bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors Associated with Reduced Medicare Spending in the Accountable Care Organization (ACO) Investment Model
Authors: Trombley M. , Fout B. , Zhou C. , Brodsky S. , Morefield B. , McWilliams M. , Nyweide D.
Published: August 2020

Research Objective

The ACO Investment Model (AIM) was designed to encourage providers in rural or underserved areas to participate in the Medicare Shared Savings Program (SSP) by providing up‐front financial support for care transformation. In the second performance year, there were 41 ACOs that continued participation in AIM, with 423,434 beneficiaries assigned them. Our research objective was to determine whether the significant reductions in total Medicare spending we found in the first performance year were sustained in the second year, and whether specific ACO or market characteristics were associated with spending in both performance years.

Study Design

We utilized a difference‐in‐differences evaluation design to estimate differences in total spending between Medicare fee‐for‐service (FFS) beneficiaries attributed to AIM ACOs and comparison beneficiaries, before versus after the start of AIM. The comparison group included beneficiaries residing in each AIM ACO’s market who were eligible but not attributed to an ACO. Regression and weighting were used to adjust for demographic characteristics and health status. We stratified first and second performance year results based on ACO and market characteristics, including whether an ACO used a management company; partnered with a hospital; had fewer than 6,500 enrolled beneficiaries; was in the top quartile of rurality among AIM markets; had a discontinuous market; or had total Medicare spending at baseline that was above the median among all AIM markets.

Population Studied

Medicare FFS beneficiaries attributed to ACOs in AIM, which targeted ACO formation in rural/underserved areas in 2016 and 2017.

Principal Findings

Across all 41 AIM ACOs, we estimated a significant reduction in total spending of $36.94 per beneficiary per month (PBPM) in the second performance year—a reduction of 3.5% and similar to findings from the first performance year. There were no significant differences in AIM impacts based on any of our six stratifications, but results across the two performance years suggest that greater reductions were achieved by ACOs working with a management company.

Conclusions

ACOs participating in AIM sustained reductions in total Medicare spending across the first two performance years and across diverse ACO and market characteristics.

Implications for Policy or Practice

Results from the second performance year strengthen the evidence that ACOs can help reduce Medicare spending in rural or underserved areas. Among AIM markets, variations in market‐level baseline spending, market dispersion, and high rurality were not barriers to achieving spending reductions. ACOs locating in rural or underserved areas may benefit through partnership with a management company.

Primary Funding Source

Centers for Medicare and Medicaid Services.
Rhetoric or Reality: Are Health Systems Redesigning How Health Care Is Delivered?
Authors: Scanlon D.
Published: August 2020

Despite strong evidence about deficiencies in quality and safety, and abundant rhetoric about moving from volume‐based to value‐based care, to date, little systematic research has examined whether and how health systems are reengineering the way health care is organized and delivered. We adopt the term care delivery redesign (CDR) to capture the variety of tools and organizational change processes used by health systems to pursue the Triple Aim. We answer the following research questions.

Are health systems motivated to engage in CDR? What factors are driving these efforts?

What CDR strategies and activities are health systems using?

Key informant interviews with 162 executives in 24 health systems as part of the Agency for Healthcare Research and Quality’s Comparative Health System Performance Initiative. Interviews were audio‐recorded and transcribed, and global codes were applied using the Dedoose qualitative software based on a systematic codebook developed by the study team. Study investigators and analysts reviewed transcripts and coded text to arrive at study findings using a team‐based qualitative analytic approach.

Purposive sample of health systems in four states (California, Minnesota, Washington, and Wisconsin). Health systems in each state were selected to provide variation across a number of dimensions including size, profit status, geography served, and financial condition.

We report seven motivating factors reported by health systems for engaging in CDR, including intrinsic factors (organizational priorities; organizational culture; fiscal health) and extrinsic factors (public policy and price and quality transparency, alternative payment models, community and population needs, current scientific guidelines). We also present and discuss five categories of CDR activities health systems are pursuing (consistency and efficiency of care; care coordination and management; consumer‐centric care; patient in environment; and evidence, data, analytics, and technology). We provide specific examples of each area and use case examples to qualitatively illustrate the variation across systems in both motivating factors and CDR activities).

The breadth and depth of CDR activities in our health system sample varied. Systems with executives who reported having strong intrinsic motivation for their efforts appear to be on a more well‐defined path than systems with executives who report strong extrinsic motivation. Health systems are engaging in a wide range of activities, with some systems focusing only on small‐scale or incremental changes and others focusing on a broad range of activities that fit within a larger vision of CDR. The variation that exists on CDR activities may be useful for developing a systematic measurement approach for CDR activity in a broader sample of health systems.

Currently, researchers are not able to validly and reliably measure CDR activities, preventing quantification of the impact these activities have on the Triple Aim outcomes.

