Data-driven Discussion Research Articles

Ave Maria out of context: prosody, poetry or piety?

ABSTRACT Focusing on singability and audience reception, this is a case study on Duy ey sevgili sesimi! ‘Hear, o beloved, my voice’, a Turkish version of Schubert’s Ellens Gesang III (D. 839; Opus 52, No. 6). The study provides a data-driven discussion on the reception of this version by the primary text user, i.e. the performer, the secondary text users, i.e. the listeners, and a first-hand account of the intentions behind the choices of the target song lyricist. The data provide evidence for a hierarchical understanding of Johan Franzon’s three layers of singability: prosodic, poetic, and semantic-reflexive. However, the hierarchical ordering of the layers depends on the priorities of each user group. The performer has focused on the musical aspects of the song rather than the target text itself. Listeners with no background in music or translation have prioritized the semantic-reflexive layer. Listeners with a background in translation studies have paid attention to the poetic and semantic-reflexive layers. In contrast, those listeners with musical training or a special interest in music have regarded the lyrics as subordinate to the original composition, standing aloof from the translation of a classical song. Such diverging views point towards a more fine-grained understanding of singability.

Organizational Resilience Factors of Startups: Exploratory Case Study

In an increasingly competitive environment subject to uncontrollable risks, the continuity of organizations can be severely threatened, and the decision-making process takes place under circumstances of great uncertainty. Therefore, it is necessary to develop strategies and competencies that allow the business to thrive. Startups, particularly technology-based ones, are an essential source of innovation. However, several studies indicate that approximately 60% of Startups fail in the first five years of business. To succeed, startups need to develop skills that allow them to rapidly evaluate their decisions and options, and to identify what is vital for the survival of their business. Thus, organizational resilience becomes of paramount importance to those companies. The term resilience is used in different areas of knowledge, but all the definitions share common ground regarding the concept: it describes the ability of an element to return to its normal state after a period of stress and crisis. The main objective of this exploratory research developed in Portugal is to identify the resilience factors of technological Startups. It is also intended to contribute to the design and development of instruments which promote organizational resilience in technological ecosystems. The current research follows the case study methodology based on a sample of 10 technological startups collected from the Startup Leiria ecosystem (Portugal). The Startup Leiria is an incubator of startup ventures which makes it a prime source of data and knowledge. The main findings point out the necessity to develop agility skills in Startup ecosystems. It was concluded that resilient organizations are characterized by having the ability to anticipate, respond, adapt, and recover from a disruptive event. The uniqueness of this study concerns its contribution to stimulate data-driven discussions regarding the necessity to implement programs for the reskilling of Startups in the context of their ecosystems.

How did early North American clinical psychologists get their first personality test? Carl Gustav Jung, the Zurich School of Psychiatry, and the development of the "Word Association Test" (1898-1909).

Clinical psychology emerged in the United States during the first decades of the 20th century. Although they focused on intelligence tests, starting around 1905 certain clinical psychologists pursued personality assessment through a specific, nonintellectual kind of test: the word association test as devised by Swiss psychiatrist Carl Gustav Jung (1875-1961) at the Burghölzli psychiatric clinic in Zurich. The test was a key device in the professionalization of North American psychiatry and psychology during the early 20th century: from 1905 onward it was acknowledged, discussed, and applied by experimental and clinical psychologists. However, Jung's original experiments and the development of the test itself have received only superficial or casual attention by historians of science. This article attempts to provide a critical, streamlined, and detailed account on the origin, development, and substance of the Zurich word association experiments. By drawing on heretofore overlooked primary sources, I offer a new, critical perspective on the emergence and development of Jung's test while engaging with its main theoretical and methodological aspects. I show that the test was neither Jung's sole creation nor did it consist of a simple, straightforward set of tasks. Contrarily, it was the result of a highly collaborative, multilayered institutionalized research program on linguistic and mental associations. The program, its data and its assumptions fueled several debates and data-driven discussions at Zurich, precluding the test from achieving a stable, standardized character. As a result, the history of Jung's program reflects both the advances and the limitations of early 20th-century personality testing. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Adequate lung cancer surgery lymphadenectomy within a statewide quality collaborative: Quality improvement in action

