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Background: We aimed to assess whether the United States-developed Claims-based Frailty Index (CFI) can be implemented in Japanese older adults using claims data.Methods: We used the monthly claims data and certification of long-term care (LTC) insurance data of residents from 12 municipalities from April 2014 to March 2019. The 12 months from first recording was defined as the “baseline period,” and the time thereafter as the “follow-up period”. Participants aged ≥65 years were included, and those with no certified LTC insurance or who died at baseline were excluded. New certification of LTC insurance and all-cause mortality during the follow-up period were defined as outcome events. CFI categorization consisted of three steps including: 1) using 12 months deficit-accumulation approach that assigned different weights to each of the 52 items; 2) the accumulated score to derive the CFI; and 3) categorizing the CFI as “robust” (<0.15), “prefrail” (0.15–0.24), and “frail” (≥0.25). Kaplan–Meier survival curves and Cox proportional hazard models were used to determine the association between CFI and outcomes. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated.Results: There were 519,941 participants in total. After adjusting for covariates, the severe CFI category had a high risk of certification of LTC insurance (prefrail: HR 1.33; 95% CI, 1.27–1.39 and frail: HR 1.60; 95% CI, 1.53–1.68) and all-cause mortality (prefrail: HR 1.44; 95% CI, 1.29–1.60 and frail: HR 1.84; 95% CI, 1.66–2.05).Conclusion: This study suggests that CFI can be implemented in Japanese claims data to predict the certification of LTC insurance and mortality.

In recent decades, there has been an increasing number of studies on control flow integrity (CFI), particularly those implementing hardware-assisted CFI solutions that utilize a special instruction set extension. More recently, ARM and Intel, which are prominent processor architectures, also announced instruction set extensions for CFI called branch target identification (BTI) and control-flow enhancement technology (CET), respectively. However, according to our preliminary analysis, they do not support various CFI solutions in an efficient and scalable manner. In this study, we propose Bratter, a new instruction set extension for forward CFI solutions on RISC-V. At the center of Bratter, there are Branch Tag Registers and dedicated instructions for these registers. We implemented well-known CFI solutions (i.e., branch regulation and function signature check) using Bratter to evaluate its performance. Our experimental results show that, by using Bratter, even when these two solutions work together, they impose only 1.20% and 5.99% overhead for code size and execution time, respectively.

Despite the intense efforts to prevent programmers from writing code with memory errors, memory corruption vulnerabilities are still a major security threat. Consequently, control-flow integrity has received significant attention in the research community, and software developers to combat control code execution attacks in the presence of type of faults. Control-flow Integrity (CFI) is a large family of techniques that aims to eradicate memory error exploitation by ensuring that the instruction pointer (IP) of a running process cannot be controlled by a malicious attacker. In this paper, we assess the effectiveness of 14 CFI techniques against the most popular exploitation techniques, including code reuse attacks, return-to-user, return-to-libc, and replay attacks. We also classify these techniques based on their security, robustness, and implementation complexity. Our study indicates that the majority of the CFI techniques are primarily focused on restricting indirect branch instructions and cannot prevent all forms of vulnerability exploitation. We conclude that the performance overhead introduced, jointly with the partial attack coverage, is discouraging the industry from adopting most of them.

The cognitive flexibility inventory (CFI) was developed to be a brief self-report measure of the type of cognitive flexibility necessary for individuals to successfully challenge and replace maladaptive thoughts with more balanced and adaptive thinking. It was designed to measure three aspects of cognitive flexibility: (a) the tendency to perceive difficult situations as controllable; (b) the ability to perceive multiple alternative explanations for life occurrences and human behavior; and (c) the ability to generate multiple alternative solutions to difficult situations. The two studies presented in this manuscript describe the initial development of the CFI and a 7-week longitudinal study. Results from these studies indicate the CFI has a reliable two-factor structure, excellent internal consistency, and high 7-week test–retest reliability. Preliminary evidence was obtained for the CFI’s convergent construct validity via the CFI’s correlations with other measures of cognitive flexibility (Cognitive Flexibility Scale) and coping (Ways of Coping Checklist-Revised), respectively. Support was also demonstrated for the concurrent construct validity of the CFI via its correlation with the BDI-II. Further research is needed to investigate the reliability and validity of the CFI among clinical populations.

