bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stress levels among workers: an observational study
Authors: Testa T , Comba M , Nicolini D , Rinaldi C , Opizzi A , Concina D , Panella M 
Published: October 2020

Abstract

Introduction
While some stress is a common part of everyday work for most people, higher or prolonged levels of stress might be harmful. Work-related stress is becoming a study subject because of its important implications: it is related to coronary heart disease and health in general and it also influences employee satisfaction and productivity. Because of this, workers should be aware of their stress levels in order to prevent disease and increase performance levels. Therefore, the aim of our study was to evaluate stress levels among employees.

Methods
We conducted an observational study in collaboration with Anteo, an onlus society based in Biella which employs more than 1000 workers. The first step of our study ran from December 2019 to February 2020, and included 300 workers. Informed consent was gathered trough structure chiefs prior to the intervention. We administered an online questionnaire based on the Kessler Psychological Distress Scale (K10) for screening than, subjects with a high perceived stress level were invited for a personal interview with our medical and psychological staff.

Results
The response rate was 31% with 94 questionnaires completed by the end of February 2020. 80% of respondents were women (75 out of 94). 17% of the employees presented a moderate to high level of stress (16 total, 72% women). Only 5% of workers presented a high level of stress (4 total, 50% women). All Patients presenting a high level of perceived stress went through medical and psychological evaluation, which confirmed the results in 88% cases (14 out of 16).

Conclusions
Our study evidenced that workers are often exposed to high levels of stress, which can influence health, everyday life as well as productivity. The introduction of stress management programs in companies could improve workers health and productivity having a positive impact on one's health, company productivity and society in general.

Key messages
The introduction of stress management programs might improve workers health and productivity. The introduction of stress management programs might have a positive impact on one’s health, company productivity and society in general.
What weights on the user experience of hospital inpatient episodes? A Portuguese national study
Authors: Galhano Lopes D , Nicola P , Esteves H 
Published: October 2020

Abstract

Background
Information about the users' experience is an essential element in patient-centered healthcare. We determined the score of the different elements of inpatient experiences of admission episodes in hospitals of the Portuguese health system and examined their contribution to the overall experience score.

Methods
A national cross-sectional study using randomized telephone interviews was conducted in the general population for the last episode of individuals who had an episode of hospitalization care between November 2016 and October 2017. Descriptive analysis of sociodemographic characteristics, care episode, hospital, elements of experience (16 dimensions), and global opinion was performed. The elements of experience were compared with the global experience through Spearman's correlation, with the contribution of each element to the global opinion calculated through weighted least squares regression.

Results
We obtained a total of 308 responses, 60.7% were female and the average age was 53.1 years, the average length of stay was 8.06 days; 35.1% were in medical departments; 56.5% were elective; 43.8% hospitals were in the Lisbon Metropolitan Area and 88.3% were from the public health service. All elements of experience and the overall opinion presented median values between 3 and (the maximum) 4. The correlation of each element with the global opinion is positive and statistically significant, having a contribution to the global opinion which varies between 11.5% and 51.6%, independently of demographic, episode of care or hospital characteristics. The domains of emotional support, empathy and respect; and communication, information and personal interaction make the greatest contribution to global opinion.

Conclusions
Elements of experience do not have the same weight on the global evaluation of inpatient individuals, which seem to privilege relational and interpersonal aspects of care. These findings have implications for patient-centered healthcare.

Key messages
Most users are satisfied with their hospitalization episodes of the Portuguese health system. The elements that contribute the most to the experience have to do with the healthcare workforce and their interaction with the users.
Barriers to reproductive health services utilization among adolescents
Authors: Hayrumyan V , Grigoryan Z , Sargsyan Z , Harutyunyan A , Petrosyan V 
Published: October 2020

Abstract

Background
Adolescents' access to quality reproductive health services is crucial for their psychosocial and physical wellbeing. Yet, adolescents encounter various barriers while utilizing reproductive health services, globally. Adolescent-friendly health services (AFHS) is an evidence-based intervention to meet the reproductive health needs inclusively of all adolescents. The study aimed to explore adolescents' experiences while seeking reproductive health services in primary healthcare facilities (PHCF) in Armenia.

