An integrated simulation-optimization approach for combined allocation of water quantity and quality under multiple uncertainties.

Multiple uncertainties such as water quality processes, streamflow randomness affected by climate change, indicators' interrelation, and socio-economic development have brought significant risks in managing water quantity and quality (WQQ) for river basins. This research developed an integrated simulation-optimization modeling approach (ISMA) to tackle multiple uncertainties simultaneously. This approach combined water quality analysis simulation programming, Markov-Chain, generalized likelihood uncertainty estimation, and interval two-stage left-hand-side chance-constrained joint-probabilistic programming into an integration nonlinear modeling framework. A case study of multiple water intake projects in the Downstream and Delta of Dongjiang River Basin was used to demonstrate the proposed model. Results reveal that ISMA helps predict the trend of water quality changes and quantitatively analyze the interaction between WQQ. As the joint probability level increases, under strict water quality scenario system benefits would increase [3.23, 5.90] × 109 Yuan, comprehensive water scarcity based on quantity and quality would decrease [782.24, 945.82] × 106 m3, with an increase in water allocation and a decrease in pollutant generation. Compared to the deterministic and water quantity model, it allocates water efficiently and quantifies more economic losses and water scarcity. Therefore, this research has significant implications for improving water quality in basins, balancing the benefits and risks of water quality violations, and stabilizing socio-economic development.

The Influence of Non-High-Density Lipoprotein Cholesterol on the Efficacy of Genotype-Guided Dual Antiplatelet Therapy in Preventing Stroke Recurrence.

BACKGROUND AND PURPOSE: Non-high-density lipoprotein cholesterol (non-HDL-C), which represents the total cholesterol content of all pro-atherogenic lipoproteins, has recently been included as a new target for lipid-lowering therapy in high-risk atherosclerotic patients in multiple guidelines. Herein, we aimed to explore the relationship between non-HDL-C level and the efficacy and safety of ticagrelor-aspirin versus clopidogrel-aspirin in preventing stroke recurrence. METHODS: This study comprised a post hoc analysis of the CHANCE-2 (Ticagrelor or Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events II) trial, from which 5,901 patients with complete data on non-HDL-C were included and categorized by median non-HDL-C levels, using a cutoff of 3.5 mmol/L. The primary efficacy and safety outcomes were recurrent stroke and severe or moderate bleeding within 90 days. RESULTS: Ticagrelor-aspirin significantly reduced the risk of recurrent stroke in patients with low non-HDL-C (71 [4.8%] vs. 119 [7.7%]; adjusted hazard ratio [HR] 0.54; 95% confidence interval [CI], 0.40-0.74), but not in those with high non-HDL-C (107 [7.3%] vs. 108 [7.6%]; adjusted HR, 0.88; 95% CI, 0.67-1.16), compared with clopidogrel-aspirin (P for interaction=0.010). When analyzed as a continuous variable, the benefit of ticagrelor-aspirin for recurrent stroke decreased as non-HDL-C levels increased. No significant differences in the treatment assignments across the non-HDL-C groups were observed in terms of the rate of severe or moderate bleeding (5 [0.3%] vs. 8 [0.5%] in the low non-HDL-C group; 4 [0.3%] vs. 2 [0.1%] in the high non-HDL-C group; P for interaction=0.425). CONCLUSION: CHANCE-2 participants with low non-HDL-C levels received more clinical benefit from ticagrelor-aspirin versus clopidogrel-aspirin compared to those with high non-HDL-C, following minor ischemic stroke or transient ischemic attack.

The Cultural Evolution of Games of Chance : A Historical Investigation of Chinese Gambling.

Chance-based gambling has been a recurrent cultural activity throughout history and across many diverse human societies. In this paper, I combine quantitative and qualitative data and present a cultural evolutionary framework to explain why the odds in games of chance in premodern China appeared "designed" to ensure a moderate yet favorable house advantage. This is especially intriguing since extensive research in the history of probability has shown that, prior to the development of probability theory, people had very limited understanding of the nature of random events and were generally disinclined to think mathematically about the frequency of their occurrence. I argue that games of chance in the context of gambling may have culturally evolved into their documented forms via a process of selective imitation and retention, and neither the customers nor the gambling houses understood the probability calculus involved in these games.

Thoracic Vertebra Chance Fracture Resulting from Mechanical CPR.

