Comprehensive Goals Research Articles

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension.

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension.

Study on the influence of carbon trading pilot policy on energy efficiency in power industry

PurposeTo cope with climate change and achieve the dual carbon goal, China has actively promoted the implementation of carbon trading pilot policy, among which the power industry plays an important role in China’s carbon emission reduction work. The purpose of this paper is to study the influence of carbon trading policy on the energy efficiency of power industry and achieve the comprehensive goal of carbon emission reduction, carbon peak and carbon neutralization.Design/methodology/approachThis paper constructs the difference-in-differences model based on 2012–2019 provincial data to study the impact of carbon trading policy on energy efficiency in the power industry and its effect path. Heterogeneity analysis was conducted to compare the effects of carbon trading policy in eastern, central and western regions as well as at different levels of power structures.FindingsCarbon trading policy can significantly improve the energy efficiency of the power industry, and the policy effect is more significant in eastern and western regions and areas with high power structure. Mechanism analysis shows that carbon trading policy mainly influences the energy efficiency of power industry by environmental protection investment, power consumption demand and industrial structure.Originality/valueThis paper uses provincial panel data to deeply study the influence of carbon trading policy on energy efficiency of the power industry and its effect path. By constructing the difference-in-differences model, this paper empirically analyzes the governance effect of carbon trading policy. Meanwhile, it controls individual and time effects to solve the endogeneity problem prevalent in previous literature.

Change Management Framework: Development Curriculum of Islamic Education at School

The purpose of this study was to analyze how the concept of change management from PAI curriculum development at SMP Muhammadiyah 1 Gamping. The method used in this research is field research which was developed with a qualitative approach model. Called field research because the data that the authors collect comes from the field. Curriculum development itself is related to the preparation of all dimensions of the curriculum, starting from the foundation, the structure of the composition of subjects, the scope, the sequence of learning materials, the outline of the learning program, to the development of implementation guidelines. In addition, curriculum development is a planning process, resulting in better tools based on the results of the current curriculum assessment, to provide better teaching in learning conditions. This means that curriculum development is an activity to produce a new curriculum through the preparation of the curriculum itself or the basis of the results of the assessment carried out within a certain period. Therefore, it is important to evaluate and develop curriculum changes accurately to the existing educational process to achieve common and comprehensive goals, including what happened and was done by SMP Muhammadiyah 1 Gamping.

SDN and NFV for QoE-driven multimedia services delivery: The road towards 6G and beyond networks

The concept for developing the future mobile communication systems has been explored in recent years with a vision towards 5G and 6G systems. Meeting performance targets such as higher data rate transmission, lower end-to-end latency, higher capacity, lower cost, and satisfied Quality of Experience (QoE) for delivered services is the key for the success of 5G and 6G networks. Within these performance targets and associated enabling technologies, QoE and the overall management of multimedia services is the one which has been less well addressed for 5G in the past. This paper provides a comprehensive and ground-breaking discussion regarding QoE management in the context of future softwarized 5G/6G networks. We introduce a generalized QoE provisioning ecosystem for emerging multimedia streaming services in softwarized 5G/6G and beyond networks. We explore potential network softwarization and communication technologies that will enable the end-user’s QoE in 5G/6G. We further provide promising use case scenarios regarding (a) QoE-driven management of multimedia services over multi-access cloud/edge softwarized and virtualized 5G networks, (b) QoE monitoring for large traffic variations in business, residential and public areas in 5G networks, along with a Machine Learning (ML)-based softwarized controller for QoE provisioning over 5G/6G networks. We build on the achievements of 5G networks to provide the roadmap towards the development of 6G and beyond networks in terms of requirements, use case scenarios and service classes. We also present potential technologies that will be dominant through 2025–2030 in shaping the vision of 6G and beyond networks including (a) self-driving 3D network architecture, (b) network management, automation and orchestration, and (c) pervasive artificial intelligence. Moreover, we provide challenges and research directions in 6G and beyond wireless communication systems. The paper provides the first roadmap towards the management, orchestration and monitoring of multimedia 3D services in 6G and beyond networks. The comprehensive goal of this paper is to encourage researchers from the industry and academia to work together towards the realization of softwarized 6G and beyond networks while tackling the critical research challenges regarding the management of emerging 3D multimedia services and applications. The comments made by the authors in this paper are expectations on 6G, and the standardization of 6G where these aspects will be decided in 6G networks and beyond, will be started soon by different standardization bodies and fora.