Agency for Healthcare Research and Quality.
SOCIAL DETERMINANTS AND SOCIAL NEEDS
Authors: Gottlieb L. , Joe S. , Cadet T. , Bibbins‐Domingo K.
Published: August 2020

Over the last thirty years, consistent and compelling evidence has documented strong associations between socio‐economic risk factors and health outcomes. This has led to a growing number of payment and practice innovations across the health care sector related to identifying and addressing patient social risks alongside more traditional biomedical care. In 2018, the National Academies of Sciences, Engineering, and Medicine (NASEM) convened a one‐year national expert committee charged with examining the potential for integrating social care and health care services to achieve better health outcomes and to help overcome major challenges facing the U.S. health care system.

Over the course of 2018‐2019, the NASEM Consensus Study Committee conducted multiple literature reviews and held several open meetings to gather evidence related to the charge.

Though much of the innovation in this field relates to primary care, evidence was also reviewed from other health disciplines.

The final committee report highlights five health care sector approaches to providing social care and to strengthening the social resources landscape, including increasing awareness about patients’ social risks; making adjustments to clinical care based on social needs; providing assistance to more consistently and effectively link patients with community‐based social resources; better aligning health care resources with community social care activities; and ensuring the health care system is involved in advocacy activities to strengthen social resources. The report also explores the workforce demands of social and medical care integration; health information and technology needs of social and medical care integration; payment models that can support integration; and other major barriers to integration.

The NASEM report articulates concrete approaches for the health care sector to address social needs as one part of comprehensive strategies to improve patient and population health and health equity.

Key policy recommendations based on the report findings include designing a health care system to accommodate the five approaches; recruiting and training a workforce able to provide social care; developing financing mechanisms that support integrated care activities; improving an interoperable digital infrastructure across health and social care sectors; and funding, conducting, and translating research on effectiveness and implementation of integrated care activities.

40 funders convened to support the NASEM consensus study.
Guidance on infection control and plume management with Laser and Energy‐Based Devices taking into consideration COVID‐19
Authors: Sullivan John R , Rademaker Marius , Goodman Greg , Bekhor Philip , Al‐Niaimi Firas
Published: August 2020

Background

The COVID‐19 pandemic has disrupted the practice of medicine. Dermatologic laser and energy‐based device (EBD) treatments carry a potential risk for the transmission of SARS‐CoV‐2 both for the patient and the practitioner. These risks include close practitioner to patient proximity, the treatment of higher viral load areas such as the face, the potential for infective bioparticles being carried by generated plumes and aerosols, and the direct contact between device, practitioner and patient.

Objectives

SARS‐CoV‐2 is a highly infective respiratory pathogen transmitted by respiratory droplets, respiratory/mucosal secretions, medically generated aerosols and via its transfer from contaminated fomites. This requires a review of the appropriateness of infection control protocols in regard to dermatologic laser and energy‐based device treatments.

Methods

A critical evaluation of patient skin preparation including skin asepsis, device disinfection, laser and electrosurgical plume management and PPE in regard to SARS‐CoV‐2 was performed.

Results

The adherence to a high standard of skin preparation and asepsis, device disinfection, laser and electrosurgical plume and aerosol management and appropriate PPE should help mitigate or reduce some of the inherent treatment risks. Head and neck treatments along with aerosol and laser plume generating treatments likely carry greater risk.

Conclusions

COVID‐19 needs to be considered in the clinic set‐up along with the planning, treatment and post‐treatment care of patients utilising EBD procedures. Some of these treatment precautions are COVID‐19 specific; however, most represent adherence to good infectious disease and established laser and EBD safety precautions.
The Uneven Geographies of Politicisation: The Case of the Undocumented Immigrant Youth Movement in the United States
Authors: Nicholls Walter J.
Published: August 2020

This paper examines the uneven geographies of politicisation through the case of the undocumented immigrant youth movement in the United States, known as the Dreamers. Engaging the “urban political” literature, the paper maintains that politicisation involves the constitution of a subject that disrupts the order through claims for equality. The paper identifies the process of transforming highly marginalised and repressed people into an actual disruptive political subject. It suggests a three‐stage, spatially mediated process. First, “free spaces” are frontline sites that allow marginalised and risk‐averse groups like undocumented immigrants to meet with others, forge emotional bonds, and construct transgressive collective identities. Second, the potential of free spaces to politicise marginalised groups varies by geographical setting. Geographical settings, like large central cities, with high levels of organisational density and some ideological support facilitate politicisation more than settings with low organisational density and high hostility. Third, the uneven geographies of politicisation results in a political subject that is constituted and divided by core–periphery relations.
Site types revisited: Comparison of traditional Russian and Finnish classification systems for European boreal forests
Authors: Pohjanmies Tähti , Genikova Nadezhda , Hotanen Juha‐Pekka , Ilvesniemi Hannu , Kryshen Alexander , Moshnikov Sergey , Oksanen Jari , Salemaa Maija , Tikhonova Elena , Tonteri Tiina , Merilä Päivi
Published: August 2020

Questions

Forest classifications are tools used in research, monitoring, and management. In Finland, the Cajanderian forest site type classification is based on the composition of understorey vegetation with the assumption that it reflects in a predictable way the site's productive value. In Russia, the Sukachevian forest classification is similarly based on understorey vegetation but also accounts for tree species, soil wetness, and paludification. Here we ask whether Cajander's and Sukachev's forest types are effectively the same in terms of species composition, site productivity, and biodiversity.