Chest compressions, used in cardiopulmonary resuscitation (CPR), cause rib and sternum fractures in around 79% and 54% of patients, respectively. Spinal fractures resulting from CPR are far rarer. We present the case of a 70-year-old man who underwent mechanical CPR after choking whilst eating. The patient received a cerebral and thoracic CT scan upon arrival to the hospital. The cerebral scan was normal, but the chest CT scan revealed signs of ankylosing spondylitis and an unstable Chance fracture of the 12th thoracic vertebra. The patient was hospitalised but passed away. This case highlights the need for awareness of uncommon spine fractures due to the high associated morbidity. Teaching point: In patients who have undergone thoracic compressions, one should not only search for rib fractures but also for spine fractures, which, though uncommon, have a far greater impact on the patient's morbidity, especially in patients with predisposing spine conditions.

Prospective assessment of functional and clinical results of surgical patellar stabilization in rural and urban populations. Equal chance to success?

INTRODUCTION AND OBJECTIVE: Patella dislocation represents 3.3% of all knee injuries often leading to persistent instability. Medial patello-femoral ligament(MPFL) reconstruction is the standard method of treatment in the patellar instability. Rehabilitation after MPFL-R is a long and demanding procedure. The hypothesis presented reflects the idea that despite relatively good access to hospital care and surgical options, the post-operative rehabilitation care system is still inferior in rural areas versus the one offered in major cities and towns. MATERIAL AND METHODS: Between January 2015 - January 2018, 47 patients met the study inclusion criteria, diagnosed and operated on due to patellar instability. 8 patients were lost for full follow-up. Finally, 39 patients were included, divided into two groups - group A (19 from cities), group B (20 from rural area). Prospective KOOS and Kujala scales assessments were conducted: preoperative, 6 and 12 months after surgery. Knee isokinetic muscle strength was measured at 3 stages; prior to surgery, 6 and 12 months after reconstruction. RESULTS: All patients showed significant improvement measured in the KOOS and Kujala scales after the procedure, compared to the pre-operational results. Despite equal clinical improvement, patients from Group A(city) achieved better functional outcomes as presented in the results of knee extensor functional tests using a Biodex dynamometer. CONCLUSIONS: Rehabilitation after MPFL reconstruction improves muscle strength and clinical outcome. Patients from rural areas had inferior functional results in comparison to the patients from major cities, even 12 months after surgical patella stabilization. Despite the development of roads and transport according to the EU cohesion policy, there are still differences in rehabilitation results between rural and city areas.

The need for the GREAT+ score to predict relapse in Graves' disease: a questionnaire among patients and internal medicine specialists.

PURPOSE: Graves' disease (GD) is an auto-immune cause of hyperthyroidism. First-line treatment often consists of a 12-18 month course of antithyroid drugs (ATD). After discontinuation of ATD, GD relapses in approximately 50% of patients. The 'Graves recurrent event after therapy+ ' (GREAT+) score may predict individual relapse chances after ATD discontinuation more accurately based on clinical and laboratory parameters at diagnosis. We investigated the need for the GREAT+ score through an online questionnaire among GD patients and physicians treating GD. METHODS: An anonymous online questionnaire was distributed to patients and physicians between June 2022 and August 2023. RESULTS: The questionnaire was completed by 532 patients and 44 physicians. Results showed that 94% of patients were interested in knowing their GREAT+ score at the start of treatment. 55% would consider definite treatment (radioiodine/thyroidectomy) as first-line treatment in case of a high relapse chance. 98% of the physicians indicated the GREAT + score would support patient counseling. 84% may change their advice for first-line treatment if a patient has a high relapse chance based on the score. CONCLUSION: Patients and physicians considered the GREAT+ score as a valuable addition to the current available information which could change treatment decisions. Therefore, external validation of the GREAT+ score is justified to implement this score in clinical practice.

Prospective Surgical Cohort Analysis.

A well-conducted prospective cohort study has the potential to change the way in which surgeons practice. However, not all are equal. In this article, we provide many of the tools needed to critically appraise this powerful study design. We advocate for using a 3-step approach that centers on understanding the study's generalizability, results, and validity. We illustrate how this process is applied into practice regularly at our hospital section's journal club sessions.

What do women undergoing in vitro fertilization (IVF) understand about their chance of IVF success?