Integrating multiple dimensions of biodiversity to inform global parrot conservation

In addition to changes associated with climate and land use, parrots are threatened by hunting and capture for the pet trade, making them one of the most at risk orders of birds for which conservation action is especially important. Species richness is often used to identify high priority areas for conserving biodiversity. By definition, richness considers all species to be equally different from one another. However, ongoing research emphasizes the importance of incorporating ecological functions (functional diversity) or evolutionary relationships (phylogenetic diversity) to more fully understand patterns of biodiversity, because (1) areas of high species richness do not always represent areas of high functional or phylogenetic diversity, and (2) functional or phylogenetic diversity may better predict ecosystem function and evolutionary potential, which are essential for effective long–term conservation policy and management. We created a framework for identifying areas of high species richness, functional diversity, and phylogenetic diversity within the global distribution of parrots. We combined species richness, functional diversity, and phylogenetic diversity into an Integrated Biodiversity Index (IBI) to identify global biodiversity hotspots for parrots. We found important spatial mismatches between dimensions, demonstrating species richness is not always an effective proxy for other dimensions of parrot biodiversity. The IBI is an integrative and flexible index that can incorporate multiple dimensions of biodiversity, resulting in an intuitive and direct way of assessing comprehensive goals in conservation planning.

Polycentric Collaborative Governance, Sustainable Development and the Ecological Resilience of Elevator Safety: Evidence from a Structural Equation Model

The goal of public security and safety under the concept of sustainable development has been transformed into the maximization of the comprehensive goal of economic, environmental, and social security and safety. The polycentric collaborative governance mode is a crucial approach for the reform of government regulation. Social–ecological resilience has become a typical paradigm in the field of risk governance. Polycentric collaborative governance and safety resilience are the foundation and booster of elevator safety governance. In this paper, we expound on the system elements and mechanisms of polycentric collaborative governance and ecological resilience of elevator safety under the guidance of sustainable development by using a conceptual framework method. On this basis, we explore the influence degree and mechanism of elevator safety polycentric collaborative governance on elevator safety ecological resilience under the guidance of sustainable development by constructing a structural equation model based on micro-survey data. The results show that (1) the polycentric collaborative governance subject composed of the government, business, society, and the public is the key force to enhancing the ecological resilience of elevator safety; (2) enhancing the ecological resilience of elevator safety has a significant direct promoting effect on improving the mitigation, recovery, learning, and coping ability of elevator safety; (3) improving the learning ability has a significant direct promoting effect on improving the mitigation, recovery, and coping ability of elevator safety; (4) improving the coping ability has a significant direct promoting effect on improving the mitigation and recovery ability of elevator safety; (5) improving the mitigation ability has a significant direct promoting effect on improving the recovery ability of elevator safety. Therefore, in the process of elevator safety governance under the guidance of sustainable development, we should not only adhere to the polycentric collaborative governance mode but also attach importance to the ecological resilience governance paradigm of elevator safety, which together can improve the elevator quality and safety level.

Responding to pandemic challenges: leadership lessons from multinational enterprises (MNEs) in India

PurposeThe business sector plays a major role in achieving comprehensive economic development goals in emerging economies. Consequently, the effects of business responses to the COVID-19 pandemic are receiving increasing research attention from an organizational management development perspective. This article aims to examine the role of leadership in charting the course in an extraordinary crisis context.Design/methodology/approachUsing institutional leadership theory, leadership contingency theory and dynamic leadership capability theory, the authors present a research framework that defines macrochallenges and organizational level responses and outcomes. The article adopts a case study approach, which includes the identification of four target companies and conducting in-depth interviews with senior management professionals within those companies at different time periods.FindingsBased on the interviews, the steps that Indian companies adopted to respond to the COVID-19 challenge are identified. Expanding the insight from the case study, the findings suggest that although feeling overwhelmed at first, organizational leaders combine prudent (i.e. timely and speedy actions for survival first) and bold (i.e. future envisioning for expansion and growth) actions enabling these firms to weather two waves of the COVID-19 pandemic in India.Originality/valueThese multiple case studies are unique in exploring MNEs from different industries. This study also highlights the dynamic relationships between leadership practices, risk management strategies and performance outcomes based on a sound theoretical model and rigorous study methods.

