bluuebunny/crossref_metadata_2025 huggingface dataset:
Nanomodification of mineral binders
Authors: Derevianko V , Kondratieva N , Volkova V , Hryshko H
Published: June 2021

In the result of researches performed on the directed regulation of properties of gypsum binders, it was determined that the specific surface of various anisotropic surfaces regulates the shape of crystals as well as kinetics of their formation and growth. It has been established that the process of hydration and formation of gypsum binders can be regulated through the size of the specific surface, parameters of nanoadditives as well as through the change of concentration in solution. The influence of micro - and nanoadditives on the change of the system surface energy, as well as on introduction of plasticizer and change of time solution is in the supersaturated state (which increases the number of nuclear centers of crystallization) has been established experimentally and theoretically proved.
Influence of matrix-filler thermal conductivity on micro heat transfer in two-component composites
Authors: Pysarenko A , Zaginaylo I
Published: June 2021

The maps of local heat fluxes in the composite matrix with randomly located heat-insulating and heat-conducting inclusions have been calculated in this work. It was shown that with a significant difference in the thermal conductivity of inclusions and matrix, the main heat transfer occurs through the induced heat-conducting channels. It was found that the weighted average angles of local heat fluxes deviation from the direction of the temperature difference between the sample faces depend on the concentration of heat-insulating and heat-conducting inclusions of various sizes. A sublinear decrease or super linear increase in the effective thermal conductivity of the composite with an increase in the concentration of heat-insulating or heat-conducting inclusions, respectively, was associated with a change in the path length of local heat fluxes due to the flow at an angle to the direction of the temperature difference. An approximation formula for the dependence of the composite effective thermal conductivity on the filler concentration has been proposed, which makes it possible to take into account the presence of both heat-conducting and heat-insulating inclusions.
Fiber type influence on the reinforced concrete under axial tension
Authors: Surianinov M , Kirichenko D , Korneieva I , Neutov S
Published: June 2021

The results of experimental studies of properties of steel fiber-reinforced concrete of different types under axial tension are presented. A stand with a flexible design of the grip element connection has been developed, which provides axial load application and minimizes the effect of stress concentration at the ends of the specimen. The design is based on the ideas of the well-known Michaelis device. The design of the stand is such that the distance between the axis of load application and the central joint is 108 cm and between this joint and the axis of the test specimen is 21 cm, resulting in the load applied to the specimen being 5.143 times the applied load. The limits of fiber concrete axial tensile strength have been determined - 1.28 MPa when reinforced with wave or spun fiber and 1.37 MPa when reinforced with anchor fiber or a combination of the three types of fiber, which is 4.1 % and 4.4 % of compressive strength, respectively. It was also found that the concrete reinforced with anchor fiber or with the combined dispersed fiber reinforcement has higher deformation properties than the concrete reinforced with wave or spun fiber. The analysis of strength and deformation properties of fiber concrete when reinforced with different types of fibers allows to recommend anchored fibers for practical application.
Caregiver Experiences and Roles in Care Seeking During COPD Exacerbations: A Qualitative Study
Authors: Suresh Madhuvanthi , Young Jessica , Fan Vincent , Simons Carol , Battaglia Catherine , Simpson Tracy L , Fortney John C , Locke Emily R , Trivedi Ranak
Published: June 2021

Background

Chronic obstructive pulmonary disease (COPD) is a progressive, debilitating illness characterized by exacerbations that require timely intervention. COPD patients often rely on informal caregivers—relatives or friends—for assistance with functioning and support. Caregivers perform roles that may be particularly important during acute exacerbations in monitoring symptoms and seeking medical intervention. However, little is known about caregivers’ roles and experiences as they support their patients during exacerbations.

Purpose

To explore the experiences, roles in care seeking, and needs of caregivers during COPD exacerbations.

Methods

Semi-structured interviews were conducted with 24 caregivers of Veterans with COPD who experienced a recent exacerbation. Interviews were recorded, transcribed, and analyzed using inductive content analysis.

Results

Five themes arose: (a) caregivers reported continuously monitoring changes in patients symptom severity to identify exacerbations; (b) caregivers described emotional reactions evoked by exacerbations and constant vigilance; (c) caregivers described disagreements with their patient in interpreting symptoms and determining the need for care seeking; (d) caregivers noted uncertainty regarding their roles and responsibilities in pursuing care and their approaches to promote care varied; and (e) expressed their need for additional information and support. Caregivers of patients with COPD often influence whether and when patients seek care during exacerbations. Discrepancies in symptom evaluations between patients and caregivers paired with the lack of information and support available to caregivers are related to delays in care seeking. Clinical practice should foster self-management support to patient–caregiver dyads to increase caregiver confidence and patient openness to their input during exacerbations.
What Drives Preventive Health Behavior During a Global Pandemic? Emotion and Worry
Authors: Coifman Karin G , Disabato David J , Aurora Pallavi , Seah T H Stanley , Mitchell Benjamin , Simonovic Nicolle , Foust Jeremy L , Sidney Pooja Gupta , Thompson Clarissa A , Taber Jennifer M
Published: June 2021

Background & Purpose

Primary prevention of COVID-19 has focused on encouraging compliance with specific behaviors that restrict contagion. This investigation sought to characterize engagement in these behaviors in U.S. adults early during the pandemic and to build explanatory models of the psychological processes that drive them.