STUDY QUESTION: How well informed are Australian women who undergo IVF about their chances of having a baby? SUMMARY ANSWER: Only one in four women estimated their individual chance of success with IVF accurately, with most women overestimating their chance. WHAT IS KNOWN ALREADY: Limited knowledge about infertility and infertility treatment in the general population is well-documented. The few studies that have investigated patients' knowledge about the chance of IVF success suggest that while IVF patients are aware of average success rates, they tend to be unrealistic about their own chance of success. STUDY DESIGN, SIZE, DURATION: We conducted an anonymous online survey of 217 women who had started IVF since 2018 in Australia. The survey was advertised on social media, enabling women from across Australia to participate. Responses were collected in June 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS: The survey included questions on demographic characteristics and IVF history. It asked what participants thought their chance of having a baby from one IVF treatment cycle was, how they rated their knowledge about chance of success, and about their experience of receiving IVF-related information. Participants' estimations of their chance of success were compared with their chance as calculated by the Society for Assisted Reproductive Technology's (SART) online calculator. Responses to a free-text question about what information women wished they had been given when they started treatment were analysed thematically. MAIN RESULTS AND THE ROLE OF CHANCE: Only about a quarter (58/217, 27%) of participants accurately estimated their chance of having a baby within 20% relative to their SART calculated chance, with more than half (118/217, 54%) overestimating their chance. Ninety percent of women indicated that their preferred source of treatment information was a consultation with their doctor, despite less than half (44%) reporting that doctors explained the probability of having a baby with IVF well (mean 5.9/10). In free-text responses, many women also reported that they wished they had been given more realistic information about IVF and their chance of success. LIMITATIONS, REASONS FOR CAUTION: The dissemination method precludes calculation of response rate, and it is not possible to know if participants are representative of all women undergoing IVF. Additionally, we only surveyed women undergoing IVF, while those who decided not to have IVF were not included. Therefore, women who overestimated their chance may have been overrepresented. There is also inherent imprecision in the way understanding of chance of success was estimated. The potential impact of recall bias could neither be quantified nor excluded. It is difficult to determine to what extent women's lack of understanding of what is possible with IVF is due to poor information-provision by clinicians and the clinic, and how much can be explained by optimism bias. WIDER IMPLICATIONS OF THE FINDINGS: The finding of poor understanding of personal chance of success amongst women undergoing IVF in Australia requires further investigation to determine potential reasons for this. The findings can be used by clinics to develop strategies for improvement in the information-provision process to ensure that women can make informed decisions about their fertility treatment. STUDY FUNDING/COMPETING INTEREST(S): This study received no external funding. S.L. is supported by a NHMRC Investigator Grant (APP1195189). R.W. is supported by a NHMRC Investigator Grant (APP2009767). B.W.M. is supported by a NHMRC Investigator Grant (GNT1176437). B.W.M. reports consultancy for Merck and ObsEva and has received research funding and travel funding from Merck. The other authors have no conflicts of interest. TRIAL REGISTRATION NUMBER: N/A.

Effects of remnant cholesterol on the efficacy of genotype-guided dual antiplatelet in CYP2C19 loss-of -function carriers with minor stroke or transient ischaemic attack: a post-hoc analysis of the CHANCE-2 trial.

Background: The atherogenicity of remnant cholesterol (RC), a contributor to residual risk of cardiovascular events, has been underlined by recent guidelines. We aimed to evaluate the relationship between RC levels and the efficacy and safety of genotype-guided dual antiplatelet therapy in the CHANCE-2 trial. Methods: This post-hoc study used data from the CHANCE-2 trial, which was a randomised, double-blind, placebo-controlled trial of 6412 patients (aged >40 years) enrolled from 202 hospitals in China, between Sept 23, 2019, and March 22, 2021, who carried CYP2C19 loss-of-function alleles and had either an acute minor stroke or high-risk transient ischaemic attack (TIA), and could start treatment within 24 h of symptom onset. Participants received either (1:1) ticagrelor plus aspirin (control) or clopidogrel plus aspirin (intervention) and the effect of reducing the 3-month risk of any new stroke was assessed (ischemic or haemorrhagic, primary outcome). From the CHANCE-2 study population, we enrolled 5890 patients with complete data on RC. The cutoff point of RC for distinguishing patients with greater benefit from ticagrelor-aspirin versus clopidogrel-aspirin was determined with subpopulation treatment effect pattern plot. The primary efficacy and safety outcome was recurrent stroke and severe or moderate bleeding within 90 days, respectively. CHANCE-2 is registered with ClinicalTrials.gov, NCT04078737. Findings: The cutoff to define elevated RC was 0.91 mmol/L. Ticagrelor-aspirin versus clopidogrel-aspirin was associated with a reduced risk of recurrent stroke in patients with non-elevated RC levels (122 [5.3%] versus 179 [7.8%]; hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.54-0.85), but this benefit was absent in those with elevated RC levels (58 [8.4%] versus 48 [7.3%]; HR, 1.10; 95% CI, 0.73-1.65; P-interaction = 0.03). When analyzed as a continuous variable, the benefit of ticagrelor-aspirin on recurrent stroke decreased as RC levels increased. The rates of severe or moderate bleeding between treatment groups were similar across RC categories (0.3% versus 0.3%, P-interaction = 0.95). Interpretation: Our post-hoc findings suggest that RC could be a potential biomarker to discriminate patients who received more benefits from ticagrelor-aspirin versus clopidogrel-aspirin therapy in CYP2C19 loss-of-function carriers with minor stroke or TIA. These findings need to be validated in an independent study. Funding: The National Key Research and Development Program of China, Beijing Natural Science Foundation Haidian original innovation joint fund, Fund for Young Talents of Beijing Medical Management Center, the high-level public health talents, Training Fund for Open Projects at Clinical Institutes and Departments of Capital Medical University; and Salubris.

