Correct Time Research Articles

Interplay Between Atmospheric Correction and Fusion Techniques Enhances the Quality of Remote Sensing Image Fusion

Remote sensing image fusion technology integrates observational data from multiple satellite platforms to leverage the complementary advantages of the different types of remote sensing images. High-quality fused remote sensing images provide detailed information on surface radiation, climate, and environmental conditions, thereby supporting governmental policies on environmental changes. Improving the quality and quantitative accuracy of fused images is a crucial trend in remote sensing image fusion research. This study investigates the impact of atmospheric correction and five widely applied fusion techniques on remote sensing image fusion. By constructing four fusion frameworks, it evaluates how the choice of fusion method, the implementation of atmospheric correction, the synchronization of atmospheric parameters, and the timing of atmospheric correction influence the outcomes of remote sensing image fusion. Aerial flights using remote sensors were conducted to acquire atmospheric parameter distribution images that are strictly synchronous with the remote sensing images. Comprehensive and systematic evaluations of the fused remote sensing images were performed. Experiments show that for the remote sensing images used, selecting the appropriate fusion method can improve the spatial detail evaluation metrics of the fused images by up to 2.739 times, with the smallest deviation from true reflectance reaching 35.02%. Incorporating synchronous atmospheric parameter distribution images can enhance the spatial detail evaluation metrics by up to 2.03 times, with the smallest deviation from true reflectance reaching 5.4%. This indicates that choosing an appropriate fusion method and performing imaging-based synchronous atmospheric correction before fusion can maximize the enhancement of spatial details and spectral quantification in fused images.

P005 CHILDREN WITH REPAIRED COARCTATION OF THE AORTA: FOLLOW-UP AND HYPERTENSIO5

Background and objective: Coarctation of the aorta (CoA) is a congenital heart disease with high morbidity and mortality due to cardiovascular disease even after adequate therapeutic management. A fundamental factor is the development of high blood pressure over the years. The objective of this work is to analyze the blood pressure phenotype of the population under follow-up in a high blood pressure clinic. Methods: Retrospective review of medical records of patients aged 0 to 22 years with CoA corrected by surgery or interventional catheterizations, which were followed up between January 2017 and February 2023 in the high blood pressure clinic of a pediatric center. Variables to analyze: age at the time of correction, technique, time since correction, associated cardiac or extracardiac pathologies, office blood pressure, left ventricular hypertrophy. In patients with adequate height and tolerance to the procedure: Ambulatory Blood Pressure Monitoring (ABPM) and pulse wave velocity study were performed. Results: 142 medical records were reviewed (see table 1). Two groups were formed according to the age of the patients due to the possibility of performing ABPM. There were no significant differences between the age of surgical approach and the association with complex heart diseases between the groups. The younger population presented a greater number of extended terminal anastomosis technique and increased concentric remodeling. The prevalence of hypertension and overweight obesity increased over the years. The older group had 25% masked hypertension and 25% increased pulse wave velocity Conclusion: Our population has 28% of hypertension among those under 8 years of age and it increases to 46% among the eldest, coinciding with international reports that indicate that the evolution towards arterial hypertension in this population is progressive. Lifelong follow-up of these patients with corrected CoA is important to detect recoarctation or the development of hypertension and act accordingly to improve morbidity and mortality.

Topography-guided Anatomical Reassembly for Distal Penile Hypospadias Without Chordee: A Comprehensive Illustration and Midterm Results of a Novel Approach

