Significant Disagreement Research Articles

Perceptions and Expectations Regarding the Step 1 Score Change Among Surgical and Non-Surgical Program Directors: A Systematic Review and Meta-Analysis.

There are currently no studies examining differences in perceptions and expected impact of the Step 1 score change to pass/fail between surgical and non-surgical program directors (PDs). We conducted a systematic review in May 2023 of PubMed, Scopus, Web of Science, and PSYCInfo to evaluate studies examining PDs' perspectives regarding the Step 1 score change. We performed random-effects meta-analyses to determine differences in perspectives among surgical and non-surgical PDs. Surgical PDs (76.8% [95% CI, 72.1%-82.0%], I2 = 52%) reported significantly greater rates of disagreement with the score change compared to non-surgical (65.1% [95% CI, 57.9%-73.1%], I2 = 69.7%) (P = .01). Surgical PDs also reported significantly greater rates of agreement that the score change will increase the difficulty in objectively comparing applicants (88.1% [95% CI, 84.6%-91.7%], I2 = 16.4%), compared to non-surgical (81.0% [95% CI, 75.6%-86.8%], I2 = 72.6%) (P = .04). There was less heterogeneity among non-surgical PDs (88.7% [95% CI, 86.2%-91.2%], I2 = 0%), compared to surgical (84.7% [95% CI, 79.0%-90.8%], I2 = 67.3%), regarding expected increases in emphasis on Step 2, although the difference in rates of agreement was not statistically significant. Overall, there is significant heterogeneity in the literature regarding expected changes in the residency application review process. Most PDs reported significant disagreement with the score change, greater expected difficulty in objectively evaluating applicants, and greater emphasis on Step 2, with surgical PDs reporting greater rates of disagreement, greater expected difficulty, and heterogeneity regarding expected increases in emphasis on Step 2, compared to non-surgical. Additionally, there is significant heterogeneity in the overall literature regarding expected changes in the residency application review process. Further research is needed to establish evidence-based guidelines that improve the overall residency application process for all stakeholders.

Exploration of the Current State of Peripheral Intravenous Catheter Complications and Documentation: A Point Prevalence Study.

Peripheral intravenous catheters (PIVCs) are the most commonly used invasive devices in acute care hospitals, with nurses being primarily responsible for the insertion and care of these devices. This point prevalence study aimed to describe current PIVC status and nursing documentation in a large, regional health care system and to explore variables associated with PIVC complications. The study was conducted with adult inpatients. There were 665 PIVCs included in the study. Dressings were clean, dry, and intact in 83% of observations; only 2.7% did not have a transparent dressing. Thirty-one percent of PIVCs were inserted in areas of flexion. Median dwell time was 2.39days (± 2.36days), with upper arm sites having the longest dwell time. Overall inter-rater reliability (IRR) for an infiltration or phlebitis score of 0 was high (97.4% and 92%, respectively). However, overall agreement was only 77.16% for infiltration and 40.07% for phlebitis, with significant disagreement as scores increased. Study findings support that there was strong compliance with the Infusion Nurses Society's (INS) Infusion Therapy Standards of Practice vascular access practice recommendations; however, opportunities to improve infiltration/phlebitis assessment and documentation exist.

Resolving decades of debate: the surprising role of high-temperature covalency in the structure of liquid gallium.

Liquid metals (LMs) have the potential to revolutionise many important technologies, ranging from battery components to catalytic reactions. Low melting temperature gallium (Ga) is particularly promising as a solvent in many LM alloys, due to the low energy cost of maintaining its liquid state. However, despite 30+ years of study on the nature of Ga's liquid structure, it remains enigmatic with significant disagreement among the many published reports. In this work, we reconcile many of the conflicts through analysis of extensive ab initio molecular dynamics simulations of bulk Ga liquid at different temperatures. Contrary to previous assumptions, covalency becomes more important in the liquid at higher temperatures, meaning that covalency is not a significant feature of the liquid near the phase transition temperature. This explains the experimental observation of a decrease of resistivity of the metal upon melting, and its subsequent anomalously nonlinear increase with temperature. This revised understanding of structuring in the liquid has implications for the way these alloys are tailored for specific applications in the rapidly developing field of LMs.

