Accuracy and Feasibility of Clinically Applied Frailty Instruments before Surgery

Background A barrier to routine preoperative frailty assessment is the large number of frailty instruments described. Previous systematic reviews estimate the association of frailty with outcomes, but none have evaluated outcomes at the individual instrument level or specific to clinical assessment of frailty, which must combine accuracy with feasibility to support clinical practice. Methods The authors conducted a preregistered systematic review (CRD42019107551) of studies prospectively applying a frailty instrument in a clinical setting before surgery. Medline, Excerpta Medica Database, Cochrane Library and the Comprehensive Index to Nursing and Allied Health Literature, and Cochrane databases were searched using a peer-reviewed strategy. All stages of the review were completed in duplicate. The primary outcome was mortality and secondary outcomes reflected routinely collected and patient-centered measures; feasibility measures were also collected. Effect estimates were pooled using random-effects models or narratively synthesized. Risk of bias was assessed. Results Seventy studies were included; 45 contributed to meta-analyses. Frailty was defined using 35 different instruments; five were meta-analyzed, with the Fried Phenotype having the largest number of studies. Most strongly associated with: mortality and nonfavorable discharge was the Clinical Frailty Scale (odds ratio, 4.89; 95% CI, 1.83 to 13.05 and odds ratio, 6.31; 95% CI, 4.00 to 9.94, respectively); complications was associated with the Edmonton Frail Scale (odds ratio, 2.93; 95% CI, 1.52 to 5.65); and delirium was associated with the Frailty Phenotype (odds ratio, 3.79; 95% CI, 1.75 to 8.22). The Clinical Frailty Scale had the highest reported measures of feasibility. Conclusions Clinicians should consider accuracy and feasibility when choosing a frailty instrument. Strong evidence in both domains support the Clinical Frailty Scale, while the Fried Phenotype may require a trade-off of accuracy with lower feasibility. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Instruments of Debtstruction

We construct a new, comprehensive instrument-level database of sovereign debt for 18 advanced and emerging countries over the period 1913–46. The database contains data on amounts outstanding for some 3,800 individual debt instruments as well as associated qualitative information, including instrument type, coupon rate, maturity, and currency of issue. This information can provide unique insights into various policies implemented in the interwar period, which was characterized by notoriously high debt levels. We document how interwar governments rolled over debts that were largely unsustainable and how the external public debt network contributed to the collapse of the international financial system in the early 1930s.

Construction, Validity, Reliability and Effectiveness of the Psycho-Educated Module Management of Forgiveness

This study is aimed at developing and testing the Application of Forgiveness Management Module on University Malaysia Sarawak (UNIMAS) trainee counselors. The main focus of the study is focused on the module development process and the effect of the module on the emotional, cognitive and behavioral aspects of an individual. The study was conducted using a qualitative and quantitative combination method. The sample of the study consisted of 8 UNIMAS counseling students. The Instrument Level of Anger Scale (LAS) and Tendency Forgive Scale (TTFS) are used to identify the appropriate study sample to follow this module. The built-in Forgiveness Management module has a high authenticity value of 82.2%. In addition, the reliability test of this module has a high coefficient of Cronbach's Alpha coefficient of 0.884. This proves that participants have learned new knowledge better understanding the concept of forgiveness than before following the modules that have been conducted.

Interest Rate Term Structure Decomposition at the Instrument Level

The paper examines term structure decomposition at the instrument level – decomposing term structures for issues as well as the portfolio. Three different implementations are stipulated: axiomatic structural approaches, a sequential approach, and a base structure approach. The three different implementations are evaluated against a portfolio of risk-free government bonds. The goodness-of-fit and smoothness properties of instrument-level term structure decomposition are also considered. The conclusion points to remaining gaps in theory regarding instrument-level term structure decomposition, and considers areas of application – typically bond valuation.

Can Creditor Bail-in Trigger Contagion? The Experience of an Emerging Market*

The successful bail-in of creditors in African Bank, a small South African monoline lender, provides an opportunity to evaluate the intended and unintended consequences of new resolution tools. Using a dataset that matches quarterly, daily, and financial-instrument level data, I show that the bail-in led to money-market funds “breaking the buck”, triggering significant redemptions and some financial contagion. To limit potential systemic effects, the authorities used complementary interventions, including imposing discretionary liquidity restrictions on mutual funds and market-making facilities for affected financial instruments. This supported a sustainable restructuring of the bank and reduced financial spillovers. The lesson is that future interventions using these new resolution tools should take into account the potential unintended systemic implications, particularly in smaller jurisdictions where there is a high degree of interconnectedness between bank and nonbank financial institutions.