Methods

US adults were recruited through Qualtrics Research Panels (N = 324; 55% female; Mage = 50.91, SD = 15.98) and completed 10 days of online reports of emotion, COVID-19 perceived susceptibility and worry, and recommended behaviors (social distancing, hand washing, etc.). Factor analysis revealed behaviors loaded on two factors suggesting distinct motivational orientations: approach and avoidance.

Results

Changes in approach and avoidance behaviors over the 10 days indicated large individual differences consistent with three types of participants. Discrete emotions, including fear, guilt/shame, and happiness were associated with more recommended behaviors. Fear and COVID-19 worry indirectly influenced each other to facilitate more behavioral engagement. While emotions and worry strongly predicted individual differences in behavior across the 10 days, they did not predict as well why behaviors occurred on one day versus another.

Conclusions

These findings suggest how daily affective processes motivate behavior, improving the understanding of compliance and efforts to target behaviors as primary prevention of disease.
Henry James: A Very Short Introduction
Authors: Mizruchi Susan L.
Published: June 2021

Henry James: A Very Short Introduction places Henry James’s notoriously difficult writings in their historical and biographical context. Henry James had a major impact on the literary culture of his time and ever since. From his childhood through his mature life, James created a unique body of fiction, travel writing, reviews, and theory that represents one of the greatest achievements in America’s literary history. This VSI studies various fictional and nonfictional works by James. These complex accounts of human experience engage with the vital issues of both James’s era and our own, including gender relations, sexuality, the nature of modernity, the threat of relativism, and the role of art.
Prologue
Authors: Mizruchi Susan L.
Published: June 2021

‘Prologue’ provides a background on Henry James’s writing, the hallmarks of which are aesthetic self-consciousness and a focus on the conventions and etiquette of the social elite. James is considered to be among the greatest English-language novelists. He specialized in profound portraits of human character, the relations between genders, and moral conflicts. He wrote with extraordinary insight about women and girls, and about the power conferred by money and the vulnerability conferred by lacking it.
Global apprenticeship
Authors: Mizruchi Susan L.
Published: June 2021

‘Global apprenticeship’ discusses how Henry James pursued a global apprenticeship, during which he produced formidable reviews of European and American writers. He schooled himself deliberately in the methods of an international array of masters, including Honoré de Balzac, Charles Baudelaire, Émile Zola, George Eliot, Thomas Hardy, and Ivan Turgenev. James’s early heroines from this apprenticeship period include Eugenia Münster, Daisy Miller, and Catherine Sloper, of, respectively, The Europeans (1878), Daisy Miller (1879), and Washington Square (1880). By making complexly imagined young women the engines of these stories, these narratives show how riveting the question of what the young woman will do, and why, can be.
Professional author
Authors: Mizruchi Susan L.
Published: June 2021

‘Professional author’ explores some of Henry James’s most renowned works, published between the late 1880s and the turn of the century. The volume and quality of novels and stories that he produced in this period made his name as a leading Anglo-American author. James’s steady focus on his signature subjects never waned. These include coming of age, gender relations, sexuality, the nature of modernity, the threat of relativism, and the rise of mass culture and the role of art within it. Three important works of this period include The Bostonians (1886), The Turn of the Screw (1898), and The Awkward Age (1899).
Epilogue
Authors: Mizruchi Susan L.
Published: June 2021

‘Epilogue’ assesses the legacy of Henry James. James endures in the twentieth and twenty-first centuries as a phenomenon as much as any writer of his time. The persisting attractions of James’s life and works undoubtedly have something to do with their rarity and difficulty. There is also the durability of his themes: the position of women, the multifariousness of human sexuality, and the problem of knowledge. James’s keen awareness of class and money and his understanding of how wealth confers power through social connections and networks have become ever more relevant in today’s era of super capitalism. Yet another source of James’s contemporaneity is his commitment to literary and technological innovation.
Introduction
Authors: Jones Darryl
Published: June 2021