Location

Boreal forests on mineral soils in Finland and the Russian part of Fennoscandia.

Methods

We use vegetation and soil survey data to compare the Cajanderian and the Sukachevian systems in terms of the understorey community composition (that is supposed to define them), soil fertility and tree productivity (that they are expected to indicate), and biodiversity (that is of interest for conservation purposes). We create and employ class prediction models to divide Russian and Finnish sites into Cajander's and Sukachev's types, respectively, based on vegetation composition. We perform cross‐comparisons between the two systems by non‐metric multidimensional scaling ordination and statistical tests.

Results

Within both systems, the site types formed similar, meaningful gradients in terms of the studied variables. Certain site types from the two systems were largely overlapping in community composition and arranged similarly along the fertility gradient and may thus be considered comparable.

Conclusions

The Cajanderian and the Sukachevian systems were both developed in the European boreal zone but differ in terms of the exact rules by which site types are determined. Our results show that analogous types between the systems can be identified. These findings aid in endeavours of technology and information transfer between Finnish and Russian forests for the purposes of basic or applied ecological research and forest management.
Development of quinoline‐based hybrid as inhibitor of methionine aminopeptidase 1 fromLeishmania donovani
Authors: Bhat Saleem Yousuf , Bhandari Sonal , Thacker Pavitra Suresh , Arifuddin Mohammed , Qureshi Insaf Ahmed
Published: August 2020

Methionine aminopeptidase 1 (MetAP1) is a target for drug discovery against many adversaries and a potential antileishmanial target for its role in N‐terminal methionine processing. As an effort towards new inhibitor discovery against methionine aminopeptidase 1 fromLeishmania donovani(LdMetAP1), we have synthesized a series of quinoline‐based hybrids, that is (Z)‐5‐((Z)‐benzylidine)‐2‐(quinolin‐3‐ylimino)thiazolidin‐4‐ones (QYT‐4a‐i) whose in vitro screening led to the discovery of a novel inhibitor molecule (QYT‐4h) againstLdMetAP1. The compound QYT‐4h showed nearly 20‐fold less potency for human MetAP1 and had drug‐like features. Time–course kinetic assays suggested QYT‐4h acting through a competitive mode by binding to the metal‐activated catalytic site. Notably, QYT‐4h was most potent against the physiologically relevant Mn(II) and Fe(II) supplemented forms ofLdMetAP1 and less potent against Co(II) supplemented form. Surface plasmon resonance and fluorescence spectroscopy demonstrated high affinity of QYT‐4h forLdMetAP1. Through molecular modelling and docking studies, we found QYT‐4h binding at theLdMetAP1 catalytic pocket occupying both the catalytic and substrate binding sites mostly with hydrogen bonding and hydrophobic interactions which provide structural basis for its promising potency. These results demonstrate the feasibility of employing small‐molecule inhibitors for selective targeting ofLdMetAP1 which may find use to effectively eliminate leishmaniasis.
Political corruption shielding and corporate acquisitions
Authors: Hossain Ashrafee Tanvir , Kryzanowski Lawrence
Published: August 2020

Corruption includes rent‐seeking behavior by public officials (e.g., lavish in‐kind benefits and monetary kickbacks for contracts/permits/regulatory leniency, improper political contributions/support, etc.) that can negatively affect firm valuations, performances, and strategic choices. Shielding strategies are used to diminish rent‐seeking attractiveness of firms. Acquisitions provide a better channel than cash or leverage for assessing the wealth effects of shielding strategies. We find that the mean 3‐day announcement returns for acquirers for a large sample of U.S. domestic acquisitions between 1990 and 2014 is significantly lower for firms headquartered in relatively higher corruption states. Our results survive an array of robustness tests.
The Growing Blessing of Unicorns: The Changing Nature of the Market for Privately Funded Companies
Authors: Brown Keith C. , Wiles Kenneth W.
Published: August 2020

The past 15 years have seen the emergence of large infusions of private capital at levels previously accessible only in public markets. One direct effect of these non‐public fundraisings is the spawning of private entities with market valuations reaching $1 billion, thereby achieving the status of unicorns. As the authors reported in an earlier study, by the end of 2015, there were 142 unicorns with an aggregate value exceeding $500 billion. The conviction of many investors and managers at that time was that these companies could best create value by staying private, often by adopting governance structures focused on creating superior operating performance. It was also widely believed that unicorns would remain outside the public markets longer and succeed in attracting even more private capital, thereby enabling their investors to capture a greater share of the increase in company value.

In this study, the authors examine how the characteristics and dynamics of “the blessing” have changed in the past five years. Despite the widespread view that the valuations and private financing trend fueling this market were not sustainable, the authors report that by March 2020, the “net” number of unicorns had grown from 142 to 464, a number that doesn't reflect the transformation of over half of the 2015 sample through acquisition or public offering and their replacement by new unicorns. Further, the cumulative market valuation of unicorns more than doubled from $500 billion to $1.37 trillion, representing growth far greater than that in the public equity markets (some 26% per annum, as compared to 9% for the S&P 500) over the same period—and the blessing has become more diversified, both in terms of industry and geographical location.