Navigating financial toxicity in patients with cancer: A multidisciplinary management approach.

Approximately one-half of individuals with cancer face personal economic burdens associated with the disease and its treatment, a problem known as financial toxicity (FT). FT more frequently affects socioeconomically vulnerable individuals and leads to subsequent adverse economic and health outcomes. Whereas multilevel systemic factors at the policy, payer, and provider levels drive FT, there are also accompanying intervenable patient-level factors that exacerbate FT in the setting of clinical care delivery. The primary strategy to intervene on FT at the patient level is financial navigation. Financial navigation uses comprehensive assessment of patients' risk factors for FT, guidance toward support resources, and referrals to assist patient financial needs during cancer care. Social workers or nurse navigators most frequently lead financial navigation. Oncologists and clinical provider teams are multidisciplinary partners who can support optimal FT management in the context of their clinical roles. Oncologists and clinical provider teams can proactively assess patient concerns about the financial hardship and employment effects of disease and treatment. They can respond by streamlining clinical treatment and care delivery planning and incorporating FT concerns into comprehensive goals of care discussions and coordinated symptom and psychosocial care. By understanding how age and life stage, socioeconomic, and cultural factors modify FT trajectory, oncologists and multidisciplinary health care teams can be engaged and informative in patient-centered, tailored FT management. The case presentations in this report provide a practical context to summarize authors' recommendations for patient-level FT management, supported by a review of key supporting evidence and a discussion of challenges to mitigating FT in oncology care. CA Cancer J Clin. 2022;72:437-453.

MP08-05 EVALUATING THE QUALITY OF ONLINE HEALTH EDUCATIONAL RESOURCES REGARDING HYPOSPADIAS DIAGNOSIS AND TREATMENT

You have accessJournal of UrologyCME1 May 2022MP08-05 EVALUATING THE QUALITY OF ONLINE HEALTH EDUCATIONAL RESOURCES REGARDING HYPOSPADIAS DIAGNOSIS AND TREATMENT Yash Shah, Nathan Hyacinthe, Nicolas Fernandez, Carlos Villanueva, Paige Bosse, Melise Keays, and Christopher Long Yash ShahYash Shah More articles by this author , Nathan HyacintheNathan Hyacinthe More articles by this author , Nicolas FernandezNicolas Fernandez More articles by this author , Carlos VillanuevaCarlos Villanueva More articles by this author , Paige BossePaige Bosse More articles by this author , Melise KeaysMelise Keays More articles by this author , and Christopher LongChristopher Long More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002530.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A diagnosis of hypospadias can be overwhelming for parents. Online patient and parental educational materials are frequently used by patients and family members as supplemental information to assist in understanding their child’s condition, for medical decision making, and for understanding post-surgery care. 98% of parents utilize the Internet for pediatric health advice. It is recommended that online resources be structured at a 6th grade level to ensure broad applicability and comprehension. We hypothesized that academic fellowship training institutional websites would exceed the average American adult’s reading level, impairing patient or caregiver understanding. METHODS: Online hypospadias educational material from all pediatric teaching hospitals with accredited Society of Pediatric Urology training programs in the US and Canada were compiled. Two reviewers independently edited text to remove extraneous information and calculated readability scores using Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Gunning-Fog Index (GFI), Simple Measure of Gobbledygook (SMOG), Coleman-Liau Index (CLI), and Automated Readability Index (ARI). Intra- and inter-observer reliability were measured. RESULTS: Of the 25 online hypospadias educational materials studied, the mean grade level across 5 tests was 11.06±2.21 (Table 1), with a wide range of grade levels across institutions from 7 to 13. None met the recommended 6th grade level. Altogether, the FRES was 50.64±11.66. This is classified as Fairly Difficult with an estimated 10-12 reading grade and 54% of U.S. adult comprehension. 17.30% of words were designated as complex. Only 1 institution had educational materials in a language other than English. Intra- and inter-observer reliability were excellent, with the Pearson correlation coefficient for each tool ≥0.95. CONCLUSIONS: Our findings indicate that online hypospadias resources published by leading pediatric hospitals are written above the recommended reading level for patient and caregiver education. Complex word usage was high and there was little information for non-English speaking patients. A standard for online resources for parental education that meets broad comprehension goals should be established to improve awareness and outcomes. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e126 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yash Shah More articles by this author Nathan Hyacinthe More articles by this author Nicolas Fernandez More articles by this author Carlos Villanueva More articles by this author Paige Bosse More articles by this author Melise Keays More articles by this author Christopher Long More articles by this author Expand All Advertisement PDF DownloadLoading ...