ObjectivesTo provide a comprehensive illustration of the newly introduced ‘topography-guided anatomical reassembly’ approach, which has shown promising early results, and to report the mid-term outcomes of an extended series. MethodsThis is a prospective cohort study of all patients presenting to the author’s facility with distal penile hypospadias without chordee between June 2018 and January 2023. Redo cases, circumcised cases, and cases with non-preservable plates are excluded. The procedure follows the most recently introduced principle of the topography-guided anatomical reassembly approach for distal penile hypospadias, that is, the exclusive zipping-up of the unfolded spongiosal plate. ResultsA subset of 97 boys met the enrolment criteria. The hypospadias meatus was coronal or sub-coronal in 35 boys, distal penile in 45 boys, and mid-penile in 17 boys. The mean age at the time of surgical correction was 8.11 months. The mean operative time was 66.7 min. After a mean follow-up of 27 months, five urethrocutaneous fistulae were reported: three glanular and two sub-coronal. Meatal disfigurement with downward stream deviation was reported in two more patients. Two more occurrences of meatal recession were identified, yet surgical correction was not necessary. The overall reoperation rate settled at 7%. ConclusionsThe proposed topography-guided anatomical reassembly technique for distal hypospadias is simple, effective, and highly feasible at mid-term follow-up of the given series. Maintaining the integrity of well-developed penile tissues eliminates the possibility of unforgivable tissue damage and avoids the need for challenging revision procedures.

Benefit of isolated surgical valve repair or replacement for functional tricuspid regurgitation and long-term outcomes stratified by the TRI-SCORE.

Severe tricuspid regurgitation (TR) is associated with increased mortality rates, but benefit of its correction and ideal timing are not clearly determined. This study aimed to identify patient subsets who might benefit from surgery. In TRIGISTRY, an international cohort study of consecutive patients with severe isolated functional TR (33 centers, 10 countries), survival rates up to 10 years were compared between patients who underwent isolated tricuspid valve (TV) surgery (repair or replacement) and those conservatively managed, overall and according to TRI-SCORE category (low: ≤3, intermediate: 4-5, high: ≥6). 1,217 were managed conservatively, and 551 underwent isolated TV surgery (200 repairs, 351 replacements). TRI-SCORE distribution was 33% low, 32% intermediate, and 35% high. At 10 years, survival rates were similar between surgical and conservative management (41% vs. 36%; hazard ratio [HR] 0.97; 95% confidence interval [CI] 0.88-1.08, P=0.57). Surgery improved survival compared to conservative management in the low TRI-SCORE category (72% vs. 44%; HR 0.27; 95% CI 0.20-0.37, P<0.0001), but not in the intermediate (36% vs. 37%, HR 1.17; 95%CI 0.98-1.40, P=0.09) or high categories (20% vs. 24%; HR 1.06; 95% CI 0.91-1.25, P=0.45). Both repair and replacement improved survival in the low TRI-SCORE category (84% and 61% vs. 44%; HR 0.11; 95% CI 0.06-0.19, P<0.0001, and HR 0.65; 95% CI 0.47-0.90, P=0.009). Repair showed benefit in the intermediate category (59% vs. 37%; HR 0.49; 95% CI 0.35-0.68, P<0.0001) while replacement was possibly harmful (25% vs. 37%; HR 1.43; 95% CI 1.18-1.72, P=0.0002). Higher survival rates were observed with repair than replacement and benefit of intervention declined as TRI-SCORE increased with no benefit of any type of surgery in the high TRI-SCORE category. These results emphasize the importance of timely intervention and patient selection to achieve the best outcomes and the need for randomized controlled trials. TRIGISTRY: ClinicalTrials.gov, NCT05825898.

Phase-type distribution models for performance evaluation of condition-based maintenance

ABSTRACT Condition-based maintenance (CBM) is gaining attention due to sensor and cloud-based analytics advancements, but research on its impact on system-level performance is limited. Insufficient understanding during CBM implementation can lead to confidence issues and failures. This study introduces a class of models using phase-type distribution to assess three maintenance strategises: run-to-failure (RTF), time-based preventive maintenance (TBM), and CBM. Employing machine health-index, the framework characterizes production performance by estimating effective process times. The model demonstrates how adjusting CBM thresholds influences process time variations and assesses the impact of changing maintenance frequency for TBM. Applied to a smart cellular manufacturing system, the model shows CBM’s early-stage implementation. Findings indicate CBM with optimized thresholds boosts maximum throughput by 6.77%. Further, CBM achieves an additional 6.84% increase assuming corrective maintenance time can be reduced by 20%. This approach can help manufacturing become smarter through smarter maintenance in the Industry 4.0 era and beyond.

