Earthquakes affect buildings in both horizontal directions, generating complex structural interactions. Although bidirectional effects on reinforced concrete (RC) frames have been studied, the influence of slab representation in numerical models under bidirectional excitations remains underexplored. This gap has practical implications: A review of 11 design codes and standards reveals no consensus on stiffness reduction factors for approximating nonlinear slab behavior with elastic models. Provisions vary from fixed values to analysis-dependent parameters, while some standards offer no guidance at all. Addressing this gap, this study benchmarks four code-based elastic slab models against a nonlinear slab model under bidirectional seismic excitations. Three RC frame buildings were analyzed using 3D OpenSeesPy models with five slab representations: nonlinear (reference), no slab, and elastic slabs with gross, 25%, and 50% effective stiffness. Each model underwent bidirectional nonlinear dynamic analyses using 22 ground motion pairs, recording interstory drifts, peak floor accelerations (PFAs), and column forces. The results provide practical guidance: Gross property models capture PFA more accurately, while 25% and 50% effective stiffness better represent column forces and drifts. Models excluding slabs perform poorly, especially in irregular buildings, indicating that this common practice in some countries should be reconsidered. Future research directions include extending this study to mid- and high-rise structures, conducting frame-slab experiments to validate nonlinear slab modeling approaches, and evaluating record-to-record variability under bidirectional excitations.
Purpose The growing use of high-flow nasal cannula (HFNC) in pediatric inpatient settings raises questions about its efficacy, safety, and cost-effectiveness compared to other non-invasive ventilation (NIV) systems. This scoping review synthesizes available evidence on the indications, benefits, and risks of HFNC in the pediatric population to identify its primary applications and key research priorities. Methods We conducted a scoping systematic review by retrieving articles from PubMed, Scopus, and Google Scholar databases, adhering to PRISMA-ScR guidelines. Studies published since 2017 were included, with a focus on the application of HFNC in bronchiolitis, asthma, pneumonia, and obstructive sleep apnea (OSA). Key parameters analyzed included dosing, clinical indications, and efficacy outcomes. Results Among the 44 selected articles, the evidence demonstrated mixed results across different pathologies. The strongest supporting evidence was consistently observed in the treatment of bronchiolitis and its effective use as a rescue or intermediate therapy in critical conditions. Conclusions The absence of standardized protocols and variability in dosing limit the widespread application of HFNC. While initial costs are reportedly high, its use may reduce the need for other therapeutic resources and pediatric intensive care unit (PICU) stays, offering long-term economic benefits. There is an urgent need for rigorously designed controlled studies to establish clear indications, optimize its use, and promote its inclusion in pediatric respiratory management guidelines.
Chiari malformation type I (CM-I) is a congenital neurological condition that can significantly impact patients' quality of life. Several studies have reported cognitive and emotional dysfunctions in individuals with CM-I, highlighting the need for a deeper understanding of its symptomatology. The aim of this study was to assess executive functioning and trait anxiety in three adult patients diagnosed with CM-I. A case study design was employed using a mixed-methods approach. Participants were three adult women aged between 28 and 55 years. The results revealed variability in cognitive profiles, showing that patients with low executive performance reported active physical symptoms that interfered with daily functioning, while the patient with higher executive functioning was clinically asymptomatic. Emotionally, all three cases exhibited elevated trait anxiety scores. These findings underscore the importance of a comprehensive assessment of CM-I that includes not only physical symptoms but also cognitive and emotional factors, in order to guide more holistic and personalized interventions.
This study examines how non-financial cooperatives with mixed governance structures-comprising both natural persons and representatives of cooperative legal entities-exhibit significantly different levels of profitability and short-and long-term indebtedness compared to cooperatives whose governance is composed exclusively of natural persons. Us-ing panel data from Colombian cooperatives over 14 years, the study estimates fixed-effects panel data models via ordinary least squares, while addressing potential endogeneity con-cerns through generalized method of moments (GMM) estimators. The results indicate that the presence of representatives of legal entities on supervisory boards and within the fiscal audit function contributes to stronger control over both short-and long-term debt. In contrast, greater participation by natural persons is associated with a higher propensity to request and approve elevated levels of indebtedness. Additionally, the analysis identifies a positive and statistically significant relationship between the presence of legal entities in cooperative gov-ernance and financial profitability, regardless of the specific governing body in which they participate. From a theoretical perspective, these findings suggest that agency theory and stewardship theory are complementary frameworks for explaining the relationship between board composition and cooperative performance.
OBJECTIVES:To update evidence-based management recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with sepsis or septic shock. DESIGN:A panel of 68 international experts, representing 13 international organizations, as well as six methodologists, was convened. A formal conflict-of-interest policy was developed at the onset of the process and applied throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and subgroup leads as well as within subgroups, served as an integral part of the guideline development process. METHODS:New priority topics and recommendations from the prior guideline iteration were used to identify Population, Intervention, Control, and Outcomes (PICO) questions likely to have new or updated evidence. We conducted a systematic review to identify the best available evidence, summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or conditional, or as a good practice statement. "In our practice," statements were included when evidence was inconclusive to issue a recommendation but the panel felt that some guidance based on practice patterns may be appropriate. RESULTS:The panel provided 61 statements on the management of children with sepsis or septic shock. Overall, five were strong recommendations, 24 were conditional recommendations, and ten were good practice statements. For 22 PICO questions, no recommendations could be made, but, for seven of these, "in our practice" statements were provided. Compared with the 2020 guidelines, 20 recommendations were new, 13 were updated for clarity and/or new evidence, six were reviewed but not changed, and 22 were carried forward based on consensus of the panel that new evidence was not available. Only three recommendations were based on high or moderate certainty of evidence. CONCLUSIONS:Updated management guidelines were issued by a panel of international experts for the best care of children with sepsis or septic shock, acknowledging that most aspects of care continue to have relatively low quality of evidence.