Planting free trees on private property: understanding urban residents’ motivations and hesitations

In order to meet comprehensive planting goals, tree-planting campaigns must plant on private properties, in residential front and backyards. Successful engagement in these kinds of neighborhood plantings requires an understanding of residents' decision making. Through surveys with past recipients of free 1″-caliper trees, past neighborhood leaders of tree-planting recruiting, and door-to-door canvassing in a pilot neighborhood, this study shows the top factors for accepting free trees and main reasons for declining. Surveys asked past tree recipients their main motivations for accepting a free tree, and three reasons rose to the top: trees provide beauty, trees help the environment, and trees keep people healthy. Top barriers for declining a free tree included not desiring more trees than they had, concerns about maintenance, and a language barrier. These results can inform tree-planting campaigns and tree-focused organizations in order to improve messaging and neighborhood engagement – all to ensure that more trees are planted and canopy is increased.

Balancing Smart City stakeholders' expectations: case of Kazakhstani cities

In Kazakhstan, the implementation of individual Smart City initiatives began more than ten years ago. Comprehensive goal setting was carried out in 2017 as part of the Digital Kazakhstan state program, and a comparative rating for the cities is being calculated from 2020. The article describes major factors that influence stakeholders' expectations and limitations associated with the unbalanced penetration of Smart City technologies. The article substantiates the need to adjust the national policy and change priorities for successful Smart City projects.

Imbalances in Kazakhstan’s Smart Cities Development

In many cities worldwide, the Smart City concept is used to solve problems that ensure the city’s development. The range of technological solutions applications varies depending on the needs and capabilities of a particular city or country in general. The proverbial all-encompassing meaning of the Smart City definition is not critical; however, it allows for reasonably unambiguous identification of implementation areas and even standardization. Differences in the conditions and goals of implementation are determined by the characteristics of a particular (unique) city, public needs, or demand from citizens for more modern services, and the peculiarities of state regulation and management. In Kazakhstan, the implementation of individual Smart City initiatives began more than 10 years ago. Comprehensive goal setting was carried out in 2017 as part of the Digital Kazakhstan state programme, and a comparative rating for the cities is being calculated from 2020. The article describes and defines the challenges and limitations associated with the unbalanced development measures of Kazakhstan’s cities based on a comparative analysis of indicators that characterize the level of penetration of Smart City technologies. The article substantiates the need to adjust the national policy and change priorities for successful Smart City projects.

Time-Varying Risk Factors Associated With the Progress of Functional Recovery and Psychological Distress in First-Ever Stroke Patients.

BACKGROUND: Evaluation of stroke recovery outcome is crucial and a major goal of clinical practice. A recovery trajectory model serves as a prognostic tool that enables development of effective intervention and long-term management to improve poststroke recovery outcomes. This study explored time-varying risk factors associated with the progression of functional recovery and psychological distress poststroke. METHODS: Participants were patients with first-ever stroke who underwent assessment for activities of daily living, psychological distress, and social support at the onset (within 72 hours) and at 1, 3, and 6 months. A generalized estimation equation was used to account for the correlation between the repeated measurements. RESULTS: Of the 101 patients, 60.4% were men, and the mean (SD) age was 63.06 (13.12) years. Over time, the physical functions of patients after stroke significantly increased, and anxiety and depression significantly decreased. Approximately 50% of patients achieved full functional recovery after 6 months. The time-varying risk factors for National Institutes of Health Stroke Scale scores and depression levels affected the trajectory of functional recovery during follow-up. Factors associated with patient anxiety levels were National Institutes of Health Stroke Scale scores and depression levels. Factors associated with patient depression levels included education, anxiety, and social support levels. CONCLUSION: This study demonstrates the progression of time-varying risk factors for functional recovery and psychological distress in patients with first-ever stroke. We recommend that nurses work with patients and their families in the early poststroke stages to identify comprehensive goals based on individual needs and related factors at different stages and that they educate patients on what is required for them to regain independence.