Application of locally regularized extremal shift to the problem of realization of a prescribed motion

Abstract A controlled system of differential equations under the action of an unknown disturbance is considered. The problem discussed in the paper consists in constructing algorithms for forming a control that provides the realization of a prescribed motion for any admissible disturbance. Namely these algorithms should provide the closeness in the metric of the space of differentiable functions of a phase trajectory of a given controlled system and some etalon trajectory of an analogous system functioning when any outer actions are absent. As the space of admissible disturbances, we take the space of measurable square integrable (with respect to the Euclidean norm) functions. The cases of inaccurate measurements of phase trajectories of both systems at all times and at discrete times are under study. Two computer oriented algorithms for solving the problem are designed. The algorithms are based on the (well-known in the theory of guaranteed control) method of extremal shift. In the process, its local (at each time of control correction) regularization is performed by the method of smoothing functional (the Tikhonov method). In addition, estimates for algorithm’s convergence rate are presented.

Surgical treatment of scoliosis in patients with osteogenesis imperfecta: a single institution case series.

Osteogenesis imperfecta (OI) is a connective tissue disorder characterized by skeletal deformities, bone fragility, and spinal complications. Various studies' insights underscored the impact of scoliosis on pulmonary function, positive outcomes with spinal fusion, and improved functional abilities post-surgery. However, partial loss of correction remains inevitable. This study examines six surgically treated OI patients with scoliosis. Surgical intervention using a posterior approach with pedicle screws and hooks aimed to correct spinal deformities. Preoperative, postoperative, and follow-up radiological assessments were conducted, revealing significant reductions in scoliotic angles post-surgery. Complications included infections and proximal junctional kyphosis requiring revision surgeries. Despite the challenges posed by poor bone quality and implant stability, no implant failures occurred in this series. Ponte osteotomies at the apex of deformity aided in corrective maneuvers. Surgical treatment of scoliosis in patients affected by OI is challenging and may be associated with perioperative and postoperative complications. Ponte osteotomy may improve the correction and reduce necessary force at the time of correction.

Early approach for the iatrogenic vesico-vaginal fistula repair: a video case report.

Vesico-vaginal fistula (VVF) is a rare but debilitating condition, characterised by an abnormal connection between the bladder and vagina. While obstetric-related cases prevail in developing countries, iatrogenic fistulas are more common in industrialised ones, often resulting from pelvic surgeries. The optimal timing for surgical correction of VVF remains debated, often leaning towards delayed intervention. Here we report a successful early laparoscopic repair of an iatrogenic VVF following hysterectomy. The patient, a 54-year-old woman, presented with VVF after a hysterectomy. The laparoscopic repair was performed promptly upon diagnosis. To assess the feasibility and effectiveness of an early repair of a gynaecological-related VVF. First, cystoscopy identified the bladder edge of the VVF. Second, laparoscopy was performed and the vesico-vaginal dissection was carried out. The excision of the previous stitches and of the fibrotic tissue was undertaken to create free flaps for suturing. The bladder was repaired in a double layer, and a single layer was applied to the vagina. Finally, the omentoplasty was done. The patient was discharged on postoperative day 5. No complications occurred. This successful case demonstrates the feasibility and safety of early laparoscopic repair for gynaecological surgery-related vesico-vaginal fistulae. While acknowledging the need for further studies to standardise techniques, this report contributes to the evolving understanding of optimal management for this complex condition.

