Purported Advantages Research Articles

The Language of Economic Growth:A New Measure of Linguistic Heterogeneity

Conventional wisdom holds that languages, as ethnic markers, build communities with shared preferences and strong social networks. Consequently, ethnolinguistic homogeneity can facilitate growth. This article challenges this conception of language as a cultural marker. It argues that language is also a practical vehicle of communication; people can be multilingual, and second languages can be learned. Hence language boundaries are neither (1) congruent with ethnic boundaries nor (2) static. If true, the purported advantages of ethnolinguistic homogeneity should also be evident in countries with large populations of non-native speakers conversant in official languages. The study tests this hypothesis using an original cross-national and time-variant measure that captures both mother-tongue speakers and second-language learners. The empirical results are consistent with the understanding of language as an efficiency-enhancing instrument: countries with exogenously high levels of heterogeneity can avoid the ‘growth tragedy’1by endogenously teaching the official language in schools.

Quality of Life Following Stereotactic Ablative Radiation Therapy Versus Surgery for Early-Stage Lung Cancer: Results From the ROSEL Randomized Controlled Trial and a Systematic Review

Purpose/Objective(s) One of the purported advantages of stereotactic ablative radiation therapy (SABR) as an alternative treatment option to surgery for early-stage non-small cell lung cancer (ES-NSCLC) is health-related quality of life (HRQOL). The objectives of this study are 1) to assess HRQOL and indirect costing outcomes from the ROSEL randomized trial comparing surgery and SABR for ES-NSCLC and 2) to perform a systematic review of HRQOL following SABR for ES-NSCLC. Materials/Methods In ROSEL, 22 patients with ES-NSCLC were randomized to either SABR or surgery before the trial closed due to poor accrual. HRQOL was evaluated at baseline, and then 3, 6, 12, 18, and 24 months posttreatment using the 30 item EORTC QLQ-C30, its corresponding 13-item lung cancer supplement, and the EuroQol disease-generic questionnaire. Indirect costs of productivity loss were evaluated using the short form health and labor questionnaire, which includes work absences, reduced efficiency at work, and substitution for unpaid work. Time to deterioration (TTD) in HRQOL was calculated from time to randomization to first appearance of clinically significant change. TTD was analyzed using Cox proportional hazard models. The Embase and MEDLINE databases were systematically reviewed to obtain English language articles investigating patient-reported HRQOL after SABR for ES-NSCLC up to August 1, 2015. Review articles, meta-analyses, and decision analyses were excluded. Relevant data regarding patient characteristics and study outcomes were abstracted and analyzed. Results In the ROSEL study, only TTD of global health status was significantly worse on univariable modeling for surgical patients compared to SABR (HR 0.19, P = 0.038). Indirect costing analysis revealed lower total productivity costs to society for SABR compared to surgery (€95 vs €3,513, P = 0.044). Patients reported a lower total degree of hindrance in paid and unpaid work for SABR compared to surgery (mean hindrance scores for SABR: 1.9, for surgery: 6.0, P = 0.010). In the SABR HRQOL systematic review, 9 out of 204 potential studies met all inclusion criteria and were analyzed. All studies were prospective in design. Overall, SABR appeared to be well-tolerated in a mostly medically inoperable patient population. Clinically and statistically significant deteriorations in fatigue and dyspnea were individually reported in two studies. An isolated report found clinically and statistically significant improvements in emotional functioning over time. Deterioration in dyspnea and physical functioning were noted in other studies, but were neither statistically nor clinically significant. Conclusion SABR is an overall well-tolerated modality in patients with ES-NSCLC who either declined surgery or were unfit. Exploratory results in operable ES-NSCLC suggest that SABR may be better tolerated than surgery and incur indirect costing savings. Future clinical trials comparing SABR and surgery would benefit from the inclusion of HRQOL metrics in study design.

Laser Assisted Root Canal Disinfection-A Review

Laser assisted procedures evoked the field of endodontics almost 3-4 decades ago by means of using appropriate energy produced by light for alteration of various hard and soft tissues. During the initial years, the cumbersome laser delivery systems and handling limited its use, despite the purported advantages. However, the last few years, have seen tremendous advancements in terms of tip designs, disinfection agents, photoacoustic streaming etc. This paper has been compiled in an attempt to discuss the effects of photo-activated technology on the root canal system.