淮北地区麦茬机插优质食味粳稻氮肥减量的精确运筹

<p id="C3">At present, “nitrogen reduction” has become one of the planting measures for good eating quality<italic> japonica</italic> rice, but the scientific management plan of nitrogen fertilizer after nitrogen reduction is unclear and further studies are needed. From 2018 to 2019, good eating quality<italic> japonica</italic> rice varieties including Nanjing 505 and Nanjing 2728 were planted as materials, and four ratios of basic and tillering to panicle fertilizer including 5:5, 6:4, 7:3, and 8:2 were arranged with nitrogen application 20% less than conventional nitrogen application (CK) for mechanical transplanting rice under wheat straw returning. Yield, rice quality, and nitrogen utilization were investigated to determine the effects under nitrogen reduction for good eating quality<italic> japonica</italic> rice. The results were as follows: With the increase of the proportion of the basic and tillering fertilizer in the total nitrogen application, the yield increased first and then decreased. The 7:3 treatment had the highest yield, reaching 11,134.80-11,280.19 kg hm ^-2 for two years. Compared with CK, the yield increased by 1.23%-2.54% and there was no significant difference. The 7:3 treatment group could obtain sufficient population spikelet, higher seed-setting rate, and 1000-grain weight. With the increase of the proportion of nitrogen application in the previous period, the dry matter weight of the population at (N-n) stage and jointing stage displayed an increasing trend, while the dry matter weight at heading stage and maturity stage, the dry matter accumulation from heading to maturity, the final nitrogen accumulation and the nitrogen efficiency increased first and then decreased, and reached a peak in the 7:3 treatment. Compared with CK, nitrogen reduction treatment could ensure higher dry matter accumulation of the population at the later stage by increasing the proportion of nitrogen fertilizer application (7:3) at the early stage, which significantly improved nitrogen absorption and nitrogen use efficiency of the population by 14.10%-15.48%, and significantly higher than CK. For eating quality of<italic> japonica</italic> rice under nitrogen reduction, the processing quality deteriorated with the increase proportion of basic and tillering nitrogen, the appearance quality became better, the cooking and eating quality improved, and rice RVA profile was optimized. Under the condition of the whole wheat straw to the field, nitrogen was reduced by 20% compared with conventional fertilization. To achieve the comprehensive planting goal of high-yield, high-quality, and high-efficiency for good eating quality rice to a certain extent, nitrogen application with the ratio of basic and tillering fertilizer to panicle fertilizer 7:3 could stabilize or slightly increase the yield of good eating quality<italic> japonica</italic> rice, greatly increase nitrogen use efficiency, and improve the appearance and taste quality in rice.

Ultrasonic Blind Stick with GPS and GSM Tracking

Abstract: In this project we are proposing to create a model which will act as a boon for the visually impaired people in our society. This study is trying to work over a hypothetical idea of a walking stick that would alert the visually challenged people on encountering an obstacle, holes and water in their vicinity which would help in preventing any kind of accidental injury to them while walking. The project visualizes the idea of a revolutionary navigation tool for the visually impaired people. This ordinary looking blind stick is actually extra ordinary it has been provided with different kind of sensors to give the person an idea about the vicinity in which he or she is present and make the individual much more aware. The GPS sensor has been designed and programmed in such a manner that is it is able to give an idea about the best possible route depending upon the location it is able to access. The user has been provided with the phenomenal feature of choosing locations from the set of destinations that have been stored in the database of the system. In this stick ultrasonic sensor GPS and GSM tracker, ESP 8266, water sensor, infrared sensor and RF sensor, battery have been used. the comprehensive goal of the device is to provide a much more comfortable and Secure method for the visually impaired people to overcome hindrances in daily life. Keywords: GPS and GSM tracker, ESP8266, Relay, Sensor, Obstacle Detection, Wi-Fi module