‘Introduction’ is a wide-ranging theoretical and historical argument for the fundamental importance of the concept of horror to the history of human culture and civilization. Horror is written into our earliest cultural and artistic documents, and our religions and their rituals. There are differences between horror and terror; the Gothic; the uncanny; and the weird that are important when considering horror. Horror is a culturally determined form that suffers from historical anxieties. This can be seen by looking at such as imperialism, nuclear warfare, and climate change.
2. The occult and the supernatural
Authors: Jones Darryl
Published: June 2021

‘The occult and the supernatural’ offers a history and an analysis of the concepts of the supernatural, the paranormal and the occult, most particularly in the modern world as a reaction against a scientific or materialist worldview, particularly as represented by the publication of Darwin’s On the Origin of Species in 1859. The rise of spiritualism, psychical research, and occultism in this context is worth a consideration. What is the role played by the Devil and Satanism in horror culture? This question can be answered by looking at landmark works of Satanic cinema, such as Rosemary’s Baby and The Exorcist. Where does the concept of ghosts come from? All human culture and religion include some conception of ghosts and spirits, who perform a variety of functions, from issuing warnings to righting historical wrongs to imparting privileged information.
5. Science and horror
Authors: Jones Darryl
Published: June 2021

Anxieties about scientific research and ethics have long been an important component of horror. Frankenstein is the most celebrated embodiment of these fears. The figures of Prometheus and Faust, risking all in search of dangerous and forbidden knowledge, are important precursors to Frankenstein and his monster. The idea of modern technophobia, which is a fear that machines will destroy humanity, has inspired films such as the Terminator and Ex Machina and many more.
6. Afterword
Authors: Jones Darryl
Published: June 2021

‘Afterword’ closes with an overview of a few of the many varieties of modern horror, and argues that the incorporation of horror within consumer culture threatens to diminish its edgy appeal. Examples include the supposedly Gothic romances following on from the success of the Twilight series, which are anything but scary or disturbing. There are many ways in which horror reflects our contemporary concerns and anxieties, from corporate culture to shifting geopolitics, race relations, and particularly environmental concerns. How about online horror and its emblematic monster, the Slender Man? What role does horror have under COVID-19?
Plague: A Very Short Introduction
Authors: Slack Paul
Published: June 2021

Plague: A Very Short Introduction explores the historical and social impact of plague from the earliest times. Throughout history, plague has been the cause of many major catastrophes, from the Black Death of 1348 to devastating epidemics in China and India in the late 1800s. Today, Corona-virus serves as a powerful reminder that we have not escaped the global impact of epidemic diseases. This VSI demonstrates the influence of plague on modern notions of government and public health, examining how plague has been interpreted in different times and place. It includes evidence from ancient DNA on the nature of plague and the latest research on plague in the Middle East.
Plague
Authors: Slack Paul
Published: June 2021

‘Plague’ discusses the identity of plague. The word ‘plague’ has been used over the centuries to denote an epidemic disease of particular severity and dramatic impact, and a disease which probably always had the same causative agent, now known to have been a bacillus, Yersinia pestis. Today, plague is certainly much better understood than it has ever been. The findings of modern medical science about plague’s causes (aetiology) and its incidence and distribution (epidemiology) have illuminated many aspects of its history. However, they have given rise to considerable debate about whether all the plagues of the past can have had the same cause as those of the present.
Pandemics and epidemics
Authors: Slack Paul
Published: June 2021

‘Pandemics and epidemics’ starts by looking at the conventional picture of the history of plague which divides it into three long pandemics, each of them made up of a series of separate but closely connected epidemics, in particular places, extending over centuries. The ‘Plague of Justinian’, the ‘Black Death’, and the epidemics in India and China in the late 1800s are useful case studies. How do plagues appear and disappear? The European defences against plague in the early modern period included quarantine precautions. Quarantine created protective thresholds which reduced the risk of plague retaining its hold across the whole European mainland.
Big impacts
Authors: Slack Paul
Published: June 2021

‘Big impacts’ focuses on the Black Death, which had an impact on every sphere of human activity. Indeed, the Black Death reshaped the course of European history. The case is strongest in the area where sudden, severe, and prolonged high mortality might be expected to have an effect—that of economic and social relations. The Black Death also had an impact on how people thought about their world and their place in it, and some have argued that there were wholesale changes in mentalities, amounting to turning points in contemporary culture. It is interesting to note that the process of accommodating plague took less time than one might imagine.
Private horrors
Authors: Slack Paul
Published: June 2021

‘Private horrors’ details the experiences of plague, looking at narrative sources illustrating how people coped. There were always two stories to tell about plague. One is about heroes undeterred by contagion, the other about victims of harsh officialdom and of quarantine measures. The fullest accounts tried to combine the two and show men and women, physicians, churchmen, magistrates, and citizens trying to cooperate in impossible circumstances. Most poignant of all are expressions of the pain and loss created by one of plague’s cruellest features: the heavy mortality it inflicted on single families and households, as relatives and servants died one after the other.
The lessons of histories
Authors: Slack Paul
Published: June 2021