Comparative analysis of biologic versus synthetic mesh outcomes in contaminated hernia repairs

Contaminated operative fields pose significant challenges for surgeons performing ventral hernia repair. Although biologic meshes have been utilized increasingly in these fields, recent evidence suggests that synthetic meshes represent a viable option. We analyzed the outcomes of biologic and synthetic mesh utilized in patients undergoing major ventral hernia repair in clean-contaminated/contaminated fields. We conducted a multicenter, retrospective review of patients undergoing open ventral hernia repair in clean-contaminated/contaminated fields using biologic or synthetic mesh. Patient and hernia details were characterized. Primary outcomes included 90-day surgical site event, surgical site infection, and hernia recurrence. A total of 126 patients undergoing major ventral hernia repair in clean-contaminated/contaminated fields (69 biologic and 57 synthetic meshes) were analyzed. Groups were similar in both patient and hernia characteristics. There were 13 (22.8%) surgical site events in the synthetic cohort compared to 29 (42.0%) in the biologic cohort, P=.024. Similarly, surgical site infections were less frequent in the synthetic group, with 7 (12.3%) vs 22 (31.9%), P=.01. With a mean follow-up of 20months, there were more recurrences in the biologic group: 15 (26.3%) vs 4 (8.9%) in the synthetic group, P=.039. The choice of mesh for clean-contaminated/contaminated ventral hernia repair remains debatable. We demonstrated that using synthetic sublay mesh resulted in a significantly lower wound morbidity and more durable outcomes versus a similar cohort of biologic repairs. This is likely secondary to improved bacterial clearance and faster integration of macroporous synthetics. Overall, our findings not only support suitability of synthetic mesh in contaminated settings but also challenge the purported advantage of biologics in clean-contaminated/contaminated ventral hernia repairs.

Uniportal video-assisted thoracoscopic lobectomy

Uniportal video assisted thoracic surgery (VATS) has become one of the most exciting new developments in minimally invasive thoracic surgery in recent years. While the debate over its purported advantages continues, this chapter instead focuses on the technical aspects of performing a lobectomy via the uniportal approach. Using clear medical illustrations to show how each step is performed, the key tips and tricks are laid out for the beginner hoping to learn the technique.

Uniportal video-assisted thoracic (VATS) lobectomy.

Uniportal video assisted thoracic surgery (VATS) has become one of the most exciting new developments in minimally invasive thoracic surgery in recent years. While the debate over its purported advantages continues, this chapter instead focuses on the technical aspects of performing a lobectomy via the uniportal approach. Using clear medical illustrations to show how each step is performed, the key tips and tricks are laid out for the beginner hoping to learn the technique.

Late Feyerabend on materialism, mysticism, and religion

Feyerabend's interests in religion and mysticism grew through his career. In his later writings, Feyerabend's numerous critiques of scientific materialism are often accompanied by purported advantages of religious orientations and temperaments. These recommendations do not simply follow from his tolerant theoretical pluralism; they are more positive attempts to articulate distinctive aspects of human life satisfied by religion, but not by scientific materialism. Elevating the human need for mystery, reverence, and love, he contrasts these goods with the deliverances of monistic conceptions of science and reason. I bring attention to some of the common themes in these remarks to argue that they were integral with other parts of his philosophical project and that they could serve as helpful rejoinders to contemporary exhortations to science-based secularism from philosophers of science.

Are There Specific Indications for Laparoscopic Appendectomy? A Review and Critical Appraisal of the Literature.