Energy Equality in Indonesia Villages: A Discourse Analysis

This study aims to uncover the program of energy independence in Indonesia villages by the government for several decades. as a development program phenomenon of energy use and the development of its sources in the developing villages in Indonesia. The areas selected for observation are four rural areas outside Java, namely the state of Central Sulawesi, West Kalimantan, Halmahera, and East Nusa Tenggara. Interview results show that not all villagers understand energy term and there are still rural areas that do not have access to energy sources. Using discourse analysis as a qualitative method and Amartya Sen's theory of development as a freedom, this study shows that energy development still unequal in Indonesia Villages. Development as an extension of human freedom requires a more comprehensive goal. This study recommends that development plans must focus on the main rights of citizens to survive and have reason to live. Villagers have the right to obtain facilities and resources equal to those of urban residents, especially in energy access equity, and to live in prosperity.

Policies in Regulating Educational Migration in Latin America and The Caribbean Countries

The article presents the results of a study on educational migration management policies in the countries of Latin America and the Caribbean (LAC). The main task was to systematize the state policy measures of the countries of the region in this area and classify countries into groups of exporters and importers of educational services, as well as countries with a neutral policy in the field of regulating educational migration. The paper analyzed four groups of tasks set by countries that attract educational migrants, and identified one additional, comprehensive goal for the development of national higher education systems. In accordance with the level of development and their political priorities, the LAC countries are also evaluated in terms of the compliance of the applied measures with the initial tasks that they set for the policy in the field of educational migration. The article substantiates the approach to the policy of stimulating educational emigration from developing countries as an import of educational services and draws conclusions about the feasibility of developing systems for evaluating the effectiveness of expenditures on the implementation of state policy in the field of educational migration management.

Directions in Addressing the Language and Literacy Needs of Children Across the Bilingual Continuum

One of the most widespread and harmful myths in our society is that very young children will learn a second language automatically, quickly, and easily—with no special attention to their needs for an optimal learning environment. —Catherine Snow There are many myths or misconceptions about bilingual children. One myth that we have come across frequently is that bilingual children experience the phenomenon of language confusion, an imagined condition in which children cannot separate their first language (L1) from their second language (L2) (Espinosa, 2013; Guiberson, 2013). In such instances, educators may erroneously view code-switching, a normal bilingual behavior in which children draw upon both languages within a given utterance, as evidence for language confusion or a general deficit in the ability to separate languages. The myth of language confusion is frequently used to justify an English-only approach to educational programming and discussions with families about choosing a language. Unfortunately, this line of flawed reasoning is applied to both typically developing children and those with language disorders. Language confusion does occur when educators become confused about bilingual children and their development. Bilingual children can be perplexing because there is a tremendous amount of variability in bilingualism, with L1 and L2 proficiencies that are dynamic across time and settings. That is, bilingualism operates on a continuum and the quantity, quality, and context of L1 and L2 exposure and usage are major sources of variability and influence on a child's bilingual profile. In this issue of Topics of Language Disorders, we hope to advance the understanding of the bilingual continuum across ages and educational settings. We have assembled original research and clinical tutorials with the goal of highlighting the unique language and literacy needs of children with diverse proficiencies in L1 and L2. In two of the articles, vocabulary teaching and learning for bilingual children is the focus. Ehren, Rosa-Lugo, and Hagan present an adapted version of the promising Vocabulary Scenario Technique that taps into L1 strengths while teaching L2. Roseberry-Mckibbin presents a clinical tutorial on ways to differentiate academic vocabulary instruction for bilingual children with developmental language disorders. This article also presents the use of L1 as a cross-linguistic tool to teach L2 vocabulary, as well as several other innovations to enrich vocabulary instruction. Two of the articles focus on addressing both language and literacy development in bilingual children. Guiberson reviews extant research and presents a descriptive study of early literacy behaviors of Spanish-speaking caregivers of 2- and 3-year-old children. Findings from the review and the descriptive study are combined, and 26 early literacy and language strategies are described. Fiestas and colleagues describe a packaged literacy and language intervention for primary- grade bilingual children. Incidentally, this intervention also targets vocabulary and the use of L1 to support new L2 development through both oral and print activities. It also includes narrative comprehension and production instruction and goals. The final study describes the use of English learner case simulations with graduate students in speech–language pathology to practice a strategy used with bilingual children that considers their language proficiency. Findings from this work show general benefits in graduate students' overall engagement and preparedness to consider English learners and their specific needs. Although we recognize there is a need for more research, particularly treatment research with bilingual children, it is our hope that this issue of Topics in Language Disorders will demonstrate that meeting the language and literacy needs of bilingual learners requires careful consideration and specialized instruction. We also hope this issue provides educators and researchers direction in addressing the complex and varied language and literacy profiles of bilingual children across the bilingual continuum. —Mark Guiberson, PhD —Linda I. Rosa-Lugo, EdD Issue Co-Editors