Prevalence of Gastroesophageal Reflux Disease in Congenital Diaphragmatic Hernia Survivors From Infancy to Adulthood

BackgroundGastroesophageal reflux disease (GERD) is a common comorbidity associated with congenital diaphragmatic hernia (CDH), with reported cases of Barrett's esophagus (BE) and esophageal adenocarcinoma before the age of 25. The prevalence and natural course of GERD in CDH survivors remain uncertain due to variations in diagnostic methods. We aimed to analyse the GERD prevalence from infancy through young adulthood. MethodsWe retrospectively analyzed pH-impedance measurements and endoscopic findings in 96 CDH survivors evaluated as routine care using well established clinical protocols.GERD was defined as an abnormal acid exposure time for pH-MII measurements and as presence of reflux esophagitis or BE at upper endoscopy. Clinical data including symptoms at time of follow-up and use of antireflux medication were collected. ResultsGERD prevalence remained consistently low (≤10%) across all age groups, yet many patients experienced GER symptoms. Histological abnormalities were observed in 80% of adolescents and young adults, including microscopic esophagitis in 50%. BE was diagnosed in 7% before the age of 18, all had GER symptoms. CDH severity, anatomy at the time of CDH correction, alcohol usage, and smoking did not emerge as significant risk factors for GERD. ConclusionsGiven the low GERD prevalence in CDH survivors, a symptom-driven approach to diagnosis and follow-up is warranted. We advise long-term follow-up for all adult patients due to the early onset of BE and the limited evidence available. The longitudinal course and impact of GERD on other long-term CDH-related comorbidities should be explored in larger cohorts. Level of EvidenceNot applicable

'Suspension Palatoplasty' - A method of surgical correction of VPI post Cleft Palate repair.

To design the technique of 'Suspension Palatoplasty' for Velopharyngeal Insufficiency (VPI) post Cleft Palate (CP) based on optimal spatial positioning of palate at the time of VPI correction, by using a non-obstructive, high, midline pharyngeal flap for predictable velopharyngeal closure and normal speech. To evaluate the results of CP patients with VPI operated using the technique of 'Suspension palatoplasty'. An ambi-spective longitudinal clinical study. Comprehensive cleft care clinic in a private trust hospital. Patients operated using the 'Suspension Palatoplasty' technique for VPI post CP repair between 2014 and 2018 with a minimum follow-up period of 5 years. 'Suspension Palatoplasty' - Double Opposing Z (DOZ) plasty with palatal myoplasty is used to revise soft palate and a narrow superiorly based pharyngeal flap is used to suspend it for a dynamic velopharyngeal closure. Speech outcome and surgical complications. 70 out of 119 studied were found to have normal speech (59%), and another 25 patients (21%) had acceptable speech. Thus 95 out of 119 patients (80%) had normal or near-normal speech and did not require any further speech therapy or surgeries. 12 patients had snoring without difficulty in breathing. One patient had symptoms suggestive of obstructive sleep apnea. Younger patients had a higher percentage of normal speech outcomes. Many of our adult patients also attained normal speech. 'Suspension Palatoplasty' aims to achieve normal speech with little effort. It has minimal side effects. The author has performed 403 cases to date.

Primary frequency control optimization of coal-fired power plants with high-low position shafts: Employing a revised strategy with power-decoupling and feedforward-compensating

Coal-fired units play a critical role in peak-shaving and frequency regulation with high penetration of renewable energy. The coal-fired unit arranged by high-low position shafts applied in power stations will participate in these regulation processes. In this study, the dynamic model of the 1100 MW supercritical coal-fired unit is built and verified, dynamic characteristics of the primary frequency regulation process are analyzed and a poor control effect of the original control strategy is illustrated. Then, the dynamic coupling relationship between high and low-level units is obtained, and there is a 14-s time delay between the two power outputs, and a revised regulation strategy that employs load distribution factor and flow-rate feedforward-compensating is proposed. Compared with the original control strategy, the revised control strategy can effectively lower fluctuations of the steam parameters by approximately 50%, and the corrective regulation time decreases from 25.1 s and 15.8 s to 6.9 s and 12.1 s under positive and negative load disturbance, respectively. Moreover, it can improve the control effect of low-level unit, whose regulation time under positive and negative load disturbance decreases from 45.7 s and 27.7 s to 9.4 and 20.6 s, respectively. This research can provide technical guidance for the operation of coal-fired units.

Conformation Effect on the Mechanical and Microbiological Behavior of Invisible Orthodontic Aligners.