Laparoscopic appendectomy (LA) has proven to be a feasible alternative to open appendectomy (OA). However, as some of the purported advantages of LA (versus OA) are marginal, evidence is accumulating that appendectomy may not be necessary for uncomplicated appendicitis and there is concern about using laparoscopy for all patients with suspected acute appendicitis. In spite of widespread popularity and use, the literature reporting the indications is sparse and sometimes misleading (i.e., containing distorted deductions or conclusions, also called "spin"). This study aimed to determine subsets of patients for whom LA may present real advantages over OA and to analyze the validity of specific indications for LA (instead of OA). A systematic review and critical analysis of the literature were conducted. We analyzed 90 retrospective reviews, prospective studies, meta-analyses, and cohort and prospective randomized studies, presenting a total of approximately 390,000 patients, concerning potentially specific advantages of LA in the elderly, the obese, during pregnancy, and complicated appendicitis, including diffuse peritonitis and ectopic appendices. Overall, LA was associated with (1) lower overall complication rates (and notably less decompensated comorbidities), mortality, and costs, as well as shorter duration of hospital stay, in the elderly, (2) decreased morbidity (notably parietal) in the obese, and (3) potential (diagnostic) advantages in pregnancy (even though LA is associated with a higher rate of fetal loss than in OA). In complicated or ectopic appendicitis, LA is feasible and safe and, if performed without conversion, should lead to less short- and long-term parietal morbidity. However, published data are very heterogeneous, there are few sound controlled trials, and conclusions found in the literature are often based on misleading deductions or a very low level of evidence. LA is a safe and effective method to treat acute appendicitis in specific settings such as the elderly and the obese, as well as in ectopic appendices, with potentially specific parietal advantages in these subsets of patients. Further randomized studies and robust meta-analyses are necessary before recommending LA for complicated appendicitis and peritonitis, as well as in pregnancy.

Performance based planning in Queensland: A case of unintended plan-making outcomes

Performance based planning (PBP) is purported to be a viable alternative to traditional zoning. The implementation of PBP ranges between pure approaches that rely on predetermined quantifiable performance standards to determine land use suitability, and hybrid approaches that rely on a mix of activity based zones in addition to prescriptive and subjective standards.Jurisdictions in the USA, Australia and New Zealand have attempted this type of land use regulation with varying degrees of success. Despite the adoption of PBP legislation in these jurisdictions, this paper argues that a lack of extensive evaluation means that PBP is not well understood and the purported advantages of this type of planning are rarely achieved in practice. Few empirical studies have attempted to examine how PBP has been implemented in practice. In Queensland, Australia, the Integrated Planning Act 1997 (IPA) operated as Queensland's principal planning legislation between March 1998 and December 2009. While the IPA did not explicitly use the term performance based planning, the Queensland's planning system is widely considered to be performance based in practice. Significantly, the IPA prevented Local Government from prohibiting development or use and the term zone was absent from the legislation. How plan-making would be advanced under the new planning regime was not clear, and as a consequence local governments produced a variety of different plan-making approaches to comply with the new legislative regime. In order to analyse this variation the research has developed a performance adoption spectrum to classify plans ranging between pure and hybrid perspectives of PBP. The spectrum compares how land use was regulated in seventeen IPA plans11Called planning schemes in Queensland. across Queensland.The research found that hybrid plans predominated, and that over time a greater reliance on risk adverse drafting approaches created a quasi-prohibition plan, the exact opposite of what was intended by the IPA. This paper concludes that the drafting of the IPA and absence of plan-making guidance contributed to lack of shared understanding about the intended direction of the new planning system and resulted in many administrative interpretations of the legislation. It was a planning direction that tried too hard to be different, and as a result created a perception of land use risk and uncertainty that caused a return to more prescriptive and inflexible plan-making methods.

Deployment of an unmanned aerial system to assist in mapping an intermittent stream

AbstractRecent growth in the capabilities of unmanned aerial vehicles and systems (UASs) as airborne platforms for collecting environmental data has been very rapid. There are now ample examples in the literature of UASs being deployed to map fine‐scale vegetation, glacial, soil and atmospheric conditions. The purported advantages of UASs are their ability to collect spatial data at lower cost, lower risk, higher resolution and higher frequency than ground surveys or satellite platforms. In this specific study, whether or not obtaining high‐resolution UAS imagery was advantageous for identifying an intermittent stream network was determined by comparing it with coarse‐scale satellite imagery collected for the same purpose. It was also determined if the UAS imagery could be an improvement to Global Positioning System acquired ground‐truth points for classifying an intermittent stream network across the same large‐scale satellite image. The UAS‐acquired and satellite‐acquired imageries were derived from a visible spectrum camera capable of 2‐cm resolution and multispectral SPOT‐5 with 10‐m resolution, respectively. The SPOT‐5 imagery with its relatively coarse resolution could not always detect the narrow intermittent stream, which was well resolved in the UAS imagery. When a classified UAS image was applied as a training area for the SPOT‐5 image, the identification of the stream network and accuracy of the satellite imagery classification did not necessarily improve. UASs have the potential to revolutionize hydrological research the same way that geographic information systems did three decades ago. A final goal of the paper is to provide insight into the advantages and disadvantages of deploying a UAS for this kind of research. © 2015 Her Majesty the Queen in Right of Canada. Hydrological Processes. © 2015 John Wiley & Sons, Ltd.