The Society for Vascular Surgery Objective Performance Goals for Critical Limb Ischemia are attainable in select patients with ischemic wounds managed with wound care alone

To set therapeutic benchmarks, in 2009 the Society for Vascular Surgery defined objective performance goals (OPG) for treatment of patients with chronic limb threatening ischemia (CLTI) with either open surgical bypass or endovascular intervention. The goal of these OPGs are to set standards of care from a revascularization standpoint and to provide performance benchmarks for 1 year patency rates for new endovascular therapies. While OPGs are useful in this regard, a critical decision point in the treatment of patients with CLTI is determining when revascularization is necessary. There is little guidance in the comprehensive treatment of this patient population, especially in the nonoperative cohort. Guidelines are needed for the CLTI patient population as a whole and not just those revascularized, and our aim was to assess whether CLTI OPGs could be attained with nonoperative management alone. Our cohort included patients with an incident diagnosis of CLTI (by hemodynamic and symptomatic criteria) at our institution from 2013-2017. The primary outcome measured was mortality. Secondary outcomes were limb loss and failure of amputation-free survival. Descriptive statistics were used to define the 2 groups - patients undergoing primary revascularization and patients undergoing primary wound management. The risk difference in outcomes between the 2 groups was estimated using collaborative-targeted maximum likelihood estimation. Our cohort included 349 incident CLTI patients; 60% male, 51% white, mean age 63 +/- 13 years, 20% Rutherford 4, and 80% Rutherford 5. Most patients (277, 79%) underwent primary revascularization, and 72 (21%) were treated with wound care alone. Demographics and presenting characteristics were similar between groups. Although the revascularized patients were more likely to have femoropopliteal disease (72% vs. 36%), both groups had a high rate of infrapopliteal disease (62% vs. 57%). Not surprisingly, the patients in the revascularization group were less likely to have congestive heart failure (34% vs. 42%), complicated diabetes (52% vs. 79%), obesity (19% vs. 33%), and end stage renal disease (14% vs. 28%). In the wound care group, 2-year outcomes were 65% survival, 51% amputation free survival, 19% major limb amputation, and 17% major adverse cardiac event. The wound care cohort had a 13% greater risk of death at 2 years; however, the risk of limb loss at 2 years was 12% less in the wound care cohort. A comprehensive set treatment goals and expected amputation free survival outcomes can guide revascularization, but also assure that appropriate outcomes are achieved for patients treated without revascularization. The 2-year outcomes achieved in this cohort provide an estimate of outcomes for nonrevascularized CLTI patients. Although multi-center or prospective studies are needed, we demonstrate that equal, even improved, limb salvage rates are possible.

MANAJEMEN SPIRITUAL DI PONDOK PESANTREN AL MUNAWWIR KRAPYAK YOGYAKARTA

This paper aims to analyze the mapping of spiritual management process in Pondok Pesantren Al-Munawwir Kolplek L Krapyak Yogyakarta. The type of research used is qualitatively descriptive with a case study approach. Data collection techniques used are interviews, observations and documentation. Spiritual management makes a bridge to the peak consciousness of human self existence in the vertical line called fitrah awareness, one consciousness that is tawhid. Management concept is understood not only to be empirical-rational by relying on the ability of the five senses and human intellectuality, but more deeply to the values of spirituality that are the main center in success with various aspects of life. The results showed that Pondok Pesantren Al Munawwir Kompleks L implemented a pesantren management system that emphasizes managerial and applies spiritual values in its management through programs realized to achieve more comprehensive and holistic goals, namely through 1) takhalli management; 2) tahalli management; 3) tajalli management.