Conventional four-legged intersections are inefficient under heavy traffic requirements and are prone to congestion problems. Unconventional intersections with innovative designs allow for more efficient traffic operations and can increase the capacity of the intersection, in some cases. Common unconventional designs for four-legged intersections include the upstream signalized crossover intersection (USC), continuous flow intersection (CFI), and parallel flow intersection (PFI). At present, an increasing number of cities are using such unconventional designs to improve the performance of their intersections. In the reconstruction of original intersections or the design of new intersections, the question of how to more reasonably select the form of unconventional intersection becomes particularly critical. Therefore, we selected a typical intersection in Xi’an for optimization and investigated traffic data for this intersection. The traffic operations, with respect to the four solutions of a conventional intersection, USC, CFI, and PFI, were evaluated using the VISSIM software. Then, we evaluated the suitability of each solution under different situations using the CRITIC (CRiteria Importance Through Intercriteria Correlation) method, which is a multi-criteria decision-making (MCDM) method that enables a more comprehensive and integrated evaluation of the four solutions by taking into account the comparative intensities and conflicting character among the indices. The results show that the conventional intersection is only applicable to the case of very low traffic volume; PFI has the advantage in the case of moderate and high traffic volume; CFI performs better in the case of high traffic volume; and USC is generally inferior to CFI and PFI, although it has greater improvement, compared with the conventional solution, in a few cases.

Confirmatory factor analysis (CFA) is the bread and butter of many psychology and social science researchers. To evaluate how the data aligns with the instruments’ hypothesized structure, researchers often rely on the so-called rules of thumb, model fit cutoffs, such as RMSEA ≤ .05 or CFI ≥ .95, whose validity has been widely criticized. The cutoffs have been derived from experience or based on simulation studies. However, it is impossible to use universal cutoffs for models and data with characteristics that differ from those used in prior experience or simulations. In this paper, we offer an approach to model fit assessment grounded in conceptual understanding and situational character of the fit measures. We hope that this tutorial, together with an R script with illustrative examples and a model-fitting decision tree, may inspire fellow researchers to conduct more in-depth fit assessments and prevent the accumulation of bad-fitting models in the literature.

Background Numerous approaches have been adopted to evaluate limited freshwater resources and the associated health hazards due to excessive amounts of fluoride in drinking water. The study aims to assess the degree and severity of dental and skeletal fluorosis and examine the broader effects of fluorosis on human health and society in the Manbhum-Singhbhum Plateau region, India. Methods The Community Fluorosis Index (CFI) and Dean’s Index have been used to measure the magnitude and severity of dental and skeletal fluorosis. Questionnaire surveys, Focus Group Discussions (FGDs), and appropriate statistical methods have been applied to identify the social impacts. Risk-prone zones have been identified through overlay analysis using geoinformatics. Results About 54.60% of people in 67 villages of this part of the Manbhum-Singhbhum Plateau are affected in varying degrees of fluorosis ranging from very mild to mild, moderate, and severe dental fluorosis. Among these 67 villages, Janra (Manbazar I) and Hijla (Barabazar) have the most severely affected people. School dropout ( n  = 426), social isolation ( n  = 149), remarriage ( n  = 21), and physically disabled ( n  = 75) have also been reported. The study shows that about 414.29 km 2 of the Manbhum-Singhbhum Plateau comes under the high-risk-prone category. Conclusions The societal and environmental awareness of the fluorosis-affected individuals is almost absent in this region. Economic hardships, lack of education, inadequate health care facilities, water scarcity, and lack of awareness increase the magnitude of health hazards and societal vulnerability of the people in this region, who are largely dependent on natural resources.