Invited Commentary

Invited Commentary

Sacral Screw Strain in a Long Posterior Spinal Fusion Construct with Sacral Alar-Iliac versus Iliac Fixation

Introduction Long instrumented posterior fusion constructs to the lumbosacral spine have a significant rate of pseudoarthrosis and S1 screw failure. With the increasing popularity of Sacral Alar-Iliac (S2AI) fixation with its purported advantages of (1) decreased implant profile and (2) obviating the need for a lateral offset connector, the biomechanical properties with respect to S1 screw strain remain unknown. We set out to compare the biomechanical effect of S2AI versus traditional iliac screw fixation on S1 screw strain. Methods Five fresh-frozen human cadaveric specimens were instrumented from L2–pelvis, maintaining all osteoligamentous structures, with bilateral titanium 6.0 × 40-mm pedicle screws and 5.5-mm cobalt–chromium rods. Bilateral S1 pedicles were instrumented with 8.0 × 50-mm screws that were centrally cored out and two uniaxial strain gauges inserted at 0 and 90 degrees. S2AI fixation and/or iliac fixation with 8.0 × 80-mm titanium pedicle screws was performed to evaluate the following four different constructs: (1) bilateral S1 screws (control); (2) bilateral S2AI; (3) bilateral iliac; (4) hybrid (S2AI with contralateral iliac). Bilateral S1 screw strain was measured (microstrain), and pure moment loads (12.0 Nm) were applied in axial rotation (AR), flexion extension (FE), and lateral bending (LB). One way repeated measure ANOVA was used to analyze the S1 screw strain data. Results Compared with S1 screws alone, both S2AI fixation and iliac fixation significantly reduced sacral screw strain in FE by 58 and 67%, respectively ( p < 0.05), in AR by 35 and 41%, respectively ( p < 0.05), while no significant difference in LB for either construct ( p > 0.05). Hybrid constructs demonstrated a significant reduction in only FE, with reduction in screw strain by 56% for S2AI fixation and 59% for iliac fixation, with no difference in AR and LB moments. When S2AI fixation and iliac fixation were compared, there was no significant difference in screw strain for all bending moments ( p > 0.05). Similarly, hybrid constructs demonstrated no side-to-side significant difference between S2AI fixation and iliac fixation for all bending moments ( p > 0.05). Conclusion Both S2AI fixation and iliac fixation provide significant reduction in S1 sacral screw strain compared with sacral fixation alone. Bilateral S2AI fixation is a viable and biomechanically comparable to alternative traditional iliac fixation, and presents another option to achieve protection of the S1 sacral screws for long segment constructs to the pelvis.

Revision of a single type of large metal head metal-on-metal hip prosthesis.

Large-head metal-on-metal (MoM) total hip arthroplasties were introduced because of their purported advantages. Inflammatory pseudotumours occasionally occur after MoM hip arthroplasty and often lead to revision. The purpose of this study was to assess the outcome of revision of large-head MoM total hip arthroplasties after an extensive screening protocol for all MoM articulations with a minimum 2 year follow-up. We identified 50 hips that had undergone large-head MoM total hip arthoplasty and required revision at a mean of 44 months after index operation. Of these, 38 were revised for pseudotumours, 7 for loosening, 2 for infection and 3 for instability. There was bone loss in 44 hips. The majority were revised to a 28 mm metal or ceramic head on a polyethylene-cemented cup. In 12 patients there was a complication. There was a decrease of whole blood cobalt from 20.8 µg/L preoperatively to 1.8 µg/L 1 year after revision. We found 6 residual masses on routine postoperative CT scans. The indication for revision of this cohort is inevitable but the clinical outcome 2 years after revision for pseudotumour is disappointing. Revising a MoM hip arthroplasty to a conventional cemented polyethylene or dual-mobility cup with bone impaction grafting and a 28 mm head can adequately treat the high ion levels and probably the disease of ARMD.