CONSTRUÇÃO E VALIDAÇÃO DE UM BANCO DE ITENS SOBRE AUTOMEDICAÇÃO DE RISCO

ABSTRACT Objective: to construct an item bank to measure risk self-medication and assess its content validity. Method: this is a methodological study carried out from May to October 2022, with two phases: 1) item bank elaboration in the light of medication literacy and Theory of Planned Behavior based on a scoping review; and 2) content validity by twenty-two health experts. The Content Validity Index, Content Validity Ratio, binomial exact test for small samples and intraclass correlation coefficient were calculated. Results: Risk Self-Medication construct item elaboration was based on a broad review of solidified national and international publications in the health area. The definitions were approved by judges, with their respective domains. In the first version, the bank contained 136 items. Two rounds of analysis were carried out with judges, which resulted in the removal of 87 items. The final version presented 49 items, distributed across three domains: Medication literacy; Behavioral intention; and Behavior. The total Content Validity Index was 0.89, with excellent reliability (0.964). There was significant disagreement in the attribution of scores among judges (p>0.05) in some items. Conclusion: the item bank has satisfactory content. It is recommended to undergo semantic analysis and subsequent structure validity.

Moses, Elijah, and Jesus’ Divine Glory (Mark 9.2–8)

AbstractScholars generally agree that Moses and Elijah appear at the Transfiguration because they are connected to each other in some way, and that this connection informs the significance of the story as a whole. However, there is no consensus regarding how Moses and Elijah are related, and consequently there is significant disagreement about how their presence contributes to the Transfiguration. The present study, which focuses on Mark's account (Mark 9.2–8), argues that Moses and Elijah appear together because they received similar theophanies at Mount Sinai and, as a result, the Transfiguration should be read as a mountaintop theophany in which Jesus constitutes the personal presence of Israel's God.

Some notes on the types of pollen aperture in the genus Crocus L. (Iridaceae)

Crocus L. (Iridaceae) is systematically a very problematic genus due to the lack of clear distinctive features, wide range of habitats and the heterogeneity of morphological features. This genus is also highly heterogeneous from a karyological point of view. Apart from the most common spiraperturate pollen grains in Crocus, the authors frequently mentioned a number of other aperture types for individual species (subspecies, variations, etc.), i.e. polyrugoidate, nonaperturate (inaperturate), polyaperturate, with more or less extensive furrows, with short furrows, etc. The purpose of this work is to perform a palyno-morphological analysis of pollen aperture types noted in the genus Crocus. The reason for the study is a significant disagreement among researchers when describing the types of pollen apertures in the genus Crocus. An analysis of the literature, as well as the results of our previous studies, showed that the genus Crocus is characterized by inaperturate (nonaperturate), polyaperturoidate, spiraperturate and net-like pollen apertures. The similar net-like apertures were observed for some representatives of the subgenus Scorpiris Sach of the genus Iris L., in particular, in Iris atropatana Grossh. In our opinion, this aperture type can serve as a link between the genus Crocus and the subgenus Scorpiris of the genus Iris. We suggest, that the spiraperturate pollen type mentioned most often for the representatives of the genus Crocus can be considered the basic type within the genus. On the other hand, formless aperture-like areas are genetically unstable transitory variations, which occurred arbitrarily due to mutations. Finally, “polyrugoidate” (or with net-like apertures) pollen type noted in the literature for C. chrysanthus subsp. punctatus F.Candan et N.Özhatay may be considered to be more advanced in the genus Crocus

Evaluation of the departmental inter-rater reliability when scoring thyroid nodules according to the British Thyroid Association Ultrasound-classification model: Is there significant disagreement?

The British Thyroid Association Ultrasound-classification is a risk stratification model which grades thyroid nodules in U2-5 based on their sonographic appearance. Existence of variability between the ultrasound operators when U-scoring is reported in the literature with some evidence found in the author's department. The aim of this study was to investigate whether there is significant disagreement in the department and identify potential reasons for variability. Eight operators, radiologists and sonographers, were recruited to grade 33 TNs and answer a tick box questionnaire using the British Thyroid Association lexicon. The inter-operator variability for the U-categories, indication for fine-needle aspiration biopsy and ultrasound features was assessed using Fleiss' kappa and Gwet-AC1. The operators' accuracy was measured against the most experienced operator in the department using Cohen's kappa and percentage agreement. Fair agreement (Fleiss' K = 0.21) was obtained between the participants when U-scoring (U2-5). Fair-to-moderate agreement was noted between sonographers (K = 0.40). Significant variability was demonstrated between radiologists (p > 0.05). Indication for fine-needle aspiration biopsy reached fair to almost substantial agreement (radiologists' AC1 = 0.34, sonographers' AC1 = 0.58, overall AC1 = 0.41). No significant variability measured for echogenicity (K = 0.29), composition (K = 0.33), shape (K = 0.58), margin (K = 0.45), halo (K = 0.34) and vascularity (K = 0.44). Accuracy reached fair agreement (mean Cohen's K = 0.29) and moderate agreement (mean AC1 = 0.53) for the U-categories and fine-needle aspiration biopsy, respectively. Radiologists demonstrated lower accuracy. No significant inter-rater variability in U-scoring or recommending fine-needle aspiration biopsy was demonstrated between all the operators in the department. Radiologists showed significant variability in U-scoring and lower accuracy. Reliability and accuracy could be improved by addressing those problematic categories and features identified with this study.