PurposeThe study aims to test, measure and quantify the impacts of lean construction and BIM implementation on flow in construction projects.Design/methodology/approachDetailed control data from a set of 18 high-rise residential construction projects executed between years 2011 and 2020 were analyzed using the construction flow index (CFI), a measure of workflow quality. Seven comparable projects with a diverse range of LPS, BIM, VDC and 5S implementation were selected to compare the impacts of these innovations on flow.FindingsImplementing BIM in the big room and applying the last planner system and other lean construction techniques increased the CFI from 4.31 to 8.12 (on a 10-point scale). Avoiding trades crossing one another's paths between tasks was the most significant aspect of improved flow. Moreover, the benefits of implementing lean practices with BIM or VDC were found to be measurably greater than when these approaches were implemented separately.Research limitations/implicationsThe primary limitation of the study is that the degree of confidence in the results is limited by the nature of the case study approach. Although 18 is a respectable number of case study projects, it cannot offer the degree of confidence that a broader, representative sample of projects could. Similarly, the case studies are all drawn from the same construction context (residential apartments) and the same geographic region, which necessarily limits confidence concerning the degree to which the findings can be generalized.Originality/valueThe research is the first of its kind to quantitatively assess the impacts of BIM and lean construction on flow. Use of the CFI to quantify flow quality also highlights the potential value of CFI in providing project managers and planners a clear view of the smoothness or irregularity of flow and of differences between subcontractors' production rates.

Forests are critically important for the provision of ecosystem services. The Sacramento Mountains of New Mexico, USA, are a hotspot for conservation management and the Mescalero Apache Tribe’s homeland. The multiple ecosystem services and functions and its high vulnerability to changes in climate conditions make their forests of ecological, cultural, and social importance. We used data from the Mescalero Apache Tribal Lands (MATL) Continuous Forest Inventory over 30 yr to analyze changes in the structure and composition of ecosystems as well as trends in ecosystem services. Many provisioning, regulating, cultural, and supporting services were shared among the MATL ecosystems and were tied to foundational species dominance, which could serve as a reliable indicator of ecosystem functioning. Our analysis indicates that the MATL are in an ongoing transition from conifer forests to woodlands with declines in two foundation species, quaking aspen and ponderosa pine, linked to past forest management and changing climate. In addition, we detected a decrease in species richness and tree size variability, amplifying the risk of forest loss in a rapid climatic change. Continuous permanent plots located on a dense grid (1 × 1 km) such as the ones monitored by the Bureau of Indian Affairs are the most detailed data available to estimate forests multiresource transitions over time. Native lands across the USA could serve as the leading edge of detecting decadal-scale forest changes and tracking climate impacts.

Purpose This study aims to demonstrate a correlation between cervical spine injury and location and severity of facial trauma. Methods We did a 10-year retrospective analysis of prospectively collected patients with at least one facial and/or cervical spine injury. We classified facial injuries using the Comprehensive Facial Injury (CFI) score, and stratified patients into mild (CFI < 4), moderate (4 ≤ CFI < 10) and severe facial trauma (CFI ≥ 10). The primary outcome was to recognize the severity and topography of the facial trauma which predict the probability of associated cervical spine injuries. Results We included 1197 patients: 78% with facial injuries, 16% with spine injuries and 6% with both. According to the CFI score, 48% of patients sustained a mild facial trauma, 35% a moderate one and 17% a severe one. The midface was involved in 45% of cases, then the upper facial third (13%) and the lower one (10%). The multivariate analysis showed multiple independent risk factors for associated facial and cervical spine injuries, among them an injury of the middle facial third (OR 1.11 p 0.004) and the facial trauma severity, having every increasing point of CFI score a 6% increasing risk (OR 1.06 p 0.004). Conclusions Facial trauma is a risk factor for a concomitant cervical spine injury. Among multiple risk factors, severe midfacial trauma is an important red flag. The stratification of facial injuries based on the CFI score through CT-scan images could be a turning point in the management of patients at risk for cervical spine injuries before imaging is available.