‘The lesson of histories’ explores the lessons from histories of plague. These lessons highlight the importance of cultures and institutions, contexts and agents in creating epidemics and reactions to them. They show that the ways in which people think and live, the kinds of information available to them, and the kinds of behaviour they adopt make a difference. Whether they were effective or not, the quarantine policies invented and developed in early modern Europe demonstrated the role played by political cultures and political institutions in shaping reactions to plague. The responses to new or ‘re-emerging’ diseases, which seemed to threaten fresh pandemic disasters, including HIV/AIDS and COVID-19, have shown that public and private responses to them will be necessary, diverse, and divisive, and no more certain to succeed than they were in the past.
Machine learning identifies novel markers predicting functional decline in older adults
Authors: Valerio Kate E , Prieto Sarah , Hasselbach Alexander N , Moody Jena N , Hayes Scott M , Hayes Jasmeet P ,   for the Alzheimer’s Disease Neuroimaging Initiative
Published: June 2021

The ability to carry out instrumental activities of daily living, such as paying bills, remembering appointments and shopping alone decreases with age, yet there are remarkable individual differences in the rate of decline among older adults. Understanding variables associated with a decline in instrumental activities of daily living is critical to providing appropriate intervention to prolong independence. Prior research suggests that cognitive measures, neuroimaging and fluid-based biomarkers predict functional decline. However, a priori selection of variables can lead to the over-valuation of certain variables and exclusion of others that may be predictive. In this study, we used machine learning techniques to select a wide range of baseline variables that best predicted functional decline in two years in individuals from the Alzheimer’s Disease Neuroimaging Initiative dataset. The sample included 398 individuals characterized as cognitively normal or mild cognitive impairment. Support vector machine classification algorithms were used to identify the most predictive modality from five different data modality types (demographics, structural MRI, fluorodeoxyglucose-PET, neurocognitive and genetic/fluid-based biomarkers). In addition, variable selection identified individual variables across all modalities that best predicted functional decline in a testing sample. Of the five modalities examined, neurocognitive measures demonstrated the best accuracy in predicting functional decline (accuracy = 74.2%; area under the curve = 0.77), followed by fluorodeoxyglucose-PET (accuracy = 70.8%; area under the curve = 0.66). The individual variables with the greatest discriminatory ability for predicting functional decline included partner report of language in the Everyday Cognition questionnaire, the ADAS13, and activity of the left angular gyrus using fluorodeoxyglucose-PET. These three variables collectively explained 32% of the total variance in functional decline. Taken together, the machine learning model identified novel biomarkers that may be involved in the processing, retrieval, and conceptual integration of semantic information and which predict functional decline two years after assessment. These findings may be used to explore the clinical utility of the Everyday Cognition as a non-invasive, cost and time effective tool to predict future functional decline.
A Comprehensive Molecular Analysis of in Vivo Isolated EpCAM-Positive Circulating Tumor Cells in Breast Cancer
Authors: Strati Areti , Zavridou Martha , Kallergi Galatea , Politaki Eleni , Kuske Andra , Gorges Tobias M , Riethdorf Sabine , Joosse Simon A , Koch Claudia , Bohnen Anna-Lena , Mueller Volkmar , Koutsodontis George , Kontopodis Emmanouil , Poulakaki Nikiforita , Psyrri Amanda , Mavroudis Dimitris , Georgoulias Vasilis , Pantel Klaus , Lianidou Evi S
Published: June 2021

Background

Circulating tumor cell (CTC) analysis is highly promising for liquid biopsy-based molecular diagnostics. We undertook a comprehensive molecular analysis of in vivo isolated CTCs in breast cancer (BrCa).

Methods

In vivo isolated CTCs from 42 patients with early and 23 patients with metastatic breast cancer (MBC) were prospectively collected and analyzed for gene expression, DNA mutations, and DNA methylation before and after treatment. 19 healthy donor (HD) samples were analyzed as a control group. In identical blood draws, CTCs were enumerated using CellSearch® and characterized by direct IF staining.

Results

All 19 HD samples were negative for CK8, CK18, CK19, ERBB2, TWIST1, VEGF, ESR1, PR, and EGFR expression, while CD44, CD24, ALDH1, VIM, and CDH2 expression was normalized to B2M (reference gene). At least one gene was expressed in 23/42 (54.8%) and 8/13 (61.5%) CTCs in early BrCa before and after therapy, and in 20/23 (87.0%) and 5/7 (71.4%) MBC before and after the first cycle of therapy. PIK3CA mutations were detected in 11/42 (26.2%) and 3/13 (23.1%) in vivo isolated CTCs in early BrCa before and after therapy, and in 11/23 (47.8%) and 2/7 (28.6%) MBC, respectively. ESR1 methylation was detected in 5/32 (15.7%) and 1/10 (10.0%) CTCs in early BrCa before and after therapy, and in 3/15(20.0%) MBC before the first line of therapy. The comprehensive molecular analysis of CTC revealed a higher sensitivity in relation to CellSearch or IF staining when based on creatine kinase selection.