ObjectivesIn January 2016, our statewide quality improvement collaborative focused on 3 metrics of adequate lymph node harvest during lung cancer surgery: (1) rates of pathologic examination of 10 lymph nodes or more; (2) sampling 5 or more lymph node stations or more within the hilum or mediastinum; and (3) pathologic nodal upstaging (pathologic nodal stage higher than clinical nodal stage). Unblinded, hospital-level outcomes were presented at biannual meetings, and opportunities for education or improvement were discussed. We set out to describe this quality improvement initiative and the subsequent impact on surgical lymphadenectomies statewide. MethodsWe retrospectively reviewed patients undergoing lobectomy for stage IA to IIIA non–small-cell lung cancer from July 2015 to December 2020 at the 16 participating centers. ResultsThe study cohort included 3753 patients. The rates of examining 10 lymph nodes or more statewide increased from 215 lobectomies (44.0%) in 2015 to 522 lobectomies (78.9%) in 2020 (P < .001). Similar trends were noted statewide for 5 lymph node stations or more, which increased from 193 lobectomies (39.6%) to 531 lobectomies (80.3%) in 2020 (P < .001). The overall rate of nodal upstaging was more variable year to year and generally declined over time (P = .004). ConclusionsOur statewide quality improvement initiative improved rates of appropriate lymph node staging for surgically treated non–small cell lung cancer compared with national rates. This work demonstrates the power that a “community of practice” philosophy can have on surgical treatment of lung cancer. Quality improvement interventions including transparent data-driven discussions and collaboration can help guide future quality improvement initiatives and should be readily transferrable to other clinical domains.

Adaptability to Teleworking in European Countries

The process of digital transformation and teleworking are some of the most debated topics in the specialized literature of the last decade due to the major impact they have on the stability, the evolution and the efficiency of the economy. The COVID-19 pandemic highlighted the competitive advantage offered to the national economies by the implementation of policies dedicated to the digitalization of the society and the economy. In the last year, national economies have been faced with huge challenges imposed by the continuation and adaptation of economic processes in the virtual environment. The pace of adaptability of the workforce to digital technologies, the functional and technical literacy of human resources, the work organization and the level of digitalization influence the economic and social performance of the countries. The main aim of this research is to determine the defining characteristics in terms of the ability to adapt to telework in 30 European countries, to classify them according to their digital performance, but also to analyze their differences and determine the directions of action to capitalize on the opportunities offered by the online environment. The results of this research highlight that despite the investments which the analyzed European countries have made in recent years in digital infrastructure, there are large disparities in terms of adaptability to telework, as follows: poor adaptability (Southern and South-Eastern Europe), medium (Central Europe), high adaptability (Western and Central Europe), very high adaptability (Northern and North-Western Europe). The research is intended to be a catalyst for data-driven discussions on the adaptability of the European countries to digital innovations and the process of managing adaptation by governments to meet the economic and social needs. The analysis of the potential for adaptation to telework represents a contribution to the exploring of potential post-crisis developments. The limits of the research are related to the involvement of only six variables, the analysis can be extended in future research to other variables as well. © 2021, Amfiteatru Economic. All Rights Reserved.

Thermodynamics of high entropy oxides

With the hype of “high entropy” alloys and more recently, “high entropy” ceramics and “high entropy” oxides (HEOs), there has been a great push to investigate and characterize systems with 5 or more components. This push has been extremely beneficial for the materials community as it has led to the development of many new systems with targeted applications. However, with our desire to find “new” and “exotic” materials, we have not spent enough time to step back and think deeply about the fundamental thermodynamic constraints that will guide design of future HEOs. Here, we present data-driven discussions with examples that have been collected from the fields of geology and materials science over the past 50 years to highlight critical thermodynamic parameters and principles that can be used for the design of HEOs. The goal of HEOs is to push the limit of the number of components in a single-phase solid solution to achieve unique and tunable properties. True single-phase HEOs are stabilized if the positive entropy of formation more than compensates an unfavorable enthalpy of formation above some critical temperature, making the overall ΔGf negative i.e. the HEO phase is “entropy stabilized”. Under ideal mixing, the number of components in a solid solution does not affect the solubility of an additional component. In real systems, the types of additional components, their structural transformations, and their associated non-ideal interactions influence the solubility limit. Non-ideal interactions can lead to short- or long-range ordering that decreases the overall configurational entropy. Due to the ionic-covalent nature of oxides, this ordering is the norm, not the exception. In the limited cases where mixing is ideal, charge coupled substitutions can work to influence overall configurational entropy contributions due to unique crystallographic sites. Long-range ordering can be minimized by mixing oxide components that have similar charge or are isostructural. Most excitingly, is the realization that surface energies will drastically affect the stability of oxide polymorphs and solubility limits. Thus, nano-materials are an interesting and novel approach that will vastly extend the HEO engineering space. As one can see, there are many avenues for the design and development of “HEOs” that thermodynamics will allow, even though they all may not be driven explicitly by entropy.