The authors also consider what happens when unicorns “graduate” to a different organizational form by means of an IPO, private buyout, or business failure. Analyzing the 107 firms that departed the sample between 2015 and 2020, the authors report that the average lifespan of a unicorn from its founding date to its exit date has been 9.5 years, indicating that such firms indeed remain privately owned for a longer time than in the past. Additionally, the study finds that the founders and initial investors in unicorns have fared quite well, cashing out their initial investment at almost six times invested capital, on average. These private investment performance metrics have been significantly higher than the returns to public shareholders in the same firms during the post‐IPO period, signifying that unicorn investors have captured much more of the value created in the company's growth phase than public stockholders.
Columbia Law School Roundtable on Public Aspects of Private Equity
Authors: Mendell Emily , Hitscherich Donna , Cozzone Chris , Rehman Aamir A.
Published: August 2020

The mandate of the broader private equity “ecosystem” goes well beyond earning competitive returns for the limited partners and their beneficiaries. After noting that PE investing is encountering ever larger “headline” and social risks, the panelists were in complete agreement that LPs should exert greater pressure on PE sponsors to take account of and try to address negative externalities when buying and operating their portfolio companies.

Bain Capital's Double Impact Fund, for example, while always looking for ways of increasing profits and reducing risk, sets out to have a positive influence on its non‐investor stakeholders, including employees. To that end, Bain develops and tracks company‐specific metrics linked to positive outcomes, and then links those metrics to management compensation. And the director of ESG programs at the International Limited Partners Association points to ILPA's programs for diversity and inclusion as a promising model.
A CEO's Playbook for Creating Long‐Term Value: Ten Essential Resource Allocation Practices
Authors: Kraemer Harry M. , Mauboussin Michael J. , Rappaport Alfred
Published: August 2020

A former CEO of a large and successful public company teams up with a former chief investment strategist and a well‐known academic to suggest ten practices for public companies intent on creating long‐run value:

Establish long‐term value creation as the company's governing objective.

Ensure that annual plans are consistent with the company's long‐term strategic plan.

Understand the expectations embedded in today's stock price.

Conduct a “premortem”—and so gain a solid understanding of what can go wrong—before making any large capital allocation decisions.

Incorporate the “outside view” in the strategic planning process.

Reallocate capital to its highest‐valued use, selling corporate assets that are worth more to or in the hands of others.

Prioritize strategies rather than individual projects.

Avoid public commitments, such as earnings guidance, that can compromise a company's capital allocation flexibility.

Apply best private equity practices to public companies.

CEOs should work closely with their boards of directors to set clear expectations for creating long‐term value.

These practices, as the authors note in closing, “are meant to provide a starting point for public companies in carrying out their mission of creating long‐run value—and in a way that earns the respect, if not the admiration and support, of all its important stakeholders.”
Mining TCGA database for genes of prognostic value in gastric cancer microenvironment
Authors: Lan Qingzhi , Wang Peng , Tian Shan , Dong Weiguo
Published: August 2020

Gastric cancer (GC) is the sixth most common malignancy and the third leading cause of cancer‐related death worldwide. Emerging evidence suggests that tumour microenvironment cells play a vital role in the development and prognosis of GC. To investigate the possible effect of stromal scores and immune scores on the overall survival (OS) on the GC patients, we divided GC patients into ‘high’ and ‘low’ groups based on their stromal and immune scores, and found differentially expressed genes related to prognosis of GC patients. Functional enrichment analysis and GSVA further revealed that focal adhesion and ECM‐receptor interaction are associated with GC patients' survival. Finally, we analysed the effects of genes commonly involved in focal adhesion and ECM‐receptor interaction on GC patients' survival and validated our results in another GC cohort from GEO data sets. In conclusion, we obtained a list of tumour microenvironment‐related genes that predict poor prognosis in GC patients.
Cryo‐FIB‐lift‐out: practically impossible to practical reality
Authors: PARMENTER CHRISTOPHER DAVID , NIZAMUDEEN ZUBAIR AHMED
Published: August 2020

In this paper, we explore the development of the Cryo‐Lift‐Out (cryo‐LO) technique as preparation tool for cryogenic transmission electron microscopy (cryo‐TEM). What started in early work defying what was considered ‘practically impossible’ has developed into state‐of‐the‐art practical reality. This paper presents the key hardware, basic principles and key considerations for the practical usage of cryogenic Lift‐Out for those new to the field. Detailed protocols and in‐depth description of considerations and points for further development are presented. The authors have attempted to formalise everything known about the technique gathered together from their expertise gained in the development of this approach.

Lay Description

A major challenge in electron microscopy is the production of suitable samples from hydrated biological and soft‐matter materials for subnanometre resolution imaging in a cryo‐Transmission Electron Microscope (TEM). A well‐known solution for room temperature materials is called (in situ) Lift‐Out. It uses a fine needle that picks up a tiny section called a lamella. Lamellae are made by a Focused Ion Beam (FIB). In this paper, we seek to set out the beginnings of Lift‐Out sample preparation conducted under cryogenic conditions and the development of this approach as applied to frozen, hydrated biological and soft‐matter samples.