Conclusions

In vivo-CTC isolation in combination with a comprehensive molecular analysis at the gene expression, DNA mutation, and DNA methylation level comprises a highly powerful approach for molecular diagnostic applications using CTCs.
Non-negative Matrix Factorization: A Survey
Authors: Gan Jiangzhang , Liu Tong , Li Li , Zhang Jilian
Published: June 2021

Non-negative matrix factorization (NMF) is a powerful tool for data science researchers, and it has been successfully applied to data mining and machine learning community, due to its advantages such as simple form, good interpretability and less storage space. In this paper, we give a detailed survey on existing NMF methods, including a comprehensive analysis of their design principles, characteristics and drawbacks. In addition, we also discuss various variants of NMF methods and analyse properties and applications of these variants. Finally, we evaluate the performance of nine NMF methods through numerical experiments, and the results show that NMF methods perform well in clustering tasks.
Effects of Age and Self-Performance on Memory for Who Did What
Authors: Kersten Alan W , Earles Julie L , Brymer Jennifer Walsh
Published: June 2021

Objectives

This research tested whether performing an action themselves leads young and older adults to false memory for having seen that action performed by another person. It also tested whether observing another person perform an action leads to false memory for self-performance of that action.

Method

Healthy young and older adults viewed videos involving actors performing different actions. After viewing some of the actions, participants were instructed to perform those same actions themselves. Participants were tested 1 week later on their memory for the actions of the actors in the videos and for their own actions.

Results

Older adults were more likely to believe that the actor in a test item had performed the same action previously when they had performed that same action themselves, both when the actor had indeed performed that action and when the actor had not. This effect of self-performance on memory for other people’s actions was significantly smaller in young adults. Young adults performed better than older adults at remembering which actors had performed which actions in the videos, although participants had greater difficulty remembering who did what for actions that they had also performed themselves. The 2 groups were equally likely to falsely remember having performed an action that had only appeared in the videos, but young adults were better able than older adults to correctly identify the actions that they had in fact performed.

Discussion

Older adults have greater difficulty than young adults at distinguishing self-performed actions from actions performed by other people.
Which Honesty Test for Trademark Law? Why Traders’ Efforts to Avoid Trademark Harm Should Matter When Assessing Honest Business Practices
Authors: Anemaet Lotte
Published: June 2021

This article argues that the honest practices proviso should be more empirically based. Judges should focus on the efforts made by the competitor to avoid detriment to the trademark and on whether consumers perceive the potentially infringing sign differently because of these efforts. If the defendant has taken sufficient measures to minimise possible harm to the trademark owner but some confusion still exists or some advantage is taken, the use of the trademark should be allowed when these side effects are outweighed by overarching market values, such as furthering freedom of competition and enhancing consumer information and consumer choice. This conduct-based approach ensures that not only the legitimate interests of the trademark owner but also those of third parties are taken into account. In this way, trademark owners cannot prevent honest use of the trademark if the defendant has taken sufficient efforts to minimise harm, and at the same time third parties must respect trademark owners’ interests to the largest extent possible if they want the trademark limitations to apply.
eHealth literacy during the COVID-19 pandemic: seeking, sharing, suspicion amongst older and younger UK populations
Authors: Sykes Susie , Wills Jane , Trasolini Andrew , Wood Kerry , Frings Daniel
Published: June 2021

The containment of infectious diseases is most successful when at-risk populations have a high level of relevant health literacy (HL). To achieve this both literacy needs and patterns of knowledge sharing must be understood within the context of the disease being studied. It is also important to understand these processes from both offline (HL) and online (eHL) perspectives and amongst demographics with access to different types of information and social capital, and who have different levels of vulnerability. This paper discusses the insights gained over a series of 30 interviews with the UK residents aged either 19 − 30 years of age or older than 70 years—focussing on how they seek, understand, evaluate and convey information about COVID-19 during the current pandemic. Using thematic analysis, we identified themes around motivations to seek information, the information journey, digital choice and engagement, dilemmas and challenges of managing and appraising information, and sharing information. There was little difference in the eHL between the two age groups who both had high levels of education and were sophisticated digital citizens. The COVID-19 pandemic highlights three dominant processes in managing complex and uncertain information: some individuals may suffer from information fatigue but there was no evidence of any impact on their behaviours; others seek and share information across many networks; and there were strikingly high levels of distrust leading to complex processes of meaning-making demanding critical health literacy skills.
Menopause Is Associated With Immune Activation in Women With HIV
Authors: Peters Brandilyn A , Xue Xiaonan , Sheira Lila A , Qi Qibin , Sharma Anjali , Santoro Nanette , Alcaide Maria L , Ofotokun Igho , Adimora Adaora A , McKay Heather S , Tien Phyllis C , Michel Katherine G , Gustafson Deborah , Turan Bulent , Landay Alan L , Kaplan Robert C , Weiser Sheri D
Published: June 2021

Background

Persistent immune activation due to gut barrier dysfunction is a suspected cause of morbidity in HIV, but the impact of menopause on this pathway is unknown.