Methods
We conducted a qualitative cross-sectional study using in-depth interviews, focus group discussions and observations of PHCFs. The study participants included adolescents (aged 18-19 years) (n = 17), PHC providers (PHP) (n = 29), managers of PHCFs (n = 7) and experts in the field of adolescent health (n = 5) from the two largest cities in Armenia. The Global standards for quality healthcare services for adolescents guided the instrument development process and deductive content analysis.

Results
Barriers to the utilization of reproductive health services by adolescents at PHCFs were related to various personal, cultural, and social factors. PHPs and experts blamed adolescents' insufficient knowledge of reproductive health and related services for being a major barrier. However, adolescents' reported a different set of important barriers to reproductive health services: PHPs' judgmental attitude, lack of efforts to protect privacy and confidentiality (due to lack of PHP competencies to provide AFHS and inadequate PHCF infrastructure), negative public opinion and lack of community support.

Conclusions
The study findings shed light on different perspectives related to various challenges adolescents come across in PHCFs. Addressing identified barriers have the potential of positively influencing adolescents' experiences while utilizing reproductive health services in PHCFs.

Key messages
Adolescents’ insufficient knowledge, PHPs’ judgmental attitude, lack of privacy and confidentiality, and negative public opinion are among the main barriers to the reproductive health services. Further enforcement of adolescent-friendly health services in primary healthcare facilities is needed to ensure accessibility of quality reproductive health services for all adolescents.
Strategies for improving primary care for adolescents and young adults transitioning from pediatric services: perspectives of Canadian primary health care professionals
Authors: Schraeder Kyleigh , Dimitropoulos Gina , Allemang Brooke , McBrien Kerry , Samuel Susan 
Published: October 2020

Abstract

Background
Family physicians and other members of the primary health care (PHC) team may be ideally positioned to provide transition care to adolescents and young adults (AYAs; aged 12–25 years) exiting pediatric specialty services. Potential solutions to well-known challenges associated with integrating PHC and specialty care need to be explored.

Objective
To identify strategies to transition care by PHC professionals for AYAs with chronic conditions transitioning from pediatric to adult-oriented care.

Methods
Participants were recruited from six Primary Care Networks in Calgary, Alberta. A total of 18 semi-structured individual interviews were completed, and transcribed verbatim. Data were analyzed using a qualitative description approach, involving thematic analysis.

Results
Participants offered a range of strategies for supporting AYAs with chronic conditions. Our analysis resulted in three overarching themes: (i) educating AYAs, families, and providers about the critical role of primary care; (ii) adapting existing primary care supports for AYAs and (iii) designing new tools or primary care practices for transition care.

Conclusions
Ongoing and continuous primary care is important for AYAs involved with specialty pediatric services. Participants highlighted a need to educate AYAs, families and providers about the critical role of PHC. Solutions to improve collaboration between PHC and pediatric specialist providers would benefit from additional perspectives from providers, AYAs and families. These findings will inform the development of a primary care-based intervention to improve transitional care.
Who is entitled to feel in the age of populism? Women's resistance to migrant detention in Britain
Authors: Bilgic Ali , Gkouti Athina 
Published: October 2020