Chance fracture at L2 followed by delayed jejunal transection due to a motor vehicle collision: A case report and review.

Chance fractures are rare lesions but are often associated with abdominal injuries. We present a case of a 21-year-old patient who sustained a delayed type of abdominal injury associated with a bonny Chance fracture of lumbar 2nd following a traffic accident. Initial X-rays and computed tomography (CT) scans showed a Chance fracture with subtle bowel images, evading the prompt diagnosis of bowel injuries. However, the toxic signs were presented after 17h of stay in intensive care unit, and hollow visceral perforation was diagnosed in the re-do abdominal CT scanning. The laparostomy with primary anastomosis was performed for complete transection of the middle part of the jejunum. After a follow-up period of 20 days, the patient underwent kyphoplasty, accompanied by posterior fusion of the L1-L3 vertebrae and was found well recovered at 2 weeks follow-up. Clinicians should realize the subtle but meaningful imaging signs to allow prompt diagnosis as well as management when meeting patients with seatbelt sign associated with Chance fracture after a traffic accident.

Forced choice test score of p ≤ .20 and failures on ≥ six performance validity tests results in similar Overall Test Battery Means.

Objective: To determine if similar levels of performance on the Overall Test Battery Mean (OTBM) occur at different forced choice test (FCT) p-value score failures. Second, to determine the OTBM levels that are associated with failures at above chance on various performance validity (PVT) tests. Method: OTBMs were computed from archival data obtained from four practices. We calculated each examinee's Estimated Premorbid Global Ability (EPGA) and OTBM. The sample size was 5,103 examinees with 282 (5.5%) of these scoring below chance at p ≤ .20 on at least one FCT. Results: The OTBM associated with a failure at p ≤ .20 was equivalent to the OTBM that was associated with failing 6 or more PVTs at above-chance cutoffs. The mean OTBMs relative to increasingly strict FCT p cutoffs were similar (T scores in the 30s). As expected, there was an inverse relationship between the number of PVTs failed and examinees' OTBMs. Conclusions: The data support the use of p ≤ .20 as the probability level for testing the significance of below chance performance on FCTs. The OTBM can be used to index the influence of invalid performance on outcomes, especially when an examinee scores below chance.

Normalization of Chance-Based Mechanisms in Mobile Games for Children: A Descriptive Analysis.

Games for mobiles present strategies to monetize not only from selling a title but from financial exchanges that take place in the game. Those microtransactions motivate players to purchase random or surprise items (known as loot boxes) to customize game features or to overcome narrative obstacles necessary to progress to new levels. Researchers associate the practice with gambling if completing the transaction does not mean the acquisition of an item but the chance to receive it. This research quantified gambling-like features in games available for free, classified by Apple's marketplace as suitable for children from 4 to 8 years old, and from the top-downloaded list. The findings reveal normalization traces of chance-based mechanisms in most of the games. According to the research literature, early exposure to such features may result in problem gambling in adult life. This paper concluded that legal changes and more information provided by the marketplaces are needed to raise awareness of gambling-like practices in mobile games.

Recurrence of kyphotic deformity following implant removal in pediatric pure discoligamentous Chance-type injury: A case report.