Invisible orthodontic aligners are having a great impact on tooth movement in an aesthetic and effective way. Different techniques, models, and clinical aspects have been studied for their proper use. However, the aim of this research has been to determine the effect of the shaping process on mechanical properties and their bacterial behavior. For this study, 40 original polyurethane plates and 40 identical models, obtained by hot forming the original plates, were used. The static tensile mechanical properties were studied with a Zwick testing machine using testing speeds of 5 mm/min at a temperature of 37 °C. The original plate and the aligner have been studied with a creep test by subjecting the samples to a constant tension of 30 N, and determining the elongation using a long-distance, high-resolution microscope at different time periods between 1 and 720 h. Studies of water absorption has been realized with artificial saliva for 5 h. Bacterial cultures of Streptococcus oralis and Actinomyces viscosus strains were grown on the original plates and on new and used models, to determine the proliferation of each bacterium through metabolic activity, colony-forming units, and LIVE/DEAD assays. The mechanical results showed an increase in the strength of the inserts with respect to the models obtained from 3.44 to 3.95 MPa in the elastic limit and a lower deformation capacity. It has been proven that the transition zone in the creep curves lasts longer in the original plate, producing the rapid increase in deformation at a shorter time (400 h) in the aligner. Therefore, the shaping process reduces the time of dental correction exerted by the aligner. The results of the bacterial culture assays show an increase in the number of bacterial colonies when the aligners have been used and when the polyurethane is conformed due to the internal energy of the model, with respect to the original polyurethane. It has been observed that between the original plate and the aligner there are no statistically significant differences in water absorption and therefore the forming process does not affect water absorption. A slight increase in water absorption can be observed, but after five hours of exposure, the increase is very small.

Time-varying propagation model and dynamic-feedback-phase correction for multiplexed orbital angular momentum beams in atmospheric turbulence.

Freespace optical (FSO) communication in an outdoor setting is complicated by atmospheric turbulence (AT). A time-varying (TV) multiplexed orbital angular momentum (OAM) propagation model to consider AT under transverse-wind conditions is formulated for the first time, and optimized dynamic correction periods for various TV AT situations are found to improve the transmission efficiency. The TV nature of AT has until now been neglected from modeling of OAM propagation models, but it is shown to be important. First, according to the Taylor frozen-turbulence hypothesis, a series of AT phase screens influenced by transverse wind are introduced into the conventional angular-spectrum propagation analysis method to model both the temporal and spatial propagation characteristics of multiplexed OAM beams. Our model shows that while in weak TV AT, the power standard deviation of lower-order modes is usually smaller than that of higher-order modes, the phenomena in strong TV AT are qualitatively different. Moreover, after analyzing the effective time of each OAM phase correction, optimized dynamic correction periods for a dynamic feedback communication link are obtained. An optimized result shows that, under the moderate TV AT, both a system BER within the forward-error-correction limit and a low iterative computation volume with 6% of the real-time correction could be achieved with a correction period of 0.18 s. The research emphasizes the significance of establishing a TV propagation model for exploring the effect of TV AT on multiplexed OAM beams and proposing an optimized phase-correction mechanism to mitigate performance degradation caused by TV AT, ultimately enhancing overall transmission efficiency.

Adult versus adolescent idiopathic scoliosis surgery: a meta-analysis of clinical and radiographic outcomes.