Abstract
European states have adopted strict migration policies, such as unlimited detention in Britain, to address increasing anti-immigrant emotions in the context of rising anti-immigrant populism. These state practices prioritize the feelings of insecurity of some population groups towards immigrants whose emotions and insecurities are politically marginalized. Consequently, whose emotions matter in politics intertwines with whose security matters. This article articulates emotions in politics of security as an entitlement, which feed into the question of who ‘merits’ security politically. By focusing on individuals to whom such entitlement is denied in the context of anti-immigrant populism, it investigates how immigrant women ‘feel’ detention and enact their emotions in their own everyday ‘felt’ security. The research is conducted through in-depth interviews with women who experienced detention in Britain. Through the method of ‘listening guide’ adapted from psychology, the research studies their narratives about their emotions before, during and after detention. By bringing together the feminist research on emotions and ‘everyday security’ approaches in International Relations, this analysis contributes to feminist IR and security studies on women's agency in the politics of security, by revealing the importance of emotional dynamics in their everyday ‘felt’ security practices. Therefore, it offers a path for feminist IR and security studies to prioritize those whom anti-immigrant populism aims to silence in the age of populism.
Female peacekeepers’ added burden
Authors: Wilén Nina 
Published: October 2020

Abstract
Twenty years since the adoption of UN Security Council Resolution 1325 there is an almost unanimous call for an increased number of uniformed women in peace operations from policy-makers and multilateral organizations. This continuous push for the inclusion of more women is often justified by arguments about an increased operational effectiveness related to women's ‘added value’: both implicitly and explicitly advocating for greater gender equality. Yet, in this article, I contend that using instrumentalist arguments to increase the number of female peacekeepers may on the contrary undermine gender equality. This is related to the risk of producing self-fulfilling prophecies whereby female peacekeepers try to live up to the high expectations by fitting into gender-stereotypes and/or by working harder than their male colleagues. Rather than increase gender equality, such efforts risk transforming the female ‘added value’ to an ‘added burden’ which male peacekeepers do not have to carry. Anchoring the study in feminist theory with the aim to understand gendered relations of power, to illustrate my argument I draw on extensive interview material from military staff and peacekeepers in South Africa, Burundi, Belgium and Niger; interviews and informal discussions with female and male peacekeepers; and participation in several policy and research workshops on female participation in peacekeeping.
The dynamics of prototypical police forces: lessons from two Somali cities
Authors: Hills Alice 
Published: October 2020

Abstract
Sooner or later, donor-led discussions of state- and institution-building in conflict-affected societies with low literacy rates address the role of police forces, which are to be developed in the light of community-oriented policing. However, the implementation of a basic policing programme in the Somali cities of Kismayo and Baidoa in 2014 raises important questions about the applicability of this approach. It suggests that, rather than police in the western sense of the word, Somali forces are part of an endemic power structure that accommodates and normalizes instability. Focusing on what police officers actually do and on what local residents expect from them, this article uses three practical indicators to explore the factors at work: recruitment, reward (i.e. stipends) and, importantly, retention. This pragmatic approach allows an analytical and empirical exploration of a prototypical form of police and policing in a society lacking meaningful state-based institutions and processes. Specifically, Kismayo's and Baidoa's experience helps to identify the minimal requirements needed for formal policing in unstable societies. It suggests that militia-style policing is residual, rather than novel, and its dynamics are best understood as reflecting a series of social and political influences within unequal fields of power, with the emphasis on exploitation and survival.
The unintended impact of the European discard ban
Authors: Borges Lisa 
Published: October 2020

Abstract
The European Union (EU) discard ban, called the landing obligation (LO), was initiated in 2015 to reduce unwanted catches by EU fisheries. To ease the transition to a system where total allowable catches (TACs) refer to catches rather than landings only, the majority of EU TACs was increased to account for the part of the catch that was previously discarded and would now be landed. The analysis shows an average annual upward adjustment of 36% in TACs since 2015, but these percentages were considerably higher in 2019 and 2020 (reaching 43 and 50%, respectively), when the LO was fully applicable to all fisheries, and particularly for TACs of demersal species (reaching 51 and 60%). These results demonstrate the significant impact that the discard ban has had on the quantities of EU fishing opportunities. Since discarding has not declined in EU fisheries at any significant level, the magnitude of these increases may likely have resulted in a substantial widespread increase in fishing mortality being exerted on European stocks, and thus likely lead to an implosion of the EU TAC system, the Common Fisheries Policy central instrument to manage fisheries in the EU.
A strong order 3/4 method for SDEs with discontinuous drift coefficient
Authors: Müller-Gronbach Thomas , Yaroslavtseva Larisa 
Published: October 2020