Pediatric pure discoligamentous Chance-type injury is relatively rare and the appropriate surgical method has not yet been established, particularly, whether spinal fixation with fusion or without fusion is more effective. This case report describes a 10-year-old-boy who sustained an L2-3 pure discoligamentous Chance-type injury following a car accident and underwent an L2-3 posterior fixation without fusion. The implants were removed after eight months of an uneventful postoperative course. However, four months later, the kyphotic deformity recurred. Although the deformity gradually progressed over nine months, the patient remained neurologically intact and asymptomatic. This report suggests that fixation without fusion may not be appropriate in pediatric patients with pure discoligamentous Chance-type injuries. Spinal fixation with fusion may be recommended to prevent loss of correction and ensure secure stabilization.

A normative theory of luck.

Psychologists have identified heuristics and biases that can cause people to make assumptions about factors that contribute to the success of individuals and firms, whose outcomes may have actually resulted primarily from randomness. Yet the interpretation of these biases becomes ambiguous when they represent reasonable cognitive shortcuts that offer certain advantages. This paper addresses this ambiguity by presenting four versions (weak, semi-weak, semi-strong, strong) of a normative theory of luck that integrates insights from psychology with the chance model approach to predict the circumstances under which performance non-monotonicity occurs: higher performance may not only indicate greater luck, but also lower expected merit or quality. The semi-strong version is illustrated by examining the decoupling of citations of academic publications and their impact, illuminating when higher citations indicate lower quality. We conclude by discussing the broader implications of a normative theory of luck, emphasizing strategies to address situations where people mistake luck for skill.

Effectiveness of a workshop-based intervention to reduce bullying and violence at work: A 2-year quasi-experimental intervention study.

INTRODUCTION: Bullying and violence at work are associated with reduced wellbeing of the victims, but few evidence-based interventions are available to prevent these offensive behaviours. We developed and examined the effectiveness of an intervention aimed at prevention of bullying and violence at work through modifications in psychosocial work environment. METHODS: In accordance with pre-published protocol, employees and supervisors of 12 work units in 3 cities (intervention group A: n = 315; intervention group B: n = 271) received a workshop-based intervention on organizational practices to prevent bullying and violence, including supervisor support, supervisor justice, workplace social capital, and psychological safety and were compared to a reference group (n = 2310) which did not receive the intervention. Latent change score modelling (LCSM) was used to estimate between- and within-individual differences in changes of organizational practices and prevalence of bullying and violence from baseline (2020) to follow-up (2022). RESULTS: No direct or indirect effects of intervention were observed. Of the potential mediator variables, supervisor support (B = 0.04; 95% confidence interval 0.006, 0.07) and supervisor justice (0.04; 0.01, 0.08) improved in the intervention group B between the measurements and compared to control group, but the result was not replicated in intervention group A. No changes were observed between the measurement points in bullying or violence at work. CONCLUSIONS: No intervention effects on bullying and violence at work were observed. It may be worthwhile to develop the intervention further to focus more on supervisor and co-worker relationships and on psychosocial resources of work team.

A patient with a pulmonary hernia and chance fracture of the thoracic vertebra following a fall: A case report and literature review.

INTRODUCTION AND IMPORTANCE: Pulmonary hernia is a rare disease caused mostly by chest trauma. Patients often present with non-specific signs and symptoms. Currently, there is no unified approach to treating it. For asymptomatic pulmonary hernias, conservative treatment has been chosen in the past. However, the increasing number of cases has shown that surgery has a more positive effect on some patients with asymptomatic pulmonary hernias. CASE PRESENTATION: A 63-year-old female patient who accidentally fell from an agricultural vehicle while doing farm work presented with back pain and lower limb paralysis. Her vital signs were stable. A chest computed tomography (CT) scan showed the patient had a pulmonary hernia, thoracic vertebra Chance fracture, rib fractures, and right hydropneumothorax. The patient received an open reduction internal fixation (ORIF) of the thoracic vertebra at the trauma emergency center. The postoperative chest CT scan showed that the pulmonary hernia had reset to the chest cavity. Subsequently, the patient got a pulmonary hernia repair at the thoracic surgery department. The patient was discharged on the 19th day after the injury. Long-term follow-up showed good recovery from the thoracic trauma. CLINICAL DISCUSSION: The patient had a pulmonary hernia combined with thoracic Chance fracture and other injuries. Surgical repair achieved satisfactory results. CONCLUSION: We lack guidelines on whether to manage pulmonary hernias surgically. Patients with asymptomatic pulmonary hernias particularly should have their long-term prognoses fully evaluated. Surgery is needed if the patient has high-risk factors and severe intercostal muscle defects.

Pediatric chance fracture with seatbelt syndrome: A case report.