Methods

In 350 women with HIV from the Women’s Interagency HIV Study, plasma biomarkers of gut barrier dysfunction (intestinal fatty acid binding protein; IFAB), innate immune activation (soluble CD14 and CD163; sCD14, sCD163), and systemic inflammation (interleukin-6 and tumor necrosis factor receptor 1; IL-6, TNFR1) were measured at 674 person-visits spanning ≤2 years.

Results

Menopause (post- vs premenopausal status) was associated with higher plasma sCD14 and sCD163 in linear mixed-effects regression adjusting for age and other covariates (β = 161.89 ng/mL; 95% confidence interval [CI], 18.37–305.41 and 65.48 ng/mL, 95% CI, 6.64–124.33, respectively); but not with plasma IFAB, IL-6, or TNFR1. In piece-wise linear mixed-effects regression of biomarkers on years before/after the final menstrual period, sCD14 increased during the menopausal transition by 250.71 ng/mL per year (95% CI, 16.63–484.79; P = .04), but not in premenopausal or postmenopausal periods.

Conclusions

In women with HIV, menopause may increase innate immune activation, but data did not support an influence on the gut barrier or inflammation. Clinical implications of immune activation during menopausal transition warrant further investigation.
The cross-national applicability of lean implementation measures and hospital performance measures: a case study of Finland and the USA
Authors: Reponen Elina , Rundall Thomas G , Shortell Stephen M , Blodgett Janet C , Jokela Ritva , MÄkijÄrvi Markku , Torkki Paulus
Published: June 2021

Background

Health-care organizations around the world are striving to achieve transformational performance improvement, often through adopting process improvement methodologies such as lean management. Indeed, lean management has been implemented in hospitals in many countries. But despite a shared methodology and the potential benefit of benchmarking lean implementation and its effects on hospital performance, cross-national lean benchmarking is rare. Health-care organizations in different countries operate in very different contexts, including different health-care system models, and these differences may be perceived as limiting the ability of improvers to benchmark lean implementation and related organizational performance. However, no empirical research is available on the international relevance and applicability of lean implementation and hospital performance measures. To begin understanding the opportunities and limitations related to cross-national benchmarking of lean in hospitals, we conducted a cross-national case study of the relevance and applicability of measures of lean implementation in hospitals and hospital performance.

Methods

We report an exploratory case study of the relevance of lean implementation measures and the applicability of hospital performance measures using quantitative comparisons of data from Hospital District of Helsinki and Uusimaa (HUS) Helsinki University Hospital in Finland and a sample of 75 large academic hospitals in the USA.

Results

The relevance of lean-related measures was high across the two countries: almost 90% of the items developed for a US survey were relevant and available from HUS. A majority of the US-based measures for financial performance (66.7%), service provision/utilization (100.0%) and service provision/care processes (60.0%) were available from HUS. Differences in patient satisfaction measures prevented comparisons between HUS and the USA. Of 18 clinical outcome measures, only four (22%) were not comparable. Clinical outcome measures were less affected by the differences in health-care system models than measures related to service provision and financial performance.

Conclusions

Lean implementation measures are highly relevant in health-care organizations operating in the USA and Finland, as is the applicability of a variety of performance improvement measures. Cross-national benchmarking in lean healthcare is feasible, but a careful assessment of contextual factors, including the health-care system model, and their impact on the applicability and relevance of chosen benchmarking measures is necessary. The differences between the US and Finnish health-care system models is most clearly reflected in financial performance measures and care process measures.
Differential Effects of Information and Communication Technology on (De-) Democratization of Authoritarian Regimes
Authors: Choi Changyong , Jee Sang Hoon
Published: June 2021

Utilizing state–society relations as a theoretic framework, this study investigates whether the Internet is used to facilitate or impede democratization in authoritarian regimes. The present paper uses governance practice as the mediating mechanism, along with a regime's degree of authoritarianism as a moderator, to measure the direct and indirect effects of the Internet on democratization. This research found that the Internet can be mobilized to suppress political freedom in authoritarian regimes, while at the same time reinforcing the legitimacy of the regime's basis—both of these deter democratization. The Internet, as a tool, must be complemented by democratic deliberation to fully generate democratization.
Sexual Violence by the State: The Role of Political Institutions in Sexual Violence Perpetration
Authors: Willis Christopher P
Published: June 2021