What would you do? A survey of HPB surgeons practice patterns

BackgroundThe surgical decision making for pancreatic adenocarcinoma is complex. Although practice guidelines exist for many scenarios, these do not cover many common eventualities that may be encountered during these cases. We sought to identify the practice pattern variations amongst pancreatic surgeons in response to commonly experienced clinical scenarios. MethodsA multiple-choice questionnaire was distributed to all full members of the IHPBA. Participant demographics, training history, and clinical practice information were obtained. The survey provided various operative scenarios and participants were asked how they would likely proceed. Responses were collected and stored anonymously in a secure database. Statistical analysis was performed using Stata 16.0. Results164 responses were submitted. Most of the respondents were male and had been in practice for over 10 years. The median age range was 40–50 years old. When asked about staging laparoscopy, the majority performed it selectively.For most respondents a pathological aorto-caval nodes was a reason to abort the procedure but most would have continued in the setting of a positive hepatic artery node.When encountering a single Segment 2 liver metastasis, participants who practiced in Europe were significantly more likely to resect and proceed compared to those in Asia and North America. Participants who had undergone only a Surgical Oncology fellowship were most likely to abort.With respect to direct colonic invasion, most participants would resect the specimen en bloc. Respondents who participated in fewer that 20 PDAC operations/year were most likely to abort. ConclusionsSurgical decision making in PDAC surgery is complex and there is significant disagreement on the correct management. While formal guidelines cannot exist for all situations, this survey highlights the need for consensus on commonly encountered operative scenarios.

Surface-barrier detector with smoothly tunable thickness of depleted layer for study of ionization loss and dechanneling length of negatively charged particles channeling in a crystal

A new method for the experimental study of ionization loss of relativistic negatively charged particles moving in a crystal in the channeling regime using a semiconductor surface-barrier detector with smoothly tunable thickness of the depleted layer is proposed. The thickness of the depleted layer in a flat semiconductor detector can be smoothly regulated by the value of the bias voltage applied to the detector. Therefore, the energy distribution of the ionization loss of relativistic particles which cross the detector and move in the channeling regime in the detector crystal can be measured along the path of the particles by varying the bias voltage of the detector and the dechanneling length can be found. Available literature data on experimental and theoretical researches of the dechanneling length are reviewed. The significant disagreement between the experimental and theoretical data is noted. Comparison of experimental data obtained by the detector-target with smoothly tunable thickness of the depleted layer with calculations can help to develop theoretical description of the dynamics of motion of negatively charged particles channeling in a crystal. A better understanding of the dechanneling length properties can be useful in the production of positrons and other particles such as neutrons by an electron beam in crystals, as well as in the development of crystalline undulators, and in the crystal-based extraction of electron beams from a synchrotron.

Comparative analysis of the philosophical and historical views of S.L. Frank and V.V. Zenkovsky

