexual interest in children and engaging in sexually abusive behavior contributes significantly to elevated levels of stigma targeted at people living with ...a sexual interest in children. Stigmatization and societal punitiveness surrounding people living with these interests can impact their well-being, obstruct help-seeking, and potentially increase risk of offending behavior. Recent quantitative research employing stigma intervention strategies has produced encouraging results in reducing stigmatizing attitudes toward this population. The current study sought to expand on quantitative research findings to explore qualitatively the facilitators and barriers to understanding and accepting people living with sexual interest in children. Thirty participants were interviewed following completion of an online stigma intervention study. Participants were asked about their attitudinal responses to the earlier study and how personal and professional experiences contributed to shaping their attitudes surrounding people living with a sexual interest in children. Reflexive inductive thematic analysis was used to explore what factors promote understanding and what factors act as barriers to understanding people with sexual interest in children. The significance of experiences which challenged the dominant social narrative was identified across several themes which facilitated understanding and acceptance of people who have a sexual interest in children. Themes which reflected barriers to understanding included difficulty comprehending alternate narratives, parental concern, and reinforcement of current stereotypes. Implications for developing stigma-reduction interventions and future research are discussed.
Prevalent conflation between having a sexual interest in children and engaging in sexually abusive behavior contributes greatly to elevated levels of stigma directed at people living with a sexual ...interest in children. Contemporary quantitative research employing stigma intervention techniques has produced promising results in decreasing stigmatizing attitudes toward this population. This study aims to expand on this research by qualitatively analyzing the impact of two antistigma interventions. Content and thematic analysis were used to examine N = 460 responses to two open-ended questions featured in an anonymous online survey, which explored the cognitive and emotional impact of the interventions, respectively. A total of nine themes were identified. Four themes pertained to positive/supportive views and emotional responses reflecting the challenging of stereotypes, gaining new perspective, personalized reflections, and recognizing the impacts of stigma. Three themes reflected negative views and emotional responses, which concerned minimization and normalization, adverse personal experiences, and disbelief and mistrust. Finally, two themes reflected mixed views and emotional responses, specifically the difficulty in reconciling emotional and cognitive responses. The data indicated that both interventions showed potential to impact participants' viewpoints positively. Findings offer insights into how future research can be designed and interventions can be developed more effectively.
IMPORTANCE: Nonoperative management with antibiotics alone has the potential to treat uncomplicated pediatric appendicitis with fewer disability days than surgery. OBJECTIVE: To determine the success ...rate of nonoperative management and compare differences in treatment-related disability, satisfaction, health-related quality of life, and complications between nonoperative management and surgery in children with uncomplicated appendicitis. DESIGN, SETTING, AND PARTICIPANTS: Multi-institutional nonrandomized controlled intervention study of 1068 children aged 7 through 17 years with uncomplicated appendicitis treated at 10 tertiary children’s hospitals across 7 US states between May 2015 and October 2018 with 1-year follow-up through October 2019. Of the 1209 eligible patients approached, 1068 enrolled in the study. INTERVENTIONS: Patient and family selection of nonoperative management with antibiotics alone (nonoperative group, n = 370) or urgent (≤12 hours of admission) laparoscopic appendectomy (surgery group, n = 698). MAIN OUTCOMES AND MEASURES: The 2 primary outcomes assessed at 1 year were disability days, defined as the total number of days the child was not able to participate in all of his/her normal activities secondary to appendicitis-related care (expected difference, 5 days), and success rate of nonoperative management, defined as the proportion of patients initially managed nonoperatively who did not undergo appendectomy by 1 year (lowest acceptable success rate, ≥70%). Inverse probability of treatment weighting (IPTW) was used to adjust for differences between treatment groups for all outcome assessments. RESULTS: Among 1068 patients who were enrolled (median age, 12.4 years; 38% girls), 370 (35%) chose nonoperative management and 698 (65%) chose surgery. A total of 806 (75%) had complete