Autonomous Weapons Systems, the Frame Problem and Computer Security

ABSTRACTUnlike human soldiers, autonomous weapons systems (AWS) are unaffected by psychological factors that would cause them to act outside the chain of command. This is a compelling moral justification for their development and eventual deployment in war. To achieve this level of sophistication, the software that runs AWS will have to first solve two problems: the frame problem and the representation problem. Solutions to these problems will inevitably involve complex software. Complex software will create security risks and will make AWS critically vulnerable to hacking. I claim that the political and tactical consequences of hacked AWS far outweigh the purported advantages of AWS not being affected by psychological factors and always following orders. Therefore, one of the moral justifications for the deployment of AWS is undermined.

Maximising early recovery by modified surgical approach: Randomized control prospective series of 50 patients treated with the standard medial parapatellar and mid-vastus surgical approaches

Background: The medial parapatellar approach is the workhorse of total knee replacement. Modified (mid-vastus and subvastus) approaches have been advocated to improve quadriceps power, improve knee flexion and provide better pain relief. However, detractors state difficulty in patella eversion and visualisation of the lateral tibial plateau as concerns. Does the mid-vastus approach really provide these purported advantages? We report an analysis of our prospective randomised controlled trial in 50 patients undergoing simultaneous bilateral total knee arthroplasty using a medial parapatellar approach in one knee and the mid-vastus approach in the other. Methods: 50 consecutive elderly patients with bilateral knee osteoarthritis underwent simultaneous bilateral total knee replacement (randomized to undergo standard medial parapatellar approach in one knee and mid-vastus approach in the other knee) from Dec 2012 to Mar 2013. Strict inclusion and exclusion criteria were followed and the two surgical approaches were randomised to the left or right knee. A blinded independent observer evaluated immediate and early post-operative clinical radiological criteria for each knee at 2 weeks, 6 weeks, 3 months and 12 months post-surgery. The collated results were then matched to the approach taken, and analysed for statistical differences. Results: The return of active straight leg raise, quadriceps power and function was statistically higher with the mid-vastus approach at 2 weeks, 3 months and 6 months, without any statistical difference at 12 months. Pain control was also better in the mid-vastus approached knee, though statistically not significant. All other intra-operative and post-operative parameters were the same at the points of evaluation. At 12 months, comparable criteria between the two groups were statistically insignificant. Discussion: The mid-vastus approach significantly reduces the immediate post-operative pain, and improves the quadriceps function and knee flexion. There is no difficulty in exposing the lateral tibial surface and/or implanting the tibial component. However, it needs to be reiterated that this benefit lasts for the first 3 months, and seems to provide no extra benefit in the mid- or long-term. This approach is recommended in patients with low BMI as one of the components for early recovery. It may significantly reduce the duration of hospital stay as well.

Patient safety, resident well-being and continuity of care with different resident duty schedules in the intensive care unit: a randomized trial

Shorter resident duty periods are increasingly mandated to improve patient safety and physician well-being. However, increases in continuity-related errors may counteract the purported benefits of reducing fatigue. We evaluated the effects of 3 resident schedules in the intensive care unit (ICU) on patient safety, resident well-being and continuity of care. Residents in 2 university-affiliated ICUs were randomly assigned (in 2-month rotation-blocks from January to June 2009) to in-house overnight schedules of 24, 16 or 12 hours. The primary patient outcome was adverse events. The primary resident outcome was sleepiness, measured by the 7-point Stanford Sleepiness Scale. Secondary outcomes were patient deaths, preventable adverse events, and residents' physical symptoms and burnout. Continuity of care and perceptions of ICU staff were also assessed. We evaluated 47 (96%) of 49 residents, all 971 admissions, 5894 patient-days and 452 staff surveys. We found no effect of schedule (24-, 16- or 12-h shifts) on adverse events (81.3, 76.3 and 78.2 events per 1000 patient-days, respectively; p = 0.7) or on residents' sleepiness in the daytime (mean rating 2.33, 2.61 and 2.30, respectively; p = 0.3) or at night (mean rating 3.06, 2.73 and 2.42, respectively; p = 0.2). Seven of 8 preventable adverse events occurred with the 12-hour schedule (p = 0.1). Mortality rates were similar for the 3 schedules. Residents' somatic symptoms were more severe and more frequent with the 24-hour schedule (p = 0.04); however, burnout was similar across the groups. ICU staff rated residents' knowledge and decision-making worst with the 16-hour schedule. Our findings do not support the purported advantages of shorter duty schedules. They also highlight the trade-offs between residents' symptoms and multiple secondary measures of patient safety. Further delineation of this emerging signal is required before widespread system change. ClinicalTrials.gov, no. NCT00679809.