Key Clinical Message: Prompt recognition and accurate diagnosis of seatbelt-related injuries such as Chance fractures are crucial for pediatric patients. Clinicians should be aware of the unique characteristics of children, including the presence of growth plates, and use advanced imaging techniques such as magnetic resonance imaging to guide appropriate treatment and minimize complications. Abstract: Seatbelt-related injuries, known as the "seatbelt syndrome," encompass various injuries resulting from automobile accidents, including vertebral fractures, abdominal injuries, and great vessel traumas. Seatbelt signs include bruising or peeling of the anterior chest or abdominal wall, indicating abdominal pressure against the seatbelt. Chance fractures are a type of vertebral fracture characterized by fracture lines through multiple vertebral structures and are often associated with seatbelt injuries in adults. However, the unique features of Chance fractures in pediatric patients, such as the presence of growth plates, require a comprehensive diagnostic approach using advanced imaging techniques, including magnetic resonance imaging (MRI). This case report highlights the complexity of seatbelt-related injuries in children and emphasizes the importance of accurate diagnosis and multidisciplinary management. Understanding these factors can improve clinical knowledge and outcomes in children with seatbelt-related injuries.

Cautious Bayesian Optimization: A Line Tracker Case Study.

In this paper, a procedure for experimental optimization under safety constraints, to be denoted as constraint-aware Bayesian Optimization, is presented. The basic ingredients are a performance objective function and a constraint function; both of them will be modeled as Gaussian processes. We incorporate a prior model (transfer learning) used for the mean of the Gaussian processes, a semi-parametric Kernel, and acquisition function optimization under chance-constrained requirements. In this way, experimental fine-tuning of a performance objective under experiment-model mismatch can be safely carried out. The methodology is illustrated in a case study on a line-follower application in a CoppeliaSim environment.

Investigating the Role of Second Chance Schools and COVID-19 Pandemic on the Mental Health and Self-Image of Greek Adult Students.

COVID-19 has globally impacted both physical and mental health. This study aimed to explore the impact of Second Chance Schools (SCS) and the COVID-19 pandemic on the mental health and self-image of Greek SCS students. A total of 251 SCS students from two consecutive study cycles participated, completing the research instruments at the beginning and end of their studies. Participants' anxiety, depressive symptomatology, well-being, self-esteem and self-efficacy were evaluated by means of the GAD-7, PHQ-8, WHO-5 Well-being Index, Rosenberg Self-Esteem Scale and Generalized Self-Efficacy Scale, respectively. The research spanned three years, including a year of universal lockdown, a year with protective measures and a year without anti-COVID-19 measures. Factor analysis, regression analyses and two two-way repeated measures ANOVAs were applied to the collected data. All five psychological dimensions measured by the study's instruments were grouped into two factors, namely mental health and self-image. Well-being positively influenced mental health, while anxiety and depression had a negative impact. On the other hand, self-efficacy and self-esteem positively contributed to self-image. Mental health and self-image were moderately correlated. Pre-SCS values of mental health and self-image predicted a higher percentage of variance in post-SCS values compared to anxiety, depression, well-being, self-efficacy and self-esteem. Moreover, mental health improved after the completion of SCS, but only for participants after the lifting of anti-COVID-19 measures. Conversely, self-image improved for all participants regardless of the presence of anti-COVID-19 measures. Overall, the SCS had a considerable impact on the participants' mental health and self-image, although the effect was influenced by COVID-19.

Early Dirty Buffer Flush with Second Chance for SSDs.

As high-performance server-based applications become more prevalent, there is a growing demand for high-performance storage solutions. In response, SSDs that use NAND flash memory as storage media are quickly replacing hard disks in the high-performance storage market. One way to improve SSD performance is to use an internal large-capacity memory as a buffer cache for NAND. Previous studies have shown that early flushing, which ensures sufficient clean buffers by flushing dirty buffers to NAND in advance when the ratio of dirty buffers exceeds a threshold, significantly reduces the average response time of I/O requests. However, the early flush can also have a negative side effect, namely an increase in NAND write operations. To address this problem, this study proposes a selective early flush policy. This policy evaluates the likelihood of a candidate dirty buffer being rewritten upon the early flush, and delays flushing if the candidate has a high rewrite likelihood. Through this selective early flush, the proposed policy reduces NAND write operations by up to 18.0% compared to the existing early flush policy in the mixed trace. Additionally, the response time of I/O requests is also improved in most of the considered configurations.