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This article studies multi-stakeholder initiatives (MSIs) as spaces for both deliberation and contestation between constituencies with competing discourses and disputed values, beliefs, and preferences. We review different theoretical perspectives on MSIs, which see them mainly as spaces to find solutions to market problems (economic approach), as spaces of conflict and bargaining (political approach), or as spaces of consensus (deliberative approach). In contrast, we build on a contestatory deliberative perspective, which gives equal value to both contestation and consensus. We identify four types of internal contestation which can be present in MSIs—procedural, inclusiveness, epistemic, and ultimate-goal—and argue that embracing contestation and engaging in ongoing revision of provisional agreements, criteria, and goals can enhance the democratic quality of MSIs. Finally, we explore the implications of this perspective for theorizing about the democratic quality in MSIs and about the role of corporations in transnational governance.
The rocky shores of the north-east Atlantic have been long studied. Our focus is from Gibraltar to Norway plus the Azores and Iceland. Phylogeographic processes shape biogeographic patterns of biodiversity. Long-term and broadscale studies have shown the responses of biota to past climate fluctuations and more recent anthropogenic climate change. Inter- and intra-specific species interactions along sharp local environmental gradients shape distributions and community structure and hence ecosystem functioning. Shifts in domination by fucoids in shelter to barnacles/mussels in exposure are mediated by grazing by patellid limpets. Further south fucoids become increasingly rare, with species disappearing or restricted to estuarine refuges, caused by greater desiccation and grazing pressure. Mesoscale processes influence bottom-up nutrient forcing and larval supply, hence affecting species abundance and distribution, and can be proximate factors setting range edges (e.g., the English Channel, the Iberian Peninsula). Impacts of invasive non-native species are reviewed. Knowledge gaps such as the work on rockpools and host–parasite dynamics are also outlined.
Direct numerical simulations of two superposed fluids in a channel with a textured surface on the lower wall have been carried out. A parametric study varying the viscosity ratio between the two fluids has been performed to mimic both idealised super-hydrophobic and liquid-infused surfaces and assess its effect on the frictional, form and total drag for three different textured geometries: longitudinal square bars, transversal square bars and staggered cubes. The interface between the two fluids is assumed to be slippery in the streamwise and spanwise directions and not deformable in the vertical direction, corresponding to the ideal case of infinite surface tension. To identify the role of the fluid–fluid interface, an extra set of simulations with a single fluid has been carried out. Comparison with the cases with two fluids reveals the role of the interface in suppressing turbulent transport between the lubricating layer and the overlying flow decreasing the overall drag. In addition, the drag and the maximum wall-normal velocity fluctuations were found to be highly correlated for all the surface configurations, whether they reduce or increase the drag. This implies that the structure of the near-wall turbulence is dominated by the total shear and not by the local boundary condition of the super-hydrophobic, liquid infused or rough surfaces.
High spatial resolution observations with ALMA and VLT/SPHERE show gaps and rings in continuum emission of protoplanetary disks, possibly indicating ongoing planet formation. However, it is still unclear if the gas follows the dust distribution. We present radiation thermo-chemical models for the disk of HD 163296 to study the impact of dust and gas gaps on the chemistry and molecular line emission. We compare a model with only dust gaps to a model that also has gas gaps. In both models, rings and gaps are visible in (sub)mm molecular line emission. Due to chemistry, certain molecules are sensitive to dust gaps where others are more sensitive to gas depletion. Observations of multiple molecules might allow to accurately determine the degree of gas depletion within the dust gaps, information crucial to discriminate between gap formation theories (e.g. planets, ice lines).
The serotonin-transporter-linked polymorphic region (5-HTTLPR) polymorphisms are associated with suicidal behavior; however, prospective studies are scarce. Herein we aim to determine if 5-HTTLPR polymorphisms predict risk of short-term suicide reattempt in a high-risk suicidal sample. We also explore possible mediators or moderators of this relationship.
A multicenter prospective cohort study was designed to compare data obtained form 136 patients admitted to the emergency department for current suicidal ideation or a recent suicide attempt. Subjects were clinically evaluated, genotyped, and monitored for a new suicide attempt for 6 months.
At 6 months of follow up, 21% of the subjects had a new suicide attempt. The frequency of L-allele and L-carrier was higher in reattempters when compared with non-reattempters (55.8% vs. 35.4%, p = 0.01 and 76.9% vs. 54.2%, p = 0.04, respectively). Reattempters also differ from non-reattempters patients with respect to age, history of previous suicide attempts, and age of onset of suicidal behavior. The logistic regression model showed that L-carriers had an odds ratio of 2.8 (95% CI: 1.0–7.6) for reattempts when compared to SS genotype. The adjusted model indicates that this association is not mediated or moderated by impulsivity.