Digital Transformation and Knowledge Management in the Public Sector

Digitizing public services is, at the moment, an essential necessity for numerous governments around the world. An improved government through digitization will not only have a growing effect on businesses, but it will also be able to intensify citizen engagement and push for economic growth. During the last 10 years more countries have progressively begun to provide digital services to their citizens. Therefore, in order to address this development, the purpose of this paper is to analyze the evolution of the digital government literature in order to describe the aspects of digital transformation in the public sector and how it is related to knowledge management. In this study the methodology is quantitative and it is based on a review and a survey made with the main goal being the estimation from several collected data on how the digital transformation process in the Public Administration takes place and what its relationship is with knowledge management. The review study is based on articles found on Scopus database and it addresses the role that digital government research plays in the theory and practice of knowledge management. In the survey study, 54 employees working for the services of the two governmental areas of the Portuguese Ministry of the Environment were surveyed. The results show that the research on the theme is still at an exploratory stage due to the lack of studies relating digital government to knowledge management effectiveness in the public sector. The results also show that the success of digital government seems to be related with the quality of the organizations’ knowledge management, complementing each other for significant improvements in the public sector. In terms of originality, this study aims to contribute and stimulate data-driven discussions regarding the impacts of the digital transformation in the public sector and their relation with the implementation of knowledge management practices. The results offer insights into future research needs.

POLICY SERIES: ADDRESSING LONELINESS AMONG OLDER ADULTS THROUGH RESEARCH, COMMUNITY PROGRAMS, AND A NEW FEDERAL POLICY AGENDA

Millions of older adults experience feelings of loneliness. A growing body of research has found that chronic loneliness can impact memory, physical well-being, mental health, and life expectancy rivaling the impact on health outcomes of obesity and smoking. Loneliness has been found to impact memory, physical well-being, mental health, and life expectancy. In this session, GSA policy advisor Brian Lindberg will lead a data-driven discussion about who experiences loneliness and isolation and how we might create opportunities for connectedness through new areas of research, forward-thinking policies, and innovative community programs. Presenters include Erica Solway, associate director for the National Poll on Healthy Aging, who will highlight results from a poll conducted in October 2018 among a nationally representative sample of adults age 50 to 80 which found that more than one in three respondents felt a lack of companionships and more than one in four felt socially isolated. Then Catherine Spensley, Director of the Senior Division at Felton Institute, will describe lessons learned in developing and delivering culturally and linguistically appropriate programs and services that foster community and social connections among socially isolated, low income older adults in San Francisco. Finally, Andrew MacPherson, Principal at Healthsperien, LLC, and Director of the Coalition to End Social Isolation & Loneliness will describe stakeholder efforts to advocate for federal legislative and regulatory policy options to address the epidemic including increased funding for and access to supportive services, health care, technology, and public and private research initiatives.