The purpose of the article is a comparative analysis of the historiosophical views of S. L. Frank and V. V. Zenkovsky, which were based on specific ontognoseological concepts about the essence of being and the possibilities for a creative person to comprehend it. Based on the ideas about the place and role of man in natural and socio-historical processes characteristic of Christian personalism, thinkers, interpreting the concepts of creation and the Fall in different ways, came to dissimilar conclusions about the practical meanings of the cognitive and transformative activity of the individual. When conducting the study, comparative analysis methods were used, which involved a reasoned and consistent identification of the similarities and differences in the historiosophical positions of S. L. Frank and V. V. Zenkovsky, as well as hermeneutical methods used to better understand the semantic content of their texts. The author of the article, having consistently examined the views of S. L. Frank and V. V. Zenkovsky on evolution, social utopianism, conciliarity, on the place and role of the Church in the socio-historical process and on the eschatological perspective of humanity, comes to the conclusion that, despite the fact that both philosophers have significant disagreements regarding their solution to the problem of theodicy, the theme of overcoming evil in the world is fundamental for their philosophical and historical constructions. However, due to the incompatibility of their ideological approaches, the difference in the ontognoseological ideas of philosophers about the types of connection between the Absolute and the created world (essential and beneficial) and about the cognitive capabilities of man affected their understanding of both the goal of historical development and the methodology for achieving it.

A new cropland area database by country circa 2020

Abstract. We describe a new dataset of cropland area circa the year 2020, with global coverage and with data for 221 countries and territories and 34 regional aggregates. Data are generated from geospatial information on the agreement–disagreement characteristics of six open-access high-resolution cropland maps derived from remote sensing. The cropland area mapping (CAM) aggregation dataset provides information on (i) mean cropland area and its uncertainty, (ii) cropland area by six distinct cropland agreement classes, and (iii) cropland area by specific combinations of underlying land cover product. The results indicated that world cropland area is 1500 ± 400 Mha (mean and 95 % confidence interval), with a relative uncertainty of 25 % that increased across regions. It was 50 % in Central Asia (40 ± 20 Mha), South America (180 ± 80 Mha), and Southern Europe (40 ± 20 Mha) and up to 40 % in Australia and New Zealand (50 ± 20 Mha), Southeastern Asia (80 ± 30 Mha), and Southern Africa (16 ± 6 Mha). Conversely, cropland area was estimated with better precision, i.e., smaller uncertainties in the range 10 %–25 % in Southern Asia (230 ± 30 Mha), Northern America (200 ± 40 Mha), Northern Africa (40 ± 10 Mha), and Eastern Europe and Western Europe (40 ± 10 Mha). The new data can be used to investigate the coherence of information across the six underlying products, as well as to explore important disagreement features. Overall, 70 % or more of the estimated mean cropland area globally and by region corresponded to good agreement of underlying land cover maps – four or more. Conversely, in Africa cropland area estimates found significant disagreement, highlighting mapping difficulties in complex landscapes. Finally, the new cropland area data were consistent with FAOSTAT (FAO, 2023) in 15 out of 18 world regions, as well as for 114 out of 182 countries with a cropland area above 10 kha. By helping to highlight features of cropland characteristics and underlying causes for agreement–disagreement across land cover products, the CAM aggregation dataset may be used as a reference for the quality of country statistics and may help guide future mapping efforts towards improved agricultural monitoring. Data are publicly available at https://doi.org/10.5281/zenodo.7987515 (Tubiello et al., 2023a).

Ligand 1 H NMR Chemical Shifts as Accurate Reporters for Protein-Ligand Binding Interfaces in Solution.

The availability of high-resolution 3D structural information is crucial for investigating guest-host systems across a wide range of fields. In the context of drug discovery, the information is routinely used to establish and validate structure-activity relationships, grow initial hits from screening campaigns, and to guide molecular docking. For the generation of protein-ligand complex structural information, X-ray crystallography is the experimental method of choice, however, with limited information on protein flexibility. An experimentally verified structural model of the binding interface in the native solution-state would support medicinal chemists in their molecular design decisions. Here we demonstrate that protein-bound ligand 1 H NMR chemical shifts are highly sensitive and accurate probes for the immediate chemical environment of protein-ligand interfaces. By comparing the experimental ligand 1 H chemical shift values with those computed from the X-ray structure using quantum mechanics methodology, we identify significant disagreements for parts of the ligand between the two experimental techniques. We show that quantum mechanics/molecular mechanics (QM/MM) molecular dynamics (MD) ensembles can be used to refine initial X-ray co-crystal structures resulting in a better agreement with experimental 1 H ligand chemical shift values. Overall, our findings highlight the usefulness of ligand 1 H NMR chemical shift information in combination with a QM/MM MD workflow for generating protein-ligand ensembles that accurately reproduce solution structural data.