While the natural history of adolescent idiopathic scoliosis (AIS) and adult idiopathic scoliosis (AdIS) is well documented in the literature, the impact of age on postoperative outcomes remains an active area of research. We performed a systematic review and meta-analysis to compare patients undergoing surgery for AIS and AdIS with respect to: (1) postoperative Cobb correction, (2) perioperative variables, and (3) postoperative complications. A systematic literature search was performed in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. studies published between 2002 and 2022, retrospective, and comparing AIS vs. AdIS patients undergoing deformity surgery. The primary outcome was postoperative Cobb correction. Secondary outcomes included estimated blood loss (EBL), operative time, total instrumented levels, length of stay (LOS), and postoperative complications. Random-effects models were performed according to the method of DerSimonian and Laird. Of 190 identified articles, 14 fit the inclusion criteria. A total of 1788 patients were included, 1275(71.3%) with AIS, and 513(28.7%) with AdIS. There was a significant age difference between AIS and AdIS (15.3 vs. 36.7years, mean difference (MD) = 21.3years, 95%CI = 14.3-28.4,p < 0.001). Mean postoperative Cobb percentage correction was reported in 5 articles and was significantly higher in AIS (68.4%) vs. AdIS (61.4%) (MD = -7.2, 95%CI = -11.6,-2.7,p = 0.001). EBL was not significantly different between AIS and AdIS (695.6mL vs 817.7mL,p = 0.204). Furthermore, no difference was found in operative time (MD = 37.9min,95%CI = -10.7;86.6,p = 0.127), total instrumented level (MD = 0.88,95%CI = -0.7,2.4,p = 0.273), and LOS (MD = 0.5, 95%CI = -0.2;1.2, p = 0.188). Four articles reported postoperative complications in AIS vs AdIS, with no difference in neurological deficit, instrumentation-related complications, and medical complications. AIS patients had better radiographic correction compared to AdIS. Though no difference was found in perioperative outcomes and complications, these findings emphasize the importance of counseling patients regarding the optimal timing of surgical correction.

High-Frequency Surface Wave Radar Current Measurement Corrections via Machine Learning and Towed Acoustic Doppler Current Profiler Integration

High-Frequency Surface Wave Radar Current Measurement Corrections via Machine Learning and Towed Acoustic Doppler Current Profiler Integration

A Study on the Impact of Pradhan Mantri Mathru Vandhana Yojana Among Rural Women in Kerala

Pradhan Mantri Mathru Vandhana Yojana is a maternity benefit programme started in 2017, for transfering financial benefits to pregnant lactating women to solve the problem of undernourishment in women. It is playing a prominent role in solving this issue by giving timely assistance for their first living child to pregnant women and mothers who are lactating. Pradhan Mantri Mathru Vandhana Yojana has been a helping hand to the rural women of kerala especially in Wayanad, Kasargode, Quilon and Kozhikode districts. Many rural women in kerala especially tribal women are suffering from one major problem undernourishment. Most of them work till their delivery date. Many of the problems of this rural women are solved by this scheme. Since their financial problems are solved at the correct time they are able to take rest and give birth to healthy babies who are the promises of tomorrow. Women in urban area working in daily wages are also taken care under this scheme.

Do Preoperative Corticosteroid Injections Increase the Risk of Infection after Shoulder Arthroscopy or Shoulder Arthroplasty? A Systematic Review.

Corticosteroid injections have demonstrated short-term benefits for shoulder pain. This symptomatic treatment method is used in various inflammatory conditions that affect the shoulder joint. Corticosteroid joint injections are not without risks and complications. Adverse effects have been documented, including damage to the articular cartilage, tendon rupture, and attenuation of the subject's immune response. The aim of this study was to examine the timing of preoperative corticosteroid injections on infectious outcomes of shoulder arthroscopies and shoulder arthroplasty. In accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), the PubMed, Cochrane, and Science Direct databases were systematically reviewed by two independent authors in January 2024. After full-text reading and checking the reference lists, 11 article were included. Patients who received a shoulder injection within three months prior to undergoing shoulder arthroplasty exhibited a markedly elevated incidence of infection. In addition, a significantly increased risk of periprosthetic joint infection (PJI) at 90 days postoperatively in patients who received CSIs (corticosteroid injections) within 1 month prior to shoulder arthroplasty was found. Different authors consider CSI injections within the 2 weeks prior to shoulder arthroscopy surgery principally associated with an increased risk of postoperative infection. There is still no consensus on the correct timing of preoperative CSIs in both arthroscopic and arthroplasty procedures. The literature does not identify whether the number of preoperative injections could increase the risk of periprosthetic infection. Obesity, sex, and smoking did not have a significant effect on PJIs; alcohol abuse could be considered as a risk factor for PJIs with CSIs. Both in prosthetic surgeries and in arthroscopy procedures, modifiable and unmodifiable factors play secondary roles. The risk of postoperative infection is greater within 3 months, although it is almost comparable at one- and two-year follow-ups.