follow-up: 284 (77%) in the nonoperative group; 522 (75%) in the surgery group. Patients in the nonoperative group were more often younger (median age, 12.3 years vs 12.5 years), Black (9.6% vs 4.9%) or other race (14.6% vs 8.7%), had caregivers with a bachelor’s degree (29.8% vs 23.5%), and underwent diagnostic ultrasound (79.7% vs 74.5%). After IPTW, the success rate of nonoperative management at 1 year was 67.1% (96% CI, 61.5%-72.31%; P = .86). Nonoperative management was associated with significantly fewer patient disability days at 1 year than did surgery (adjusted mean, 6.6 vs 10.9 days; mean difference, −4.3 days (99% CI, −6.17 to −2.43; P < .001). Of 16 other prespecified secondary end points, 10 showed no significant difference. CONCLUSION AND RELEVANCE: Among children with uncomplicated appendicitis, an initial nonoperative management strategy with antibiotics alone had a success rate of 67.1% and, compared with urgent surgery, was associated with statistically significantly fewer disability days at 1 year. However, there was substantial loss to follow-up, the comparison with the prespecified threshold for an acceptable success rate of nonoperative management was not statistically significant, and the hypothesized difference in disability days was not met. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02271932
Introduction
Warzone participation is associated with increased risk of stress‐related psychopathology, including posttraumatic stress disorder (PTSD) and depression. Prior research suggests that the ...mental health of spouses of warzone veterans (WZVs) is linked to that of their partners. Additionally, PTSD among WZVs has been associated with marital dysfunction. Less is known about the effects of depression among WZVs on partner mental health and family relationships. We sought in this study to examine associations between WZV PTSD and depression and partner mental health and relationship outcomes.
Methods
Using a nationally dispersed sample of Iraq and Afghanistan veterans and their married and unmarried intimate partners, 245 dyads completed structured psychiatric interviews and psychometric surveys assessing family functioning and relationship aggression.
Results
Adjusted regression analyses indicated that depression among WZVs was associated with partner depression and anxiety disorders. WZV PTSD and depression were also associated with partner‐reported relationship dysfunction, dissatisfaction, and communication issues, and higher rates of intimate partner aggression victimization and perpetration.
Conclusions
Mental health consequences of war extend beyond WZVs to the mental health of their intimate partners and their relationships with intimate partners.
The stigmatization of people with pedophilia was previously identified as a "blind spot" in stigma research. This systematic review updates and expands on Jahnke and Hoyer's 2013 review to understand ...(1) factors contributing to stigma toward people with sexual interest in children, (2) experiences of stigma, and (3) how stigma can be challenged and reduced. Thematic synthesis was used to analyze data from 35 studies from the United Kingdom, United States, The Netherlands, Germany, Canada, Norway, Australia, and New Zealand. Overarching themes were (1) misperceptions and stereotypes, (2) negative affective responses, (3) discrimination, (4) mental distress, (5) internalized public stigma, (6) negative effects of disclosure, and (7 and 8) informative and humanizing interventions. Findings highlighted substantial prevalence of stigma toward and amongst people with sexual interest in children, and methodological limitations of extant research. An agenda for future research is discussed, emphasizing how stigma can be challenged.
The objective of our study was to identify rates of readmission and late mortality in pediatric extracorporeal membrane oxygenation (ECMO) patients after discharge from their ECMO hospitalization.
We ...conducted a population-based retrospective cohort study of children who were discharged after ECMO. Data were obtained from the State Inpatient Databases for 10 states. Time-to-event analyses were used to estimate the risk of readmission and to identify factors predictive of readmission and late mortality, including characteristics of initial hospital course and ECMO center volume.
A total of 1603 pediatric ECMO patients were identified, and 42.4% of these patients died prior to discharge. Of the 924 ECMO survivors, 35.6% had an unplanned readmission, and 3% died during readmission within 1 year. The risk of readmission was significantly related to the indication for ECMO, number of complex chronic conditions, transfer status, and discharge destination (all p<0.05). The risk of late mortality was significantly related to health insurance, transfer status, number of complex chronic conditions, and indication for ECMO (all p<0.05).
Pediatric ECMO survivors have a high risk of hospital readmission with approximately 3% mortality during readmissions within 1 year of initial discharge.