Significant disagreements between conventional functional metrics and 3D echocardiography-derived ejection fraction in the detection of right ventricular systolic dysfunction

Abstract Background The conventional echocardiographic parameters of the right ventricular (RV) systolic function (e.g., tricuspid annular plane systolic excursion - TAPSE, fractional area change – FAC, free wall longitudinal strain – FWLS) only partially portray the complex functional characteristics of the RV; therefore, they may fail to capture the full spectrum of RV dysfunction and associated adverse clinical outcomes. 3D echocardiography-derived RV ejection fraction (RVEF) is a well-validated and reproducible parameter that overcomes these limitations. Purpose We aimed to investigate the discordance between TAPSE, FAC, FWLS and RVEF in RV systolic function grading and associated outcomes. Methods Two retrospective databases from different centers including consecutive patients with various cardiac diseases who underwent clinically indicated 2D and 3D echocardiography (n=750) were analysed. Patients were followed up for the occurrence of all-cause mortality. RVEF was measured by a single, commercially available 3D software package. Guideline-recommended cut-off values were used to indicate RV systolic dysfunction (TAPSE<17 mm, FAC<35%, FWLS>-20%). RVEF <45% served as the "ground truth" of RV dysfunction. Results Among patients with normal RVEF (n=511), 109 (21%) had reduced TAPSE, 168 (33%) had reduced FAC, and 42 (8%) had reduced FWLS. Among patients with reduced RVEF (n=239), 109 (46%) had normal TAPSE, 61 (26%) had normal FAC, and 98 (41%) had normal FWLS. Correspondingly, sensitivity and specificity for discrimination of RV systolic dysfunction (RVEF<45%) were 66% and 70% for TAPSE, 71% and 76% for FAC, and 89% and 69% for FWLS on ROC analysis, respectively (Figure 1). During the median follow-up time of 3.5 years, 112 patients (15%) died. Using univariable Cox regression, TAPSE (HR [95% CI]: 0.911 [0.881 - 0.942]), FAC (0.940 [0.924 - 0.957]), FWLS (1.101 [1.071 - 1.133], and RVEF (0.928 [0.913 - 0.944]) were all significant predictors of mortality (p<0.001). Interestingly, combining the conventional functional measures based on how many of them indicate dysfunction shows that outcomes are the worst if at least two parameters are impaired and gradually better if only one or none of them (Kaplan-Meier curves, Figure 2, log-rank p<0.001). Conclusion Guideline-recommended cut-off values of conventional echocardiographic parameters of RV systolic function are only modestly associated with RVEF-based assessment. Impaired values of FWLS show the closest association with the RVEF cut-off. Our results emphasize a multiparametric approach in the assessment of RV function, especially, if 3D echocardiography is not available.Figure 1.Figure 2.

Self and proxy symptom reporting in patient-caregiver dyads coping with a primary brain tumor: The role of psychosocial function in rating agreement.

223 Background: Patients with glioma experience high levels of symptom burden with often sudden performance declines. As such, family caregivers tend to report on the patient’s symptoms; yet previous research examining the validity of proxy symptom reporting points to inconsistent findings. While prior studies focused on identifying patient clinical variables that may be related to agreement, caregiver characteristics may also be important for accurately perceiving patient symptoms. We examined the associations between symptom agreement and patient and caregiver perceived illness communication, depressive symptoms, and QOL. Methods: As part of a behavioral intervention trial, baseline assessments were collected prior to randomization in 67 dyads. We report on patient symptom burden (MDASI-BT) and patient and caregiver depressive symptoms (CES-D), illness communication (CICS), and QOL (SF-36). Paired t-tests, difference scores and inter-correlations coefficients (ICCs) were used to test for agreement, accuracy and congruence in proxy symptom scores, respectively. Bivariate correlations were calculated to examine the association between psychosocial function variables and symptom agreement. Dyadic level associations between symptom agreement and QOL were examined using multi-level modeling. Results: Thirty-nine percent of patients (63% male; 93% non-Hispanic White; mean age=47 years; 84% Grade III-IV) and 49% of caregivers (79% female; 90% non-Hispanic White; mean age=51 years) endorsed clinical levels of depression. Clinically significant disagreement was found for all means scores of the MDASI-BT subscales except for GI symptoms and general symptoms. 22% of caregivers overestimated and 13% underestimated overall symptom severity and 32% overestimated and 21% underestimated symptom interference. ICCs of patient and caregiver proxy ratings were significant (except cognitive and GI subscales) ranging from small to moderate coefficients (.09 - .50). Patient illness communication was associated with agreement in overall symptom severity (r=-.27, p=.03) and affective symptom subscale (r=-.34, p<.01). Caregiver illness communication (r=-.33, p<.01) and depressive symptoms (r=.46, p<.0001) were associated with symptom interference agreement. Caregiver overestimation of patient symptom severity was significantly associated with poor caregiver physical QOL, while underestimation was significantly associated with poor patient physical and mental QOL and poor caregiver mental QOL. Conclusions: The psychosocial context of the family plays an important role in the accuracy of proxy symptom reporting. Moreover, inaccurately understanding patients' experience is related to poor QOL for both patients and caregivers, which points to important targets for symptom management interventions that involve family caregivers.