Invited Commentary

The Society of Thoracic Surgeons evolved in 1964 to offer all thoracic surgeons an opportunity to participate actively in a member organization. In 2017, recognizing responsibilities and realities as a member organization, the STS formed an ad hoc Taskforce on Diversity and Inclusion. With energy, academic commitment, and focus, this group has evolved into a workforce that is actively gathering data and creating information for all of us to review, recognize, and understand. The report1Erhunmwunsee L. Backhus L.M. Godoy L. Edwards M.A. Cooke D.T. Report from the Workforce on Diversity and Inclusion – The Society of Thoracic Surgeons members’ bias experiences.Ann Thorac Surg. 2019; 108: 1287-1292Abstract Full Text Full Text PDF Scopus (23) Google Scholar in this issue of The Annals of Thoracic Surgery is an early and thoughtful survey tabulation and commentary intended to address sensitive issues and to open the door to understanding our current realities, with a plan to further recognition of our current state and the importance of a diverse specialty for the patients we serve. Although we are more comfortable reading about adjuvant therapy for pulmonary or esophageal neoplasms, transcatheter aortic valve replacement trials, mitral repair outcomes or single ventricle realities, understanding our specialty’s membership, the opportunities we have, and societal responsibilities has an importance that we might not recognize consistently. This workforce report informs us of the reality of “gender directed implicit and explicit bias” and the disparities noted in medical education, surgical education, and training and leadership roles. Specifically, the report calls out the limited number of women in leadership positions in The Society of Thoracic Surgeons. The report notes the challenges and the commitment necessary to increase diversity. One need only peruse The Diversity Bonus by Scott E. Page to be thoughtfully challenged to recognize the benefits of a diverse workforce is more than the “right thing to do.”2Page S.E. The Diversity Bonus. Princeton University Press, Princeton, NJ2017Google Scholar Furthering the data-driven discussion, racial and ethnic implicit and explicit bias data are detailed for underrepresented groups in medicine, and the report suggests that we need to be “open to honest dialogue about experiences of bias.” I would expand on that include consideration of “bystander training” for our eventual “toolbox” to support our students, trainees, and colleagues. Although the embedded survey results from late 2017 and early 2018 are far from scientific evidence, Tables 1 and 2 are extremely informative, noting that a majority of female and Black/African/African American respondents answered yes to the question in Table 1: “Have you ever felt unfairly treated?” The report concludes using data to recognize the obvious implicit bias, and it thoughtfully notes the importance of self-reflection to recognize our internal realities—remarkably noted and supported by the oft-quoted presidential scholar Arthur M. Schlesinger, Jr: “Everything that matters in our intellectual and moral life begins with an individual confronting his own mind and conscience in a room by himself.”3Arthur M. Schlesinger, Jr. In: AZ Quotes. Available at: https://www.azquotes.com/. Accessed September 30, 2019.Google Scholar This workforce has embarked on a challenging journey, and it deserves our sincere thanks. Recognition of the realities in this report offers the society members and our specialty a unique opportunity for advancing our societal impact. Report from the Workforce on Diversity and Inclusion—The Society of Thoracic Surgeons Members’ Bias ExperiencesThe Annals of Thoracic SurgeryVol. 108Issue 5PreviewDiversity and inclusion within The Society of Thoracic Surgeons is paramount to the growth and excellence of our specialty. As such, discussions about challenges that prevent our Society from achieving this goal are necessary. The Workforce on Diversity and Inclusion has been tasked with understanding our membership’s comprehension and experience with bias, which is known to have a negative impact on those of female gender, minority race, sexual orientation status, and religious status. Bias contributes to the fact that we are far from gender parity within our Society’s leadership and that we must make significant changes in order to achieve a diverse membership. Full-Text PDF

An Integrated Analysis of Maternal-Infant Sleep, Breastfeeding, and Sudden Infant Death Syndrome Research Supporting a Balanced Discourse.

Breastfeeding and the place of sleep for the mother and the infant have been controversial internationally due to reported concerns regarding infant deaths despite the known benefits of exclusive and prolonged breastfeeding, which are increased by breastfeeding at night. The aims of this integrated analysis were to (a) review breastfeeding and maternal and infant sleep research literature via historical, epidemiological, anthropological, and methodological lenses; (b) use this information to determine where we are currently in safeguarding both infant lives and breastfeeding; and (c) postulate the direction that research might take from this point forward to improve our knowledge and inform our policy and practice. Despite well-meaning but unsuccessful campaigns in some countries to dissuade parents from sleeping with their babies, many breastfeeding mothers and caregivers do sleep with their infants whether intentionally or unintentionally. Taking cultural contexts and socio-ecological circumstances into consideration, data supports policies to counsel parents and caregivers on safe sleep practices, including bed-sharing in non-hazardous circumstances, particularly in the absence of parental smoking, recent parental alcohol consumption, or sleeping next to an adult on a sofa. Further research with appropriate methodology is needed to drill down on actual rates of infant deaths, paying close attention to the definitions of deaths, the circumstances of the deaths, and confounding factors, in order to ensure we have the best information with which to derive public health policy. Introduction and use of the concept of "breastsleeping" is a plausible way to remove the negative connotations of "co-sleeping" and redirect ongoing data-driven discussions and education of best practices of breastfeeding and sleep.