The 5-HTTLPR polymorphisms predicted short-term risk of suicidal reattempt independently of age and sex. L-carriers have almost three times more risk of relapse when compared with SS carriers.
Late-life depression affects 2–6% of seniors aged 60 years and above. Patients are increasingly embracing non-pharmacological therapies, many of which have not been scientifically evaluated. This study aimed to evaluate a category of meditation, automatic self-transcending meditation (ASTM), in alleviating symptoms of depression when augmenting treatment as usual (NCT02149810). The preliminary results of an ongoing single-blind randomised controlled trial comparing a training programme involving ASTM with a wait-list control indicate that a 12-week ASTM programme may lead to significantly greater reductions in depression and anxiety severity. As such, ASTM may be an effective adjunctive therapy in the treatment of late-life depression.
We consider dynamical systems, consisting of
-actions by continuous automorphisms on shift-invariant subgroups of
is the field of order
. These systems provide natural generalizations of Ledrappier’s system, which was the first example of a 2-mixing
-action that is not 3-mixing. Extending the results from our previous work on Ledrappier’s example, we show that, under quite mild conditions (namely, 2-mixing and that the subgroup defining the system is a principal Markov subgroup), these systems are almost strongly mixing of every order in the following sense: for each order, one just needs to avoid certain effectively computable logarithmically small sets of times at which there is a substantial deviation from mixing of this order.
OBJECTIVES/SPECIFIC AIMS: Our goal was to compare the ventriculo-arterial coupling and left ventricular mechanical work of patients with systolic and diastolic heart failure (SHF and DHF). METHODS/STUDY POPULATION: Patients with New York Heart Association Functional Class II-III HF symptoms were included. SHF was defined as left ventricular (LV) ejection fraction<50% and DHF as >50%. Analysis of the fingertip arterial blood pressure tracing captured with a finger plethysmography cuff according to device-specific algorithms provided brachial artery blood pressure and stroke volume. LV end-systolic volume was measured separately via transthoracic echocardiography. Arterial elastance (Ea), a measure of pulsatile and nonpulsatile LV afterload, was calculated as LV end-systolic pressure (ESP)/end-diastolic volume. End-systolic elastance (Ees), a measure of load-independent LV contractility, was calculated as LV ESP/end-systolic volume. Ventriculo-arterial coupling (VAC) ratio was defined as Ea/Ees. Stroke work (SWI) was calculated as stroke volume index×LV end-systolic pressure×0.0136 and potential energy index (PEI) as 1/2×(LV end-systolic volume×LV end-systolic pressure×0.0136). Total work index (TWI) was the sum of SWI+PEI. RESULTS/ANTICIPATED RESULTS: Patients with SHF (n=52) and DHF (n=29) were evaluated. Median (IQR) age was 57 (51–64) years. There were 48 (58%) and 59 (71%) patients were male and African American, respectively. Cardiac index was 2.8 (2.2–3.2) L/minute and 3.0 (2.8–3.3) L/minute in SHF and DHF, respectively (p=0.12). Self-reported activity levels (Duke Activity Status Index, p=0.48) and heart failure symptoms (Minnesota Living with Heart Failure Questionnaire, p=0.55) were not different between SHF and DHF. Ea was significantly lower in DHF compared with SHF patients [1.3 (1.2–1.6) vs. 1.7 (1.4–2.0) mmHg; p<0.001] whereas Ees was higher in DHF vs. SHF [2.8 (2.1–3.1) vs. 0.9 (0.7-1.3) mmHg; p<0.001). VAC was 1.8 (1.3–2.8) in SHF Versus 0.5 (0.4–0.7) in DHF (p<0.001). Compared with SHF, DHF patients had higher SWI [71 (57–83) vs. 48 (39–68) gm×m; p<0.001) and lower PEI [19 (12–26) vs. 44 (36–57) gm×m; p<0.001]. TWI did not differ between SHF and DHF (p=0.14). Work efficiency was higher in DHF than SHF [0.80 (0.74–0.84) vs. 0.53 (0.46–0.64); p<0.001]. DISCUSSION/SIGNIFICANCE OF IMPACT: The results underscore the differences in pathophysiology between SHF and DHF patients with similar symptom burden and exercise capacity. These results highlight the difference in myocardial energy utilization between SHF and DHF.