We discuss the required basic hardware and provide a thorough description of developed protocols. We aim at those new to the field of cryo‐Lift‐Out to fully educate them in the finer points of hardware setup and practical considerations when attempting to perform cryo‐Lift‐Out and to demonstrate what has been achieved thus far. We also discuss areas of further improvement and talking points for the future direction of this promising sample preparation technique.
Predation and competition induce variable organ size trade‐offs in larval anurans
Authors: Neptune T. C. , Bouchard S. S.
Published: August 2020

Inducible defenses allow organisms that live in variable environments to invest energy into defense when necessary. These responses are common in aquatic organisms and are particularly notable in larval anurans, which tend to develop deeper tails under sit‐and‐wait macroinvertebrate predation threat. Although trade‐offs between defense and growth have been well‐studied, trade‐offs with internal organ sizes have rarely been considered. The purpose of our study was to investigate the effects of predation and competition on trade‐offs associated with total length (body + tail), tail size and internal organ size (gut, pancreas, liver and fat body) in two larval anurans, red‐eyed treefrogs (Agalychnis callidryas) and gray treefrogs (Hyla versicolor). In two separate experiments, we reared larvae in outdoor mesocosms with and without competition in the presence and absence of a caged predator. We subsampled larvae from each mesocosm and measured tail and internal organ sizes. Both competition and predation exerted strong effects on total length and morphology, although each experiment produced unique results. Competition increased gut size in both species, supporting a previously reported trade‐off between gut and tail size. Competition also reduced total length in both experiments: Gray treefrogs balanced total length with lipid deposition, and red‐eyed treefrogs favored total length at the expense of lipid reserves. Predation threat elicited an increase in tail depth but a reduction in tail muscle size in gray treefrogs, which may have allowed larvae to maintain pancreas size and total length. Conversely, red‐eyed treefrogs developed larger tails with more muscle area, allocating resources in a way that sacrificed both liver and pancreas size, as well as total length. Although the specific tail response was different, both species prioritized larger guts over tail modifications when faced with both competition and predation, as large gut sizes were maintained in competitive environments even when predators were present.
A new method for assessing anal distensibility with a barostat and magnetic resonance imaging in healthy and constipated women
Authors: Sharma Mayank , Feuerhak Kelly , Corner Stephen M. , Manduca Armando , Bharucha Adil E.
Published: August 2020

Objectives

Defecation requires relaxation of the internal and external anal sphincters. High anal resting pressure is associated with painful constipation, defecatory disorders, and increased healthcare utilization in constipated patients; the mechanisms are unclear. Perhaps patients with a high anal resting pressure have a less distensible canal, which impedes defecation.

Methods

In 50 of 64 participants (33 healthy and 17 constipated women), anal pressures and distensibility were measured, respectively, with manometry and balloon distention combined with magnetic resonance imaging; rectal balloon expulsion time (BET) was also studied.

Results

The BET (P = .006) was longer, and the mean (SD) rectoanal pressure gradient (−58[40] vs −34[26] mm Hg,P = .03) was more negative in constipated than healthy women; anal resting pressure was not different. During anal distention, the balloon expanded rapidly at an opening pressure of 49 (18) mm Hg, which was lower (P < .0001) than resting pressure (90 [25] mm Hg). The resting pressure was correlated with the opening pressure (r = 0.57,P < .0001) and inversely (r = −0.38,P = .007) with maximum volume but not with anal distensibility (volume‐pressure slope). In healthy women, the difference (opening‐resting pressure) was correlated with anal relaxation during evacuation (r = 0.35,P = .04). Anal distensibility and sensory thresholds were not different between constipated and healthy women.

Conclusions

Among healthy and constipated women, a greater anal resting pressure is correlated with greater opening pressure and lower maximum volume during distention, and, hence, provides a surrogate marker of anal distensibility. The difference (opening‐resting pressure), which reflects anal relaxation during distention, is correlated with anal relaxation during evacuation. Anal resting pressure and distensibility were comparable in healthy and constipated women.
Photopatch testing in a tropical country, Thailand: 20 years' experience
Authors: Chaiyabutr Chayada , Sukakul Thanisorn , Limphoka Pichaya , Kumpangsin Titinun , Boonchai Waranya
Published: August 2020

Background

Photoallergic contact dermatitis is one of the important parts of photodermatoses. The investigation of choice is photopatch testing. However, reports with photopatch test results from Asian countries are scarce. The objective of this study was to determine the prevalence of positive photopatch test reactions and to ascertain the common photoallergens among Thai patients during 1998‐2018.

Methods

We retrospectively reviewed the records of 339 patients who were clinically suspected of having photoallergic contact dermatitis and had undergone photopatch testing.

Results

A total of 44 photoallergic contact reactions in 38 patients (11.2%) were found. The positive photoallergic reactions were mainly found with organic ultraviolet filters and fragrances.