What explains the variation in sexual violence perpetrated by state-security forces? Prior research has suggested sexual violence is an explicit strategy of violence. More recent work has suggested sexual violence in certain contexts acts as a tolerated practice. I argue that the type of regime institutions influences the perpetration of sexual violence by deterring behavior of individuals and providing pathways to accountability. Authoritarian regimes in general have weaker institutional accountability compared to democracies. Institutions in personalist regimes in particular are geared toward preservation of personal power, rather than accountability for the regime. Regimes with higher accountability will experience lower sexual violence, while those with lower accountability experience higher perpetration. Moreover, the gendered nature of regime institutions influences perpetration of sexual violence where masculine institutions predominate. I test these predictions using cross-national data on the incidence of sexual violence, during both peace and conflict. The results suggest that personalist regimes, and especially regimes with weaker female empowerment or higher levels of corruption, experience more sexual violence. This analysis links political institutions to the toleration of sexual violence by state-security forces, underscoring the importance of institutional structure and behavior in the perpetration of sexual violence.
Use of Electronic Cigarettes and Other Tobacco Products Among Active Component Services Members
Authors: Smucker Sierra , Meadows Sarah O , Beckman Robin
Published: June 2021

Introduction

e-cigarettes have been touted as a safer alternative to classic cigarettes and other combustible tobacco products. However, a growing body of evidence finds that any risk reduction associated with e-cigarette use is eliminated when individuals use “both” e-cigarettes and other tobacco products. Recent analyses from the Health Related Behaviors Survey suggest that rates of e-cigarette use are higher among active component service members than in the general population. However, little is known about the frequency and health behaviors associated with the dual use of e-cigarettes and other tobacco products among service members.

Data and Method

Using data from the 2018 Health Related Behaviors Survey, this paper investigates whether active component service members who use both e-cigarettes and other tobacco products are more likely to engage in other types of substance use or negative health behaviors.

Results

We find that the dual use of e-cigarettes and other tobacco products is associated with poorer physical and mental health, higher rates of alcohol misuse, and higher rates of insufficient sleep.

Conclusion

The association between the dual use of e-cigarettes and tobacco products suggests that these individuals represent an important target group for health-related resources and attention in DoD.
A fundamental Christian argument for vaccine promotion
Authors: Galang Joseph Renus F , Galang Justine Renus F
Published: June 2021

A recent correspondence highlighted the need to change the COVID-19 vaccine narrative to combat vaccine hesitancy by stressing that vaccination is a moral act. The said article was in response to another correspondence which said that science and religion must work together for vaccine promotion. This article presents a fundamental Christian argument for vaccine promotion by saying that God may have provided an answer to the pandemic through the COVID-19 vaccine.
Impact of barrier tissue inflammation and physical activity on joint homeostasis in mice
Authors: Van Mechelen Margot , Martens Tobie , Vanden Berghe Pieter , Lories Rik , Gulino Giulia R
Published: June 2021

Objectives

To investigate whether physical activity interferes with joint homeostasis in the presence of distant inflammation originating at barrier tissues such as skin or gut.

Methods

Eight-week-old male C57/Bl6 mice were treated with imiquimod cream on a shaved area of the back skin or with dextran sodium sulphate dissolved in the drinking water to induce psoriasis-like skin or inflammatory bowel disease-like gut inflammation. Afterwards, one group of mice was subjected to a 4-week forced running routine (n = 10 per group). Severity of cutaneous or intestinal inflammation was assessed clinically, by histology and by quantitative PCR. Knees and paws were analysed by micro-CT, histology, immunohistochemistry, second-harmonic generation microscopy and quantitative PCR.

Results

Local induction of inflammation triggered a systemic response with splenomegaly, loss of bone mass and bone marrow changes. Psoriasis- but not inflammatory bowel disease-like inflammation led to synovial lining layer hyperplasia, an increase in infiltrating CD45+ synovial cells, and suppressed entheseal extracellular matrix gene expression levels. Mechanical loading decreased the amount of F4/80+ synovial macrophages in untreated mice only and led to morphological alterations in the collagen fibres of the enthesis.