Utilizing the focused conversation method in qualitative public health research: a team-based approach

BackgroundQualitative research studies are becoming increasingly necessary to understand the complex challenges in the healthcare setting. Successfully integrating interdisciplinary teams of investigators can be challenging, as investigators inherently view data through their disciplinary lens. Thus, new methods, such as focused conservation, are needed to facilitate qualitative data analysis by interdisciplinary teams. The purpose of this manuscript is to provide a clear description of how we implemented the focused conversation method to facilitate an organized data-driven discussion that responded to our study objectives and ensured participation of our interdisciplinary team. The focused conversation method has not, to our knowledge, been utilized for this purpose to date.MethodsTo better understand the experience of healthcare personnel (HCP) during preparations for the 2014–2015 Ebola Virus Disease (EVD) outbreak, we interviewed HCP who participated in decision making about EVD preparations and training of workers in the use of enhanced personal protective equipment ensembles in the metropolitan Chicagoland area of Illinois to attain a priori research objectives. We identified a systematic method – the focused conversation method – that enabled our interdisciplinary team to interactively contribute to the framing, analysis and interpretation of the data that would enable us to focus on our research objectives.ResultsThe focused conversation developed to support our a priori research objective about the training of HCP in preparations included objective, reflective, interpretive and decisional questions. These questions grounded the conversation in the data, while leveraging discipline-specific lenses and professional experience in the analysis and interpretation. Insights from the conversation were reviewed later against interview transcripts to ensure validity. The conversation identified areas for future research directions and deficiencies in the interview instrument.ConclusionsThe focused conversation is an efficient, organized method for analysis of qualitative data by an interdisciplinary team.

Continuing to build knowledge: Undergraduate nonprofit programs in institutions of higher learning

ABSTRACT As student demand for nonprofit management education (NME) grows, new program offerings proliferate. While longitudinal data track the development of graduate NME programs, their curricula and location, we know less about the trajectory of undergraduate programs. Preliminary research finds evidence of undergraduate programs that are more diverse and span a greater number of locations than ever before. As a compilation, these findings facilitate analysis of the institutionalization of NME by expanding the focus beyond courses to include program development (certificates, majors, and/or minors). The results enable data-driven discussions, highlighting NME distinctiveness in facilitating the development of student engagement with community.

High Performance Two-Step Model for Early Detection and Management of Type 2 Diabetes Risk in the Workplace

Background: Identification of T2D high risk individuals is key for early implementation of prevention interventions. Employers could be instrumental in reversing T2D risk for a majority of its population via improved predictive power risk detection tools. Objective: To test the feasibility of a two-step screening model, based on the combination of a risk test score and Hb1Ac, for early detection and management of risk in an employee population. Methodology: The model was tested in nondiabetic employees of a large employer in Mexico. As a first step, a T2D risk score was computed for each participant via a multivariate logistic regression model that integrates 16 T2D genetic variants, T2D parental history and BMI. Subjects with a risk score above certain cut points were considered medium and high-risk individuals. As a second step, medium and high-risk individuals identified in the first step were tested for levels of Hb1Ac. Subjects with Hb1Ac of ≥5.7% were recommended to join the employer’s diabetes prevention program. Results: 5,201 of 7,480 (69.5%) employees (46% women, 54% men) aged 18-60 years and free of diabetes agreed to participate in the screening program. 5,201 samples (buccal swabs) for genotyping and corresponding data (demographics, personal and family medical history) were collected on-site at 36 branch offices from 10/2017 to 12/2017 in Mexico City, Monterrey and Guadalajara. Participants risk scores stratified as low (52%), medium (34%) or high risk (14%). Of the medium and high-risk individuals, 31% showed elevated Hb1Ac (≥5.7%), and were suggested to join the employer’s diabetes prevention program. Conclusions: Our study initiates a data-driven discussion of how employers can radically support employee diabetes prevention and lower healthcare costs via improved predictive power tools. A two-step system, based on the combination of a risk test score and Hb1Ac, may be a useful tool for an effective identification of high risk individuals in a workplace setting. Disclosure M. Zulueta: Employee; Self; Patia, Patia.

Development of a Risk Tool to Support Discussions of Care for Older Adults Admitted to the ICU With Pneumonia.