Conclusions

Organic ultraviolet filter chemicals especially benzophenone‐3 and fragrances were found to have a high prevalence of photoallergic contact reactions. Monitoring of the photoallergens employed in photopatch tests should be conducted periodically to provide the best patient care.
Checking Executive Personalism: Collegial Governments and the Level of Democracy*
Authors: Altman David
Published: August 2020

The world is facing a tide of “cult‐of‐personality” governments that threaten liberal democracy (e.g., Trump, Duterte, Bolsonaro, Orbán). Collegial executives are a long‐established institutional alternative, predicated upon disarming this very shortcoming in the practice of democracy. These are regimes in which multiple people share power, limiting executive excess. Historiographic accounts regard the collegial executive as inimical to resolute decision‐making and responsible for democratic deterioration. Despite being used since antiquity, there is no empirical research on how collegial executives influence democracy. This paper tests, for the first time, whether collegial executives are substantially worse for democracy than single‐leader executives. The focus is on the only robust polyarchy to have alternated twice between single‐person and collegial‐executive governments: Uruguay. Using the Synthetic Control Method, the paper creates a fictional Uruguay to compare with the country’s real experience. The results show that multiple‐executive governments have had no impact on Uruguay’s level of democracy.
Risk of hematological malignancy in blood donors: A nationwide cohort study
Authors: Zhao Jingcheng , Dahlén Torsten , Brynolf Anne , Edgren Gustaf
Published: August 2020

Background

There has been a concern that blood donations can increase the risk of hematological malignancies. We investigated if blood donations increase the risk of developing hematological malignancies, specifically acute lymphoblastic leukemia, acute myeloid leukemia (AML), chronic lymphocytic leukemia (CLL), chronic myeloid leukemia, Hodgkin lymphoma, and myeloma, as well other non‐Hodgkin lymphoma.

Study Design and Methods

In total, the study included 1,021,433 Swedish blood donors, with 19.5 million person‐years of follow‐up. Two sets of analysis were performed. In the first cohort analysis, standardized incidence ratios (SIRs) were calculated, comparing the incidence of the different types of hematological cancers in blood donors to that of the general population. In the second analysis, a nested case–control study was conducted, investigating the association between number of donations and the risk of each type of malignancy.

Results

Apart from a modestly elevated risk of CLL (SIR, 1.07; 95% confidence interval [CI], 1.01‐1.15) and a modestly decreased risk of AML (SIR, 0.85; 95% CI, 0.77‐0.83), the risk of hematological malignancies did not differ between blood donors and the general population. In the nested case–control study there were no convincing associations between number of prior whole blood donations and site‐specific malignancy risk.

Conclusions

There was no convincing evidence of an increased risk in any hematological malignancy when interpreting the results from both series of analyses.
Acoustic characteristics of American English liquids /ɹ/, /l/, /ɹl/ produced by Korean L2 adults
Authors: Espinal Alexis , Thompson Austin , Kim Yunjung
Published: August 2020

This study examined the acoustic characteristics of American English liquids /ɹ/, /l/, and /ɹl/ produced by 14 adult learners of English (L2) and 13 native speakers of English. Several temporal and spectral measures were examined, including a novel measure to describe the relative timing of the maximum constriction during liquid production. The results indicated that L2 speakers rely more on duration contrasts to distinguish the three liquids than spectral contrasts. Reduced spectral differences among the liquids in L2 speakers are discussed concerning the influence of the native language of L2 speakers.
Diagnosis and quantification of military noise-induced hearing loss
Authors: Moore Brian C. J.
Published: August 2020

The diagnosis and quantification of noise-induced hearing loss (NIHL) in a medico-legal context are usually based on the pattern of hearing loss that is typically associated with long-term exposure to steady broadband noises, such as occur in noisy factories. Evidence is reviewed showing that this pattern is not typical for hearing loss produced by intense impulsive sounds of the type that military personnel are exposed to. The audiometric characteristics of noise-exposed military personnel are reviewed. A set of audiograms from a sample of 58 hearing-impaired noise-exposed military veterans was analyzed and used to develop methods for the diagnosis and quantification of military NIHL. Three requirements are specified for diagnosing military NIHL. Quantification of any loss is done by comparison with audiometric thresholds for non-noise exposed individuals, as specified in ISO7029 [International Organization for Standardization, 2017].
External Validity of the T-SAFT90: A Soccer Simulation Including Technical and Jumping Activities
Authors: da Silva Cristiano D. , Lovell Ric
Published: August 2020