Conclusion

Systemic inflammation and mechanical loading act independently of each other. The former, originating from distant sites, can trigger mild synovial inflammation in mice, a propensity that may also impact the development of arthritis in patients; the latter has no impact on the severity of systemic inflammation, but independently affects joint homeostasis.
The Dilution of Parents’ Nonmaterial Resources in Stepfamilies: The Role of Complex Sibling Configurations in Parental Involvement
Authors: de Leeuw Suzanne G , Kalmijn Matthijs , van Gaalen Ruben
Published: June 2021

It has been argued that an increase in the number of siblings means that there are fewer parental investments made per child (resource dilution hypothesis). Yet, these studies are mostly based on biological two-parent families in which it can be assumed that parental resources are distributed more or less equally across siblings. This assumption does not hold in the complex family structure of a stepfamily where not all siblings are biologically related and living in the same household. Since more and more children are growing up in stepfamilies, a distinction between sibling types (full/half/step) is needed. In this study, we focus on the dilution of nonmaterial resources (i.e., parental involvement) and use the OKiN dataset to examine paternal (n = 1,077) and maternal (n = 1,369) resources separately. In this way, this study provides the first comprehensive overview of the dilution of parental resources in stepfamilies. While maternal resources are mostly diluted by full siblings, paternal resources are diluted by all sibling types (full, half, and step). We reflect on the implications of these results for the literature on sibship size as well as the literature on social mobility.
Adaptation and feasibility of a multimodal mindfulness-based intervention to promote sexual health in cancer survivorship
Authors: Gorman Jessica R , Drizin Julia H , Al-Ghadban Fatima A , Rendle Katharine A
Published: June 2021

Sexual health concerns after cancer are common and distressing, and mindfulness-based interventions (MBIs) are effective in supporting women experiencing these concerns. The goals of this study were to: (i) systematically adapt and document modifications to a mindfulness-based sexual health intervention for cancer survivors in a community setting and (ii) assess feasibility, appropriateness, and acceptability, and to identify strategies to increase reach for future implementation and dissemination. Following the ADAPT-ITT model, we first conducted key informant interviews with 10 female cancer survivors and four healthcare providers to obtain feedback on perceived need and feasibility of the intervention approach, and preferences for content, structure, and delivery format. This feedback informed initial intervention adaptations, which we then pretested with five female cancer survivors. We tracked and coded intervention adaptations. Key informant cancer survivors and providers confirmed the lack of sexual health services, acceptability of a sexual health MBI, and identified initial adaptations including modifying the intervention for delivery in a community, rather than clinical, setting. Pretest participants (aged 48–57) were survivors of breast (n = 4) and cervical (n = 1) cancer. All participants completed the intervention attending an average of 7.2 of 8 weekly sessions. Qualitative and quantitative results suggest the intervention was feasible, appropriate and acceptable. Engaging stakeholders in the adaptation process is essential for creating a feasible, appropriate, and acceptable intervention. Tracking intervention modifications contributes to our overall understanding of how MBIs can be adapted for new populations and contexts.
A 20-year perspective on the Ottawa Ankle Rules
Authors: Herman Lawrence
Published: June 2021

The Ottawa Ankle Rules, finalized in 1995, are a clinical decision directive for the use of radiographs in patients with traumatic ankle and foot injuries. The researchers who developed the rules defined clinically insignificant ankle fractures as distal fibular or malleolar chip fractures of 3 mm or less. They concluded that at least one-third of all ankle and foot radiographs could be eliminated by using their rules, which have since been adopted as the standard of care in EDs. This article explores whether, after more than 20 years in use, the Ottawa Ankle Rules are still valid, and whether they should continue to be used or be replaced by a superior protocol.
Can loratadine help in treating granulocyte-colony stimulating factor-induced bone pain?
Authors: Gajarawala Shilpa N. , Pelkowski Jessica N. , DeStephano Christopher C.
Published: June 2021

Febrile neutropenia is an oncologic emergency with serious consequences. Granulocyte colony stimulating factors (G-CSFs), used to stimulate neutrophil production to prevent febrile neutropenia, can cause bone pain in more than 25% of patients. Severe bone pain may not respond to acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, or dose reduction of the G-CSF agent. A study found that patients taking loratadine had fewer treatment-associated adverse reactions and discontinuations than those on naproxen. Although more research is needed, loratadine's tolerability, ease of administration, and potential benefit mean that it should be considered for management of pegfilgrastim-associated bone pain. This article describes a patient whose G-CSF-induced bone pain was completely alleviated by loratadine.
Comparing physicians and PAs as solo providers in a rural ED
Authors: Moore S. Jason
Published: June 2021

Objective:

To examine the use of physician assistants (PAs) as solo providers in rural EDs.

Methods:

This study compared ED metrics and patient characteristics between physicians and PAs at a critical access hospital in Arizona.

Results:

Nearly 26,000 patient encounters from the ED of the host institution were analyzed. Although minor variances in metrics were appreciated, transfers, 72-hour returns, and death rates were all similar among provider types. Results from this work do not demonstrate a clinically meaningful difference among ED metrics between physicians and PAs.

Conclusions:

Results from this study suggest that an appropriately trained and experienced PA can meet commonly used metrics in the care of patients presenting to this rural ED.