Early, data-driven discussion surrounding palliative care can improve care delivery and patient experience. To develop a 30-day mortality prediction tool for older patients in intensive care unit (ICU) with pneumonia that will initiate palliative care earlier in hospital course. Retrospective Electronic Health Record (EHR) review. Four urban and suburban hospitals in a Western New York hospital system. A total of 1237 consecutive patients (>75 years) admitted to the ICU with pneumonia from July 2011 to December 2014. Data abstracted included demographics, insurance type, comorbidities, and clinical factors. Thirty-day mortality was also determined. Logistic regression identified predictors of 30-day mortality. Area under the receiver operating curve (ROC) was calculated to quantify the degree to which the model accurately classified participants. Using the coordinates of the ROC, a predicted probability was identified to indicate high risk. A total of 1237 patients were included with 30-day mortality data available for 100% of patients. The mortality rate equaled 14.3%. Age >85 years, having active cancer, Congestive Heart Failure (CHF), Chronic Obstructive Pulmonary Disease (COPD), sepsis, and being on a vasopressor all predicted mortality. Using the derived index, with a predicted probability of mortality >0.146 as a cutoff, sensitivity equaled 70.6% and specificity equaled 65.6%. The area under the ROC was 0.735. Our risk tool can help care teams make more informed decisions among care options by identifying a patient group for whom a careful review of goals of care is indicated both during and after hospitalization. External validation and further refinement of the index with a larger sample will improve prognostic value.

Dengue vaccines: implications for dengue control.

Dengue, the most common arbovirus, is an increasingly significant cause of morbidity worldwide. After decades of research, an approved tetravalent dengue vaccine is finally available. Models constructed using recently available vaccine efficacy data allow for a data-driven discussion of the potential impact of dengue vaccine deployment on global control. Phase 3 efficacy trials demonstrated that the approved dengue vaccine, chimeric yellow fever-dengue-tetravalent dengue vaccine, has an efficacy of 60% against dengue illness of any severity. However, among dengue unexposed recipients, vaccination offers limited efficacy and may increase dengue severity. The WHO consequently recommends dengue vaccination for populations in which 70% of intended recipients are dengue seropositive. Models predict that routine childhood dengue vaccine may reduce dengue burden, but over time, population-level impact may be limited. Additional vaccine candidates in late-stage development may not suffer from the same limitations as chimeric yellow fever-dengue-tetravalent dengue vaccine. The efficacy and safety profile of the recently approved dengue vaccine is favorable only in previously dengue exposed recipients, which limits its potential for global control. Future work must evaluate the approved vaccine's long-term durability, efficacy of other late phase vaccine candidates, and potential for vector control efforts to work synergistically with vaccine deployment.

Changing Paradigms in the Treatment of Severe Asthma: The Role of Biologic Therapies

Cytokine antagonists are monoclonal antibodies that offer new treatment options for refractory asthma but will also increase complexity because they are effective only for patients with certain asthma subtypes that remain to be more clearly defined. The clinical and inflammatory heterogeneity within refractory asthma makes it difficult to manage the disease and to determine which, if any, biologic therapy is suitable for a specific patient. The purpose of this article is to provide a data-driven discussion to clarify the use of biologic therapies in patients with refractory asthma. We first discuss the epidemiology and pathophysiology of refractory asthma. We then interpret current evidence for biomarkers of eosinophilic or type 2-high asthma so that clinicians can determine potential treatments for patients based on knowledge of their effectiveness in specific asthma phenotypes. We then assess clinical data on the efficacy, safety, and mechanisms of action of approved and pipeline biologic therapies. We conclude by discussing the potential of phenotyping or endotyping refractory asthma and how biologic therapies can play a role in treating patients with refractory asthma.

Inhaled corticosteroids: Effects on growth and bone health

BackgroundBoth slowed growth in children and reduced bone mineral density (BMD) are systemic effects of corticosteroids, and there is concern about the degree to which these systemic effects affect growth and BMD. ObjectiveTo engage in a data-driven discussion of the effects of inhaled corticosteroids (ICSs) on growth in children and BMD. MethodsArticles were selected based on their relevance to this review. ResultsStudies of ICSs in children in which growth was a secondary outcome have revealed slowed growth associated with low doses of budesonide, fluticasone propionate, and beclomethasone dipropionate. In the study of budesonide, the effect was permanent, and in the study of fluticasone propionate, the effect was long-lasting, but it is unclear whether the effect was permanent. However, the results of studies in which growth was the primary outcome were mixed. Slowed growth was detected in a study of beclomethasone dipropionate; however, slowed growth was not detected in a study of ciclesonide or flunisolide. A decrease in BMD acquisition in children was associated with high doses but not low to medium doses of ICSs. In adults, there was a dose-related effect of ICSs on BMD. Both higher daily dose and larger cumulative dose were associated with increased bone density loss. ConclusionBecause of the systemic effects on growth and bone health, children should be monitored for growth using stadiometry every 3 to 6 months and BMD should be monitored yearly in patients being treated with high doses of ICSs.