Liquid-infused surfaces present a novel, passive method of turbulent drag reduction. Inspired by the Nepenthes Pitcher Plant, liquid-infused surfaces utilize a lubricating fluid trapped within structured roughness to facilitate a slip at the effective surface. The conceptual idea is similar to that of superhydrophobic surfaces, which rely on a lubricating air layer, whereas liquid-infused surfaces use a preferentially wetting liquid lubricant to create localized fluid–fluid interfaces. Maintaining the presence of these slipping interfaces has been shown to be an effective method of passively reducing skin friction drag in turbulent flows. Given that liquid-infused surfaces have only recently been considered for drag reduction applications, there is no available framework to relate surface and lubricant characteristics to any resulting drag reduction. Here we use results from direct numerical simulations of turbulent channel flow over idealized, liquid-infused grooves to demonstrate that the drag reduction achieved using liquid-infused surfaces can be described using the framework established for superhydrophobic surfaces. These insights can be used to explain drag reduction results observed in experimental studies of lubricant-infused surfaces. We also demonstrate how a liquid-infused surface can reduce drag even when the viscosity of the lubricant exceeds that of the external fluid flow, which at first glance can seem counter-intuitive.
Due to rising pressure to appear egalitarian, subtle discrimination pervades today's workplace. Although its ambiguous nature may make it seem innocuous on the surface, an abundance of empirical evidence suggests subtle discrimination undermines employee and organizational functioning, perhaps even more so than its overt counterpart. In the following article, we argue for a multidimensional and continuous, rather than categorical, framework for discrimination. In doing so, we propose that there exist several related but distinct continuums on which instances of discrimination vary, including subtlety, formality, and intentionality. Next, we argue for organizational scholarship to migrate toward a more developmental, dynamic perspective of subtle discrimination in order to build a more comprehensive understanding of its antecedents, underlying mechanisms, and outcomes. We further contend that everyone plays a part in the process of subtle discrimination at work and, as a result, bears some responsibility in addressing and remediating it. We conclude with a brief overview of research on subtle discrimination in the workplace from each of four stakeholder perspectives—targets, perpetrators, bystanders, and allies—and review promising strategies that can be implemented by each of these stakeholders to remediate subtle discrimination in the workplace.
Objectives: The aim of this study was to assess viewpoints of end-users concerning the purchasing process of high-risk medical devices and to discuss the relevance of health technology assessments (HTAs) at the hospital level and other potential areas for improvement of purchasing processes.
Methods: We used a cross-sectional study and assessed the attitudes and thoughts of orthopedic specialists. The study took place between June and October 2015 in Mexico.
Results: We collected data from 187 orthopedic surgeons. Involvement of orthopedic specialists in purchasing was reported by 86 percent. However, clinical practice was perceived as negatively influenced by purchasing outcomes by 92 percent. The problems were described as: material failure; effectiveness of medical devices; obsolete medical device technology; incomplete provision of implant / instrument sets; delayed provision of implants and instruments.
Conclusions: To prevent sub-standard outcomes of purchasing decisions, this study and the current literature suggest that technologies should be assessed during the purchasing process, end-users should be adequately involved, and decisions should be based on multiple criteria including clinical impact in the short-term (e.g., primary stability of implant) and long-term (e.g., survival of implant). The focus on Mexico is particularly novel and provides insights into a health system where HTA is mainly present at the macro level and can be used for the listing of medical device technologies in the standard list. This study concludes that Mexican stakeholders of the purchasing process underestimate the contribution of HTAs at the level of purchasing decisions. HTA in Mexico has improved over the past years but still requires more advancement.
During several decades and until the end of the 1990s, the theory of structural economic dynamics has been absent in the field of so-called mainstream economic analysis. The literature included only either empirically oriented contributions or developments that were related to so-called critical theoretical approaches of structural change. At the end of the twentieth century, however, mainstream economic theorists changed this situation and began to investigate the field of structural dynamics, often using the Solovian theory of economic growth. During the last two decades, they contributed to change substantially the state of the theory of structural change. This contribution first provides an assessment of the advances realized by these theorists. It then confronts these advances with the so-called alternative or critical theoretical approaches of structural dynamics—namely, Luigi Pasinetti’s contribution and ‘evolutionary’ approaches—in order to provide a more complete picture of structural dynamics in the short and the long run.