Cervical Laminoplasty: The History and the Future.

Cervical laminoplasty was developed as an alternative to cervical laminectomy for treatment of cervical myelopathy, in which hinges are created to lift the lamina. Various techniques of laminoplasty have since been developed after two prototype techniques: Hirabayashi’s open-door laminoplasty and Kurokawa’s spinous process splitting (double-door) laminoplasty. Several in vitro studies report superior biomechanical stability of the cervical spine after laminoplasty compared with laminectomy. In clinical situation, randomized control studies are scarce and superiority of one procedure over another is not uniformly shown. Lack of hard evidence supporting the purported advantages of laminoplasty over laminectomy, that is, reduced rate of postoperative instability and kyphosis development, while preserving range of motion (ROM), has been a weak selling point. Currently, laminoplasty is performed by majority of spine surgeons in Japan, but is rarely performed in the United States and Europe. Recent development in laminoplasty is preservation of muscle attachment, which enabled dynamic stabilization of the cervical spine by neck extensor muscles. After treatment with new laminoplasty techniques with active postoperative neck ROM exercises, postoperative instability, kyphosis, axial neck pain, and loss of ROM seems minimal. Well-designed clinical trials to show the effectiveness and long-term outcome of this surgical procedure are warranted.

Periscope Modification of Right Ventricle-to-Pulmonary Artery Shunt in Norwood Operation

Given the purported hemodynamic advantages of the right ventricle (RV) to pulmonary artery (PA) conduit, many surgeons have adopted it as their preferred source of pulmonary blood flow during stage I palliation for hypoplastic left heart syndrome. Potential disadvantages of the RV-PA shunt include ventricular dysfunction, pseudoaneurysm formation, arrhythmia, and conduit obstruction, which can lead to a higher rate of unplanned reinterventions. The "dunk" technique was described to reduce the RV incision and proximal conduit obstruction; however, insertion of the ringed graft from the epicardium can be cumbersome and risk RV injury. We introduce a simplified, alternative method of placing the conduit, which we call the periscope technique, whereby the graft is withdrawn from within the RV cavity.

The concept of monobloc in Endodontic - A review

Abstract The creation of a homogenous filling within the root canal has always been one of the most sought after objectives in the field of Endodontics. While conventional root canal filling materials have given predictable results, the pursuit of developing alternative sealers or techniques that bond simultaneously to canal wall dentin as well as filling materials has continued. Breakthroughs in dentin adhesive technology in the recent past have built a new generation of bondable root canal sealers and post systems. Thus arose the concept of monoblocs, with its purported advantages of simultaneously improving the seal and fracture resistance of the filled canals. The added advantages of reduced application steps and overall improvements in their user friendliness led to the aggressive marketing of materials claiming to achieve the ‘monobloc effect’. On the other hand the credibility of this concept in practice has launched controversial discussions. This review attempts to throw light on the various dimensions of the concept of monoblocs as well as to scrutinize the potential of various root canal filling materials to create monoblocs. How to cite this article Sophia T, Deepak BS, Deepa J, Mallikarjun GK. The concept of monobloc in Endodontics - A review. CODS J Dent 2014;6;83-89

Multistatic performance prediction for Doppler-sensitive waveforms in a shallow-water environment

Navies worldwide are now operationally capable of exploiting multistatic sonar technology. One of the purported advantages of multistatics when detecting directional targets should be the increased probability of receiving a strong reflection at one of the multistatic receivers. However, it is not yet clear (or intuitive) how best to deploy multistatic-capable assets to achieve particular mission objectives. The Performance Assessment for Tactical Systems (PATS) software was recently developed by Maritime Way Scientific under contract to Defence Research and Development Canada as a research tool to assist in exploring different approaches to multistatic performance modelling. Beginning with a user-defined environment and sensor layout, PATS uses transmission loss and reverberation model results to calculate signal excess at each grid point in the model domain. Monte Carlo simulations using many realizations of target tracks allow for the calculation of the cumulative probability of detection as a means to assess performance. Results will be presented comparing the shallow-water performance of monostatic and multistatic sensors using frequency-modulated and Doppler-sensitive waveforms as well as omnidirectional and directional targets in a variety of realistic military scenarios.