Abstract
In this paper we study strong approximation of the solution of a scalar stochastic differential equation (SDE) at the final time in the case when the drift coefficient may have discontinuities in space. Recently, it has been shown in Müller-Gronbach & Yaroslavtseva (2020, On the performance of the Euler–Maruyama scheme for SDEs with discontinuous drift coefficient. Ann. Inst. Henri Poincaré Probab. Stat., 56, 1162–1178) that for scalar SDEs with a piecewise Lipschitz drift coefficient, and a Lipschitz diffusion coefficient that is nonzero at the discontinuity points of the drift coefficient the classical Euler–Maruyama scheme achieves an $L_p$-error rate of at least $1/2$ for all $p\in [1,\infty )$. Up to now this was the best $L_p$-error rate available in the literature for equations of that type. In the present paper we construct a method based on finitely many evaluations of the driving Brownian motion that even achieves an $L_p$-error rate of at least $3/4$ for all $p\in [1,\infty )$ under additional piecewise smoothness assumptions on the coefficients. This is the first higher order method known in the literature for SDEs of that type. We add that the $L_p$-error rate $3/4$ cannot be improved in general. To obtain the upper error bound for our new method, we prove in particular that a quasi-Milstein scheme achieves an $L_p$-error rate of at least $3/4$ in the case of coefficients that are both Lipschitz continuous and piecewise differentiable with Lipschitz continuous derivatives, which is of interest in itself. The latter error rates are obtained via a detailed analysis of the average size of increments of the time-continuous quasi-Milstein scheme over time intervals in which the scheme crosses a point of nondifferentiability of the coefficients.
Special Programme for Research and Training in Tropical Diseases-coordinated Multicountry Study to Determine the Burden and Causes of Residual Malaria Across Different Regions
Authors: Fouque Florence , Knox Tessa 
Published: October 2020

Abstract
The burden and causes of residual malaria were investigated between 2015 and 2019 through 5 research projects coordinated by the Special Program for Research and Training in Tropical Diseases (TDR), cosponsored by the United Nations Development Programme, UNICEF, the World Bank, the World Health Organization (WHO) and the WHO Global Malaria Programme. The 5 projects included 10 countries in 4 WHO regions: Africa, the Americas, South-East Asia, and the Western Pacific. The countries represented a range of malaria endemicities, from low to high levels of transmission. The main findings of the projects indicate that overall the core malaria vector control tools (long-lasting insecticidal nets [LLIN] and indoor residual spraying) were not deployed in the optimal way and/or not efficient in many settings of the supported projects. Furthermore, vector biting behavior and human activity–associated factors strongly contributed to malaria persistence. Changes in vector species composition and abundance, with an increase in outdoor biting, were also reported. Some of these factors may be an adaptation of the vectors to the deployment of the tools and/or can be linked to other sectors, such as agricultural practices, environmental changes, social factors, and water management. Human behaviors and sleeping habits that included activities and sleeping outside villages in unprotected dwellings were another part of the problem. The evidence collated demonstrates the need for new approaches, such as the multisectoral one and new vector control tools, all adapted to the local contexts and integrated into current malaria programs.
‘Chinese’ hegemony from a Korean shi perspective: aretocracy in the early modern East Asia
Authors: Choi Inho 
Published: October 2020