Retrospective Cohort Study
Level III
IMPORTANCE: Although opioids are an important component of pain management for children recovering from surgery, postoperative opioid prescribing has contributed to the current opioid crisis in the ...United States because these medications are often prescribed in excess and are rarely properly disposed. One potential strategy to combat opioid misuse is to remove excess postoperative opioids from circulation by providing patients with drug disposal products that enable safe disposal of opioids in the home garbage. OBJECTIVE: To determine whether the provision of a drug disposal bag increases proper opioid disposal among the families of pediatric patients undergoing ambulatory surgery. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial enrolled 202 parents or guardians of children 1 to 17 years of age who underwent otolaryngologic or urologic surgery at the outpatient surgery centers of a tertiary children’s hospital in Columbus, Ohio, from June to December 2018 and who received an opioid prescription prior to discharge. INTERVENTIONS: Families randomized to intervention were provided a drug disposal bag containing activated charcoal and instructions for use plus standard postoperative discharge instructions on opioid use, storage, and disposal. Families in standard care arm received standard postoperative discharge instructions only. All participants completed a baseline survey and a follow-up survey 2 to 4 weeks postoperatively. MAIN OUTCOMES AND MEASURES: Primary outcome was proper opioid disposal, defined as disposal using a drug disposal bag or a disposal method recommended by the US Food and Drug Administration. RESULTS: Of 202 parents or guardians enrolled, 181 completed follow-up (92 in intervention arm and 89 in standard care arm). Most patients in both groups were white (75 73.5% vs 79 80.6%) and male (63 61.2% vs 54 54.6%), and the median (interquartile range) age was 6 (5-9) years in the intervention arm and 7 (6-10) years in the standard care arm. For intention-to-treat analyses, 92 families receiving a disposal bag and 89 families not receiving a disposal bag were included. Among them, 66 families (71.7%) randomized to receive a disposal bag reported properly disposing of their child’s opioids, whereas 50 parents (56.2%) who did not receive a disposal bag reported proper opioid disposal (difference in proportions, 15.5%; 95% CI, 1.7%-29.3%; P = .03). Among only those families who filled an opioid prescription and had leftover opioids after resolution of their child’s pain, 66 of 77 parents or guardians (85.7%) who had received a disposal bag and 50 of 77 parents or guardians (64.9%) who had received standard care reported properly disposing of their child’s opioids (difference in proportions, 20.8%; 95% CI, 7.6%-34.0%). CONCLUSIONS AND RELEVANCE: Results of this study indicated that providing drug disposal bags to families of children receiving postoperative opioids increased the likelihood of excess opioid disposal. Greater availability of disposal products may complement ongoing prescribing reduction efforts aimed at decreasing opioid misuse. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03575377
Hybrid event beds are texturally and compositionally‐diverse deposits preserved within deepwater settings. They are deposited by flows exhibiting ‘mixed behaviour’, forming complex successions of ...sandstone and mudstone, which are often challenging to predict. Hybrid event beds are documented in deep‐marine settings, where they have been thoroughly characterized, and are well‐known as effective fluid transmissibility barriers and baffles in reservoirs. By comparison, there are far‐fewer studies of hybrid event beds from deep‐lacustrine settings, where their character and distribution remains relatively under‐explored. In order to provide insights into these deposits, this study presents the detailed analysis of three‐dimensional seismic data, wireline logs and core from a series of ancient deep‐lacustrine fan systems in the North Falkland Basin. Results confirm that deep‐lacustrine hybrid event beds comprise the same idealized sequence of the ‘H1–H5’ divisions. However, in this study H3 ‘debrite’ units can be sub‐divided into ‘H3a–H3c’, based on: sharp or erosional intra‐H3 contacts, bulk lithology, mud‐content and discrete sedimentary textures. This study interprets the H3a–H3c sub‐units as the products of multiple flow components formed through significant rearward longitudinal flow transformation processes, during the emplacement of a single hybrid event bed. Hybrid event beds are observed within lobe fringes, where flow types, energies and transport mechanisms diversify as a result of flow transformation. The temporal context of hybrid event bed occurrences is considered in relation to stages of fan evolution, including: the Initiation; Growth (I); Growth (II); By‐pass; Abandonment; and Termination phases. Hybrid event beds are mainly found in either the initiation phase where flow interaction and erosion of initial substrates promoted mixed flow behaviour, or in the abandonment phase as facies belts retreated landward. The results of this study have important implications in terms of flow processes of hybrid event bed emplacement, in particular sub‐division of the H3 unit, as well as the prediction of hybrid event bed occurrence and character within ancient deep‐lacustrine fan settings, in general.
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