A Grant Project to Initiate School Counselors’ Development of a Multi-Tiered System of Supports Based on Social-Emotional Data

This article reports on an Elementary and Secondary School Counseling Program (ESSCP) grant project designed to build an elementary school counseling program in a district that previously had not employed school counselors at that level. The new school counseling program was organized around an innovative shift in the district's multi-tiered system of supports (MTSS) model that expanded to integrate social-emotional and behavioral data with academic indicators. School counselors used the new social-emotional data to help answer the question of why students were struggling academically when scholastic deficiencies were not the primary cause. The grant project also focused on developing strong data literacy skills among elementary school counselors so they could serve as leaders in data-based discussions. These complementary grant goals transformed the data team process as school counselors, teachers and administrators began to use data to better understand the complex relationship between social-emotional factors and academic achievement. These practices resulted in systemic changes throughout the district as data-driven elements of the elementary school counseling program were adopted at the secondary level. The purpose of this article is to: (a) highlight the importance of engaging in data-based decision making regarding students' social-emotional needs in schools, (b) provide an overview of the specific elements that comprised the new MTSS model in the school district as a part of this grant-funded project, and (c) underscore the importance of building human capacity to enable school-based data teams to meaningfully integrate academic and social-emotional data to promote improved student outcomes. Limitations of this project, directions for future research and implications for school counselors also are discussed.School Counselors and Social-Emotional DataSchool counselors are often advised to adopt a data-based decision-making model as part of their practice (American School Counselor Association [ASCA], 2012; Dimmitt, Carey, & Hatch, 2007). Accountability mandates require school counselors to use data to demonstrate the impact of their work and to link their interventions to academic achievement (Dahir & Stone, 2009: Isaacs, 2003; Sink & Stroh, 2003.) Moreover, data use also is central to the transformed model of school counseling, which positions school counselors as advocates in educational reform efforts such as closing the achievement gap and carrying out school improvement initiatives (Dahir, 2004; Hayes, Nelson, Tabin, Pearson, & Worthy, 2002; House & Hayes, 2002). However, institutional factors can limit the role of the school counselor in data-based decision making. Typically, data teams primarily (or even exclusively) consider academic indicators, and schools often lack the infrastructure to systematically collect the social-emotional data that more directly aligns with the work of the school counselor.Accountability requirements of the No Child Left Behind Act of 2001 (NCLB; 2002) have strongly influenced schools' approaches to data-based decision making (Mandinach, Honey, & Light, 2006; Marsh, Pane, & Hamilton, 2006). The pressure to demonstrate adequate yearly progress (AYP) has prioritized state standardized tests scores and other academic benchmark assessments in data-driven discussions. A tremendous amount of achievement data were routinely collected and housed by school districts to fulfill reporting demands of NCLB; these data will continue to be gathered under the new Every Student Succeeds Act (ESSA; 2015). School staff can access these data to guide instructional practices and measure student progress. However, these data are more directly linked to teachers' work with students and primarily measure academic achievement and cognitive ability (Heckman & Rubinstein, 2001).The role of the school counselor encompasses not only students' academic achievement but also their social-emotional development (ASCA, 2012). …

Monetary policy shocks and Cholesky VARs: an assessment for the Euro area

An estimated monetary policy VAR with 1993:IV–2008:III Euro data returns an insignificant response of inflation and a borderline significant reaction of the output gap to monetary policy shocks identified with the widely employed Cholesky restrictions. We replicate this evidence with a Monte Carlo exercise, in which the true responses of inflation and the output gap, according to an estimated DSGE model which we use as data-generating process, are negative. Consequently, insignificant macroeconomic reactions to policy shocks as documented by a small-scale Cholesky-VAR for the Euro area do not necessarily point to monetary policy neutrality. Differently, the Cholesky-VAR evidence may very well be due to false short-run zero-restrictions. A data-driven discussion on this reading of the drivers of our Cholesky-VAR impulse responses versus alternative interpretations such as omitted factors and structural breaks is proposed.

Rejoinder: Need for a data-driven discussion on the socioeconomic patterning of cardiovascular health in India

Rejoinder: Need for a data-driven discussion on the socioeconomic patterning of cardiovascular health in India