Purpose: To examine the physiological, muscle-damage, endocrine, and immune responses to a modified soccer-simulation protocol to include technical and jumping activities characteristic of match play (the Technical Soccer-Specific Aerobic Field Test; T-SAFT90). Methods: Eighteen university players (age 23 [2] y, stature 175 [5] cm, body mass 74 [11] kg) performed the 90-minute protocol, with acute physiological responses monitored via heart rate, ratings of perceived exertion (6–20 scale), and body mass changes. Creatine kinase, myoglobin, cortisol, and leukocyte subset concentrations were measured at baseline, immediately (0 h), and 24 hours post T-SAFT90. Results: T-SAFT90 incurred an average heart rate equivalent to 87% (5%) of maximum, 16 (2) a.u. ratings of perceived exertion, and a 1.5% (1.0%) body mass deficit. Moderate to large proliferation of leukocyte subsets (P ≤ .01; leukocytes: 6.4-fold; neutrophils: 5.5-fold; lymphocytes: 2.0-fold) and increases in cortisol (2.3-fold) were observed at 0 hours (effect size = 1.13–3.52), each returning to baseline by 24 hours (P > .45; effect size = 0.05–0.50). Myoglobin peaked immediately post T-SAFT90 (4.8-fold), whereas creatine kinase (24 h: 6.0-fold) showed a delayed time course (both P ≤ .001; very large effects; effect size = 2.66 and 3.43, respectively). Conclusions: The magnitude and time course of the physiological, immune, endocrine, and muscle-damage markers observed during and following T-SAFT90 are similar to values reported in match-play literature, demonstrating external validity of the simulation.
Effects of Combined Strength and Power Training on Physical Performance and Interlimb Asymmetries in Adolescent Female Soccer Players
Authors: Pardos-Mainer Elena , Casajús José Antonio , Bishop Chris , Gonzalo-Skok Oliver
Published: August 2020

Purpose: To examine the effects of an 8-week combined strength and power training intervention on physical performance and interlimb asymmetries in adolescent female soccer players. Methods: Thirty-seven adolescent female soccer players (age 16.1 [1.1] y) were randomly assigned to a control group (n = 18) or experimental group (n = 19). The experimental group performed combined strength and power training twice a week, which consisted of strength and power exercises that trained the major muscles of the lower body and trunk musculature. Preintervention and postintervention tests included unilateral and bilateral horizontal and countermovement jump tests, a 40-m sprint test (10- and 30-m split times), a 10-m sprint with a 180° change-of-direction (COD) test, and a multiple-COD test (V-cut test). Asymmetries were also analyzed in the unilateral tests. Results: Significant group-by-time interaction of the improvement between pretest and posttest was observed for speed (effect size [ES]: −1.30 to −1.16) and COD tests (ES: −0.62 to −0.61) but not in jumping (ES: −0.09 to 0.28) and interlimb-asymmetry tests (ES: −0.13 to 0.57). Conclusions: The short-term in-season combined strength and power training program induced greater speed and COD performance improvements than soccer training alone in adolescent female soccer players.
Sex-Related Changes in Physical Performance, Well-Being, and Neuromuscular Function of Elite Touch Players During a 4-Day International Tournament
Authors: Dobbin Nick , Thorpe Cari , Highton Jamie , Twist Craig
Published: August 2020

Purpose: To examine the within- and between-sexes physical performance, well-being, and neuromuscular function responses across a 4-day international touch rugby (Touch) tournament. Methods: Twenty-one males and 20 females completed measures of well-being (fatigue, soreness, sleep, mood, and stress) and neuromuscular function (countermovement jump height, peak power output, and peak force) during a 4-day tournament with internal, external, and perceptual loads recorded for all matches. Results: Relative and absolute total, low-intensity (females), and high-intensity distance were lower on day 3 (males and females) (effect size [ES] = −0.37 to −0.71) compared with day 1. Mean heart rate was possibly to most likely lower during the tournament (except day 2 males; ES = −0.36 to −0.74), whereas rating of perceived exertion-training load was consistently higher in females (ES = 0.02 to 0.83). The change in mean fatigue, soreness, and overall well-being was unclear to most likely lower (ES = −0.33 to −1.90) across the tournament for both sexes, with greater perceived fatigue and soreness in females on days 3 to 4 (ES = 0.39 to 0.78). Jump height and peak power output were possibly to most likely lower across days 2 to 4 (ES = −0.30 to −0.84), with greater reductions in females (ES = 0.21 to 0.66). Well-being, countermovement jump height, and peak force were associated with changes in external, internal, and perceptual measures of load across the tournament (η2 = −.37 to .39). Conclusions: Elite Touch players experience reductions in well-being, neuromuscular function, and running performance across a 4-day tournament, with notable differences in fatigue and running between males and females, suggesting that sex-specific monitoring and intervention strategies are necessary.
The Relationships Between External and Internal Workloads During Basketball Training and Games
Authors: Fox Jordan L. , O’Grady Cody J. , Scanlan Aaron T.
Published: August 2020

Purpose: To investigate the relationships between external and internal workloads using a comprehensive selection of variables during basketball training and games. Methods: Eight semiprofessional, male basketball players were monitored during training and games for an entire season. External workload was determined as PlayerLoad™: total and high-intensity accelerations, decelerations, changes of direction, and jumps and total low-intensity, medium-intensity, high-intensity, and overall inertial movement analysis events. Internal workload was determined using the summated-heart-rate zones and session rating of perceived exertion models. The relationships between external and internal workload variables were separately calculated for training and games using repeated-measures correlations with 95% confidence intervals. Results: PlayerLoad was more strongly related to summated-heart-rate zones (r = .88 ± .03, very large [training]; r = .69 ± .09, large [games]) and session rating of perceived exertion (r = .74 ± .06, very large [training]; r = .53 ± .12, large [games]) than other external workload variables (P < .05). Correlations between total and high-intensity accelerations, decelerations, changes of direction, and jumps and total low-intensity, medium-intensity, high-intensity, and overall inertial movement analysis events and internal workloads were stronger during training (r = .44–.88) than during games (r = .15–.69). Conclusions: PlayerLoad and summated-heart-rate zones possess the strongest dose–response relationship among a comprehensive selection of external and internal workload variables in basketball, particularly during training sessions compared with games. Basketball practitioners may therefore be able to best anticipate player responses when prescribing training drills using these variables for optimal workload management across the season.
Training Load and Performance Impairments in Professional Cyclists During COVID-19 Lockdown
Authors: Muriel Xabier , Courel-Ibáñez Javier , Cerezuela-Espejo Victor , Pallarés Jesús G.
Published: August 2020