Data processing pipeline for Herschel HIFI

Context. The HIFI instrument on the Herschel Space Observatory performed over 9100 astronomical observations, almost 900 of which were calibration observations in the course of the nearly four-year Herschel mission. The data from each observation had to be converted from raw telemetry into calibrated products and were included in the Herschel Science Archive. Aims. The HIFI pipeline was designed to provide robust conversion from raw telemetry into calibrated data throughout all phases of the HIFI missions. Pre-launch laboratory testing was supported as were routine mission operations. Methods. A modular software design allowed components to be easily added, removed, amended and/or extended as the understanding of the HIFI data developed during and after mission operations. Results. The HIFI pipeline processed data from all HIFI observing modes within the Herschel automated processing environment as well as within an interactive environment. The same software can be used by the general astronomical community to reprocess any standard HIFI observation. The pipeline also recorded the consistency of processing results and provided automated quality reports. Many pipeline modules were in use since the HIFI pre-launch instrument level testing. Conclusions. Processing in steps facilitated data analysis to discover and address instrument artefacts and uncertainties. The availability of the same pipeline components from pre-launch throughout the mission made for well-understood, tested, and stable processing. A smooth transition from one phase to the next significantly enhanced processing reliability and robustness.

EARLINET instrument intercomparison campaigns: overview on strategy and results

This paper introduces the recent European Aerosol Research Lidar Network (EARLINET) quality-assurance efforts at instrument level. Within two dedicated campaigns and five single-site intercomparison activities, 21 EARLINET systems from 18 EARLINET stations were intercompared between 2009 and 2013. A comprehensive strategy for campaign setup and data evaluation has been established. Eleven systems from nine EARLINET stations participated in the EARLINET Lidar Intercomparison 2009 (EARLI09). In this campaign, three reference systems were qualified which served as traveling standards thereafter. EARLINET systems from nine other stations have been compared against these reference systems since 2009. We present and discuss comparisons at signal and at product level from all campaigns for more than 100 individual measurement channels at the wavelengths of 355, 387, 532, and 607 nm. It is shown that in most cases, a very good agreement of the compared systems with the respective reference is obtained. Mean signal deviations in predefined height ranges are typically below ±2 %. Particle backscatter and extinction coefficients agree within ±2 × 10−4 km−1 sr−1 and ± 0.01 km−1, respectively, in most cases. For systems or channels that showed larger discrepancies, an in-depth analysis of deficiencies was performed and technical solutions and upgrades were proposed and realized. The intercomparisons have reinforced confidence in the EARLINET data quality and allowed us to draw conclusions on necessary system improvements for some instruments and to identify major challenges that need to be tackled in the future.

EARLINET instrument intercomparison campaigns: overview on strategy and results

This paper introduces the recent EARLINET quality-assurance efforts at instrument level. Within two dedicated campaigns and five single-site intercomparison activities 21 EARLINET systems from 18 EARLINET stations were intercompared between 2009 and 2013. A comprehensive strategy for campaign setup and data evaluation has been established. Eleven systems from nine EARLINET stations participated in the EARLINET Lidar Intercomparison 2009 (EARLI09). In this campaign, three reference systems were qualified which served as traveling standards thereafter. EARLINET systems from nine other stations have been compared against these reference systems since 2009. We present and discuss comparisons at signal and at product level from all campaigns for more than 100 individual measurement channels at the wavelengths of 355, 387, 532 and 607 nm. It is shown that in most cases a very good agreement of the compared systems with the respective reference is obtained. Mean signal deviations in pre-defined height ranges are typically below ±2 %. Particle backscatter and extinction coefficients agree within ±2 × 10−4 km−1 sr−1 and ± 0.01 km−1, respectively, in most cases. For systems or channels that showed larger discrepancies, an in-depth analysis of deficiences was performed and technical solutions and upgrades were proposed and realized. The intercomparisons have reinforced the confidence in the EARLINET data quality and allowed us to draw conclusions on necessary system improvements for some instruments and to identify major challenges that need to be tackled in the future.