Phylogenomic conflict analyses of the plastid and mitochondrial genomes via deep genome skimming highlight their independent evolutionary histories: A case study in the cinquefoil genus Potentilla sensu lato (Potentilleae, Rosaceae)

Phylogenomic conflicts are widespread among genomic data, with most previous studies primarily focusing on nuclear datasets instead of organellar genomes. In this study, we investigate phylogenetic conflict analyses within and between plastid and mitochondrial genomes using Potentilla as a case study. We generated three plastid datasets (coding, noncoding, and all-region) and one mitochondrial dataset (coding regions) to infer phylogenies based on concatenated and multispecies coalescent (MSC) methods. Conflict analyses were then performed using PhyParts and Quartet Sampling (QS). Both plastid and mitochondrial genomes divided the Potentilla into eight highly supported clades, two of which were newly identified in this study. While most organellar loci were uninformative for the majority of nodes (bootstrap value < 70%), PhyParts and QS detected conflicting signals within the two organellar genomes. Regression analyses revealed that conflict signals mainly occurred among shorter loci, whereas longer loci tended to be more concordant with the species tree. In addition, two significant disagreements between the two organellar genomes were detected, likely attributed to hybridization and/or incomplete lineage sorting. Our results demonstrate that mitochondrial genes can fully resolve the phylogenetic relationships among eight major clades of Potentilla and are not always linked with plastome in evolutionary history. Stochastic inferences appear to be the primary source of observed conflicts among the gene trees. We recommend that the loci with short sequence length or containing limited informative sites should be used cautiously in MSC analysis, and suggest the joint application of concatenated and MSC methods for phylogenetic inference using organellar genomes.

Department ofDefense Medical Examination Review Board Audiogram Screening Comparative Analysis.

The Department of Defense Medical Examination Review Board (DoDMERB) plays a pivotal role in the assessment of medical fitness for aspiring military officers. A crucial component of this process is the screening audiogram, designed to evaluate hearing capabilities. However, recent observations of high disqualification rates following screening audiograms led to concerns about their accuracy. This quality improvement project, conducted between 2017 and 2019, aimed to assess the concordance between screening audiograms and reference-standard audiometry, as well as to investigate the relationship between disqualification status and hearing thresholds at different frequencies. A sample of 134 candidates, drawn from various locations across the United States, was analyzed. Results revealed that the screening audiogram mean thresholds were twice that of the reference-standard audiogram, particularly in the lower frequencies. Additionally, we found that 84% of candidates were incorrectly disqualified by the screening exam when followed up by the reference-standard. Overall, Bland-Altman analysis revealed significant disagreement between these two tests. This discrepancy prompted a fundamental policy shift in 2020, where candidates who fail screening audiograms now automatically undergo reference-standard audiometry before any disqualification decision. This policy change reflects the commitment of DoDMERB to refining the medical screening process. It reduces the burden on candidates, provides a more comprehensive assessment, and ensures that qualified individuals are not erroneously disqualified.In addition to policy changes, this quality improvement project explored potential courses of action to enhance the screening audiogram process. Among these, improving contract specifications for testing facilities to minimize ambient noise emerged as the most practical and cost-effective approach. In conclusion, the project underscores the importance of refining medical screening processes to accurately assess candidates' qualifications while retaining the utility of screening audiograms. These efforts not only benefit aspiring military officers but also contribute to maintaining the high standards required for military service.