Abstract
The study of pre-modern Chinese hegemony is crucial for both theorizing hegemony and envisioning a new global order. I argue the pre-modern Chinese hegemony was a reciprocal rule of virtue, or aretocracy, driven by the transnational sociocultural elites shi. In contrast to the prevailing models of Chinese hegemony, the Early Modern East Asia was not dominated by the unilateral normative influence of the Chinese state. The Chinese and non-Chinese shi as non-statist sociocultural elites co-produced, through their shared civilizational heritage, a hegemonic order in which they had to show excellence in civil virtues to wield legitimate authority. In particular, the Ming and Chosŏn shi developed a tradition of envoy poetry exchanges as a medium for co-constructing Chinese hegemony as aretocracy. The remarkable role of excellent ethos for world order making in Early Modern East Asia compels us to re-imagine how we conduct our global governance.
Fluoroquinolone resistance in Achromobacter spp.: substitutions in QRDRs of GyrA, GyrB, ParC and ParE and implication of the RND efflux system AxyEF-OprN
Authors: Magallon Arnaud , Roussel Mathilde , Neuwirth Catherine , Tetu Jennifer , Cheiakh Anne-Charlotte , Boulet Baptiste , Varin Véronique , Urbain Victor , Bador Julien , Amoureux Lucie 
Published: October 2020

Abstract

Background
Achromobacter are emerging pathogens in cystic fibrosis patients. Mechanisms of resistance to fluoroquinolones are unknown in clinical isolates. Among non-fermenting Gram-negative bacilli, fluoroquinolone resistance is mostly due to amino acid substitutions in localized regions of the targets (GyrA, GyrB, ParC and ParE) named QRDRs, but also to efflux.

Objectives
To explore quinolone resistance mechanisms in Achromobacter.

Methods
The putative QRDRs of GyrA, GyrB, ParC and ParE were sequenced in 62 clinical isolates, and in vitro one-step mutants obtained after exposure to fluoroquinolones. An in vitro mutant and its parental isolate were investigated by RNASeq and WGS. RT–qPCR and gene inactivation were used to explore the role of efflux systems overexpression.

Results
We detected seven substitutions in QRDRs (Q83L/S84P/D87N/D87G for GyrA, Q480P for GyrB, T395A/K525Q for ParE), all in nine of the 27 clinical isolates with ciprofloxacin MIC ≥16 mg/L, whereas none among the in vitro mutants. The RND efflux system AxyEF-OprN was overproduced (about 150-fold) in the in vitro mutant NCF-39-Bl6 versus its parental strain NCF-39 (ciprofloxacin MICs 64 and 1.5 mg/L, respectively). A substitution in AxyT (putative regulator of AxyEF-OprN) was detected in NCF-39-Bl6. Ciprofloxacin MIC in NCF-39-Bl6 dropped from 64 to 1.5 mg/L following gene inactivation of either axyT or axyF. Substitutions in AxyT associated with overexpression of AxyEF-OprN were also detected in seven clinical strains with ciprofloxacin MIC ≥16 mg/L.

Conclusions
Target alteration is not the primary mechanism involved in fluoroquinolone resistance in Achromobacter. The role of AxyEF-OprN overproduction was demonstrated in one in vitro mutant.
Conscientious Objection in Health Care: Pinning down the Reasonability View
Authors: McConnell Doug 
Published: October 2020

Abstract
Robert Card’s “Reasonability View” is a significant contribution to the debate over the place of conscientious objection in health care. In his view, conscientious objections can only be accommodated if the grounds for the objection meet a reasonability standard. I identify inconsistencies in Card’s description of the reasonability standard and argue that each version he specifies is unsatisfactory. The criteria for reasonability that Card sets out most frequently have no clear underpinning principle and are too permissive of immoral objections. Card has also claimed that petitioners must justify their positions with Rawlsian public reason. I argue that, although the resulting reasonability standard is principled, it is overly restrictive. I also show that a reasonability standard built on Rawls’ more lenient conception of reasonableness would be overly permissive of objections at odds with professional healthcare standards. Finally, I argue for my favored solution, which bases the reasonability standard on minimal professional standards.