Purpose: The COVID-19 outbreak has challenged professional athletes’ training and competition routines in a way not seen before. This report aims to inform about the changes in training volume and intensity distribution and their effects on functional performance due to a 7-week home-confinement period in professional road cyclists from a Union Cycliste Internationale Pro Team. Methods: A total of 18 male professional cyclists (mean [SD] age = 24.9 [2.8] y, body mass = 66.5 [5.6] kg, maximal aerobic power = 449 [39] W; 6.8 [0.6] W/kg) were monitored during the 10 weeks before the lockdown (outdoor cycling) and the 7-week lockdown (indoor cycling turbo trainer). Data from the mean maximal power output (in watts per kilogram) produced during the best 5-minute and best 20-minute records and the training intensity distributions (weekly volumes at power-based training zones) were collected from WKO5 software. Results: Total training volume decreased 33.9% during the lockdown (P < .01). Weekly volumes by standardized zones (Z1 to Z6) declined between 25.8% and 52.2% (effect size from 0.83 to 1.57), except for Z2 (P = .38). There were large reductions in best 5-minute and best 20-minute performance (effect size > 1.36; P < .001) with losses between 1% and 19% in all the cyclists. Conclusions: Total indoor volumes of 12 hours per week, with 6 hours per week at low intensity (Z1 and Z2) and 2 hours per week at high intensity over the threshold (Z5 and Z6), were insufficient to maintain performance in elite road cyclists during the COVID-19 lockdown. Such performance declines should be considered to enable a safe and effective return to competition.
Exploring Fear of Falling and Exercise Self-Efficacy in Older Women With Vertebral Fractures
Authors: Ponzano Matteo , Gibbs Jenna C. , Adachi Jonathan D. , Ashe Maureen C. , Cheung Angela M. , Hill Keith D. , Kendler David , Khan Aliya A. , McArthur Caitlin , Papaioannou Alexandra , Thabane Lehana , Wark John D. , Giangregorio Lora M.
Published: August 2020

Fear of falling is a common issue among older adults, which decreases quality of life and leads to an avoidance of activities they are still able to do. The goal of this secondary data analysis was to explore the relationship between fear of falling and exercise self-efficacy in 141 women with at least one nontraumatic Genant Grade 2 vertebral fracture. Fear of falling, exercise self-efficacy, history of falling, the number of falls, the use of assisting devices, and pain at rest or during movement were obtained using medical history and health status questionnaires. There was a negative association between fear of falling and exercise self-efficacy (pseudoR2 = .253;p = .004), which persisted when the analysis was adjusted for history and number of falls, use of assistive devices, and pain at rest (pseudoR2 = .329;p < .0001) or during movement (pseudoR2 = .321;p < .0001). Fear of falling may be negatively associated with exercise self-efficacy in older women with vertebral fracture.
Antibiotic Consumption and Stewardship at a Hospital outside of an Early Coronavirus Disease 2019 Epicenter
Authors: Buehrle Deanna J. , Decker Brooke K. , Wagener Marilyn M. , Adalja Amesh , Singh Nina , McEllistrem Mary C. , Nguyen M. Hong , Clancy Cornelius J.
Published: August 2020

There are scant data on the impact of coronavirus disease 2019 (COVID-19) on hospital antibiotic consumption, and no data from outside epicenters. At our nonepicenter hospital, antibiotic days of therapy (DOT) and bed days of care (BDOC) were reduced by 151.5/month and 285/month, respectively, for March to June 2020 compared to 2018–2019 (
P = 
0.001 and
P < 
0.001). DOT per 1,000 BDOC was increased (8.1/month;
P = 
0.
A New Approach for Evaluating Electron Transfer Dynamics by Using
In Situ
Resonance Raman Microscopy and Chronoamperometry in Conjunction with a Dynamic Model
Authors: Krige Adolf , Ramser Kerstin , Sjöblom Magnus , Christakopoulos Paul , Rova Ulrika
Published: August 2020

Bioelectrochemical systems can fill a vast array of application niches, due to the control of redox reactions that it offers. Although native microorganisms are preferred for applications such as bioremediation, more control is required for applications such as biosensors or biocomputing. The development of a chassis organism, in which the EET is well defined and readily controllable, is therefore essential. The combined approach in this work offers a unique way of monitoring and describing the reaction kinetics of a
G. sulfurreducens
biofilm, as well as offering a dynamic model that can be used in conjunction with applications such as biosensors.