An Analysis of the Structure of the Beekeeping Chain in the Territories of the State of Rio Grande do Norte (RN)

Purpose: The present research aims to analyze the organizational structure of the honey chain in the state of Rio Grande do Norte. Method/design/approach: Semi-structured interviews were conducted with eight representative subjects from the beekeeping chain in the municipalities of Rio Grande do Norte. A descriptive qualitative approach was adopted to analyze the organizational relationships within the chain. Results and conclusion: The results highlight challenges in regulating the honey production chain, suggesting improvements in governance through collaborative development of regulations. Additionally, it emphasizes the importance of associations and producer cooperatives in strengthening beekeeping, adding value, and overcoming commercial challenges. Certification was deemed more relevant for the chain links involved in honey processing and distribution. Research implications: The study reveals that the various actors involved in the honey production chain in Rio Grande do Norte have significant disagreements regarding the interpretation of the legislation governing the production of this product. Originality/value: The research contributes to understanding the organizational structure of the honey chain in Rio Grande do Norte, providing development strategies in the apiculture sector.

“Ethnic Cleansing”: An Analysis of Conceptual and Empirical Ambiguity

Abstract Despite significant scholarly disagreement about its definition, core meaning, and corresponding cases, ethnic cleansing has escaped careful conceptual examination. This article identifies five key areas of conceptual confusion that undermine the integrity and utility of the concept. These include discrepancies over the core meaning of ethnic cleansing; tension between ethnic cleansing as a practice and a policy; the lack of boundedness between ethnic cleansing and other related concepts; the universe of cases that belong together; and disparate subtype classification criteria. This conceptual confusion undermines effective comparative analysis and, in turn, our understanding of the causes of ethnic cleansing and associated policy recommendations. The solution is to abandon the social science usage of ethnic cleansing in favor of alternative concepts defined by the distinct intent of the perpetrator(s): massacre (to annihilate), mass expulsion (to remove), coercive assimilation (to eliminate a unique cultural identity), and control (to subjugate). This eliminates ambiguity, improves theoretical precision, and opens a promising new research agenda.

Probing Energy-Level Alignment in Molecular Multilayers by Frequency-Modulation Electrostatic Force Microscopy under Tapping-Mode-Combined Fowler-Nordheim Tunneling Spectroscopy.

The alignment of molecular electronic levels in a molecular multilayer is of crucial importance to realize desired functions for molecular devices. Amplitude-modulation-feedback frequency-modulation electrostatic force microscopy combined with Fowler-Nordheim tunneling spectroscopy is utilized as a probe for the energy-level alignment in an organic multilayer. Bias-dependent electrostatic force spectra were examined for bilayers including a Ru complex as a benchmark multilayer system. Electrostatic properties in the low-bias region were captured well by a single-capacitor model, which indicates weak coupling at the bilayer interface between the Ru complex and self-assembled monolayer. In contrast, in the high-bias region, significant disagreement with the expected electrostatic force was recognized for the bilayers and evaluated as the loss of electrostatic energy through the Fowler-Nordheim tunneling process. Alignment of the lowest unoccupied molecular orbital (LUMO) level of the Ru complex was determined by Fowler-Nordheim emission through resonant tunneling. These results indicate an effective method to probe level alignment at interfaces inside multilayers and to provide the partition factor β that depicts a divided electric field.

Informing Methane Emissions Inventories Using Facility Aerial Measurements at Midstream Natural Gas Facilities.

Increased interest in greenhouse gas (GHG) emissions, including recent legislative action and voluntary programs, has increased attention on quantifying and ultimately reducing methane emissions from the natural gas supply chain. While inventories used for public or corporate GHG policies have traditionally utilized bottom-up (BU) methods to estimate emissions, the validity of such inventories has been questioned. Therefore, there is attention on utilizing full-facility measurements using airborne, satellite, or drone (top-down (TD)) techniques to inform, improve, or validate inventories. This study utilized full-facility estimates from two independent TD methods at 15 midstream natural gas facilities in the U.S.A., which were compared with a contemporaneous daily inventory assembled by the facility operator, employing comprehensive inventory methods. Estimates from the two TD methods statistically agreed in 2 of 28 paired measurements. Operator inventories, which included extensions to capture sources beyond regular inventory requirements and integration of local measurements, estimated significantly lower emissions than the TD estimates for 40 of 43 paired comparisons. Significant disagreement was observed at most facilities, both between the two TD methods and between the TD estimates and operator inventory. These findings have two implications. First, improving inventory estimates will require additional on-site or ground-based diagnostic screening and measurement of all sources. Second, the TD full-facility measurement methods need to undergo further testing, characterization, and potential improvement specifically tailored for complex midstream facilities.