Cognitive effort assessment through pupillary responses: Insights from multinomial processing tree modeling and neural interconnections

The pupillary responses of humans exhibit variations in size, which are mediated by optic and oculomotor cranial nerves. Due to their sensitivity and high resolution of pupillary responses, they are used for a long time as measurement metrics of cognitive effort. Investigating the extent of cognitive effort required during tasks of varying difficulty is crucial for understanding the neural interconnections underlying these pupillary responses. This study aims to assess human cognitive efforts involved in visually presented cognitive tasks using the multinomial processing tree (MPT) model, an analytical tool that disentangles and predicts distinct cognitive processes, resulting in changes in pupil diameter. To achieve this, a pupillary response dataset was collected during mental multiplication (MM) tasks and visual stimuli presentations as cognitive tasks. MPT model describes observed response frequencies across various response categories and determines the transition probabilities from one latent state to the next. The expectation maximization (EM) algorithm is employed with MPT model to estimate parameter values based on response frequency within each category. Both group-level and individual subject-to-subject comparisons are conducted to estimate cognitive effort. The results reveal that in the group comparison and with respect to task difficulty level, that subject’s knowledge on MM task influences the successfully solve the problem. Regarding individual analysis, no significant differences are observed in parameters related to correct recall, problem-solving ability, and time constraint compliance. However, some significant differences are found in parameters associated with the perceived difficulty level and ability to recall the correct answers. MPT model combined with EM algorithm constitutes a probabilistic model that enhances pupillary responses identification related to the cognitive effort. Potential applications of this model include disease diagnostics based on parameter values and identification of neural pathways that are involved in the pupillary response and subject’s cognitive effort. Furthermore, efforts are underway to connect this psychological model with an artificial neural network.

A constant learning curve in working towards integrated health policy: twelve years of practical experience at a Dutch municipality

Background By establishing and implementing an integrated four-year health policy, Dutch municipalities contribute significantly to the protection and promotion of public health. Scientific literature has many insights into integrated health policy, determinants of health and interventions. How is this knowledge used when determining and shaping an integrated health policy? The authors share their experiences concerning the role of knowledge in: 1) determining policy; 2) integrated collaboration; 3) working towards a healthy living environment; and 4) creating a citywide health movement. Key points Based on working on an integrated health policy and the setbacks we have encountered, we have experienced that scientific knowledge and models provide a framework for policy implementation, but other types of knowledge about context, processes and practice are just as important. Furthermore, we learned that other factors are often more decisive in policy and implementation, including the interests of individual parties, correct timing, continuity of persons, and courageous administrators. Working on integrated health policy is a continuous process of staying on course and adapting at the same time, in which searching for the suitable knowledge to work in an evidence-informed way must be part of it. Conclusion The greatest challenge when using knowledge in practice lies in expanding the collaboration between researchers, policymakers, professionals and inhabitants, for example by using boundary spanners. The collaboration should aim to organise a long-lasting adaptive collaboration aimed at mutual learning. This should focus on shared discussion of relevant knowledge, with less emphasis on pure acquisition and use of scientific knowledge.

Reexamining the 'Role of the Community Reinvestment Act in Mortgage Supply and the U.S. Housing Boom'

Concerns have lingered since the 2007 subprime crisis that government housing policies promote risky mortgage lending. The first peer-reviewed evidence of a causal effect was published by the Review of Financial Studies in a paper (Saadi, 2020) linking the crisis to changes in the Community Reinvestment Act (CRA) in 1995. A review of that paper, however, shows that it misrepresents the policy changes as having taken effect in mid-1998, 2.5 years after they were implemented. When the correct timing is used, a similar analysis yields no evidence of a relationship between CRA and riskier mortgage lending. Instead, the results are shown to reflect an unrelated confounding event, the first collapse of the U.S. subprime mortgage market following Russia’s debt default in August 1998.