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Workers across the globe have evolved in their patterns of work, with increased flexibility emerging as a central theme. We highlight three forms of flexibility that workers have increasingly demanded: flexibility in location, schedule, and work design. We argue these capture the broad ways in which workers seek to structure and balance their work and nonwork lives, as well as their careers overall. We describe the evolution of each form of flexibility, review the benefits and challenges, and outline avenues for future research. Finally, we highlight a unique work arrangement, or setting, that infuses flexibility in unique ways – coworking spaces. We review what we know so far about coworking spaces, which have proliferated far faster than the scientific research that seeks to understand them. We conclude by outlining questions that may be good first priorities for emerging scholarly research in this area.
We propose the nasal administration of calcium-enriched physiological salts as a new hygienic intervention with possible therapeutic application as a response to the rapid and tenacious spread of COVID-19. We test the effectiveness of these salts against viral and bacterial pathogens in animals and humans. We find that aerosol administration of these salts to the airways diminishes the exhalation of the small particles that face masks fail to filter and, in the case of an influenza swine model, completely block airborne transmission of disease. In a study of 10 human volunteers (5 less than 65 years and 5 older than 65 years), we show that delivery of a nasal saline comprising calcium and sodium salts quickly (within 15 min) and durably (up to at least 6 h) diminishes exhaled particles from the human airways. Being predominantly smaller than 1 μm, these particles are below the size effectively filtered by conventional masks. The suppression of exhaled droplets by the nasal delivery of calcium-rich saline with aerosol droplet size of around 10 μm suggests the upper airways as a primary source of bioaerosol generation. The suppression effect is especially pronounced (99%) among those who exhale large numbers of particles. In our study, we found this high-particle exhalation group to correlate with advanced age. We argue for a new hygienic practice of nasal cleansing by a calcium-rich saline aerosol, to complement the washing of hands with ordinary soap, use of a face mask, and social distancing.
A new fossil site in a previously unexplored part of western Madagascar (the Beanka Protected Area) has yielded remains of many recently extinct vertebrates, including giant lemurs (Babakotia radofilai, Palaeopropithecus kelyus, Pachylemur sp., and Archaeolemur edwardsi), carnivores (Cryptoprocta spelea), the aardvark-like Plesiorycteropus sp., and giant ground cuckoos (Coua). Many of these represent considerable range extensions. Extant species that were extirpated from the region (e.g., Prolemur simus) are also present. Calibrated radiocarbon ages for 10 bones from extinct primates span the last three millennia. The largely undisturbed taphonomy of bone deposits supports the interpretation that many specimens fell in from a rock ledge above the entrance. Some primates and other mammals may have been prey items of avian predators, but human predation is also evident. Strontium isotope ratios (87Sr/86Sr) suggest that fossils were local to the area. Pottery sherds and bones of extinct and extant vertebrates with cut and chop marks indicate human activity in previous centuries. Scarcity of charcoal and human artifacts suggests only occasional visitation to the site by humans. The fossil assemblage from this site is unusual in that, while it contains many sloth lemurs, it lacks ratites, hippopotami, and crocodiles typical of nearly all other Holocene subfossil sites on Madagascar.
, a new answer set programming (ASP) system that integrates an efficient grounder, namely
, with an automatic selector that inductively chooses a solver: depending on some inherent features of the instantiation produced by
, machine learning techniques guide the selection of the most appropriate solver. The system participated in the latest (7th) ASP competition, winning the regular track, category SP (i.e., one processor allowed).
Introduction: Cigarette addiction results from both pharmacological effects of nicotine and the rewarding effects of associated cues, including respiratory tract sensations.
Aims: This study sought to evaluate the initial acceptability of a non-nicotine botanical formulation that provided similar respiratory tract cues.
Methods: Two active test products and matching placebos were evaluated. One test product, an e-cigarette-like device, delivered a visible aerosol upon puffing; the other test product delivered an invisible vapour at ambient temperature. Test products delivered a botanical extract with flavourings and vehicle; the placebos delivered flavourings and vehicle only. Sixteen participants had 3-h ad libitum access to each test product and associated placebos, and were deprived of combustible cigarettes for 1 h before and throughout the 3-h evaluation period. Subjects rated the satisfaction (primary outcome) and other sensory qualities of the products. Safety evaluations included pulmonary function testing and monitoring vital signs.
Results: Satisfaction ratings (seven-point scale) were significantly greater for the active e-cigarette-like condition; M = 3.18, SD = 1.04 versus M = 2.69, SD = 1.22. Safety evaluations showed no clinically significant changes.
Conclusions: The results support the potential acceptability of a non-nicotine cigarette substitute in providing satisfaction to smokers. This approach merits further evaluation for safety and acceptability in tobacco harm reduction and cessation.
Children reared in impoverished environments are at risk for enduring psychological and physical health problems. Mechanisms by which poverty affects development, however, remain unclear. To explore one potential mechanism of poverty's impact on social–emotional and cognitive development, an experimental examination of a rodent model of scarcity-adversity was conducted and compared to results from a longitudinal study of human infants and families followed from birth (N = 1,292) who faced high levels of poverty-related scarcity-adversity. Cross-species results supported the hypothesis that altered caregiving is one pathway by which poverty adversely impacts development. Rodent mothers assigned to the scarcity-adversity condition exhibited decreased sensitive parenting and increased negative parenting relative to mothers assigned to the control condition. Furthermore, scarcity-adversity reared pups exhibited decreased developmental competence as indicated by disrupted nipple attachment, distress vocalization when in physical contact with an anesthetized mother, and reduced preference for maternal odor with corresponding changes in brain activation. Human results indicated that scarcity-adversity was inversely correlated with sensitive parenting and positively correlated with negative parenting, and that parenting fully mediated the association of poverty-related risk with infant indicators of developmental competence. Findings are discussed from the perspective of the usefulness of bidirectional–translational research to inform interventions for at-risk families.
The present paper argues that the Doing Business indicators, their legitimacy (their ability to be defended through some logic or justification arising from standards) and the wider notions of legitimacy (the standards) that they promulgate are all best understood as social or, better still, ‘econosociolegal’ constructions. It tracks their, primarily post-financial crisis, re-co-construction within and beyond the World Bank from servant of the private sector and discipliner of states to something approaching social champion. But it warns that the perceptions of legitimacy that have been generated by those indicators may well linger.
Objectives: Amphetamine improves vigilance as assessed by continuous performance tests (CPT) in children and adults with attention deficit hyperactivity disorder (ADHD). Less is known, however, regarding amphetamine effects on vigilance in healthy adults. Thus, it remains unclear whether amphetamine produces general enhancement of vigilance or if these effects are constrained to the remediation of deficits in patients with ADHD. Methods: We tested 69 healthy adults (35 female) on a standardized CPT (Conner’s CPT-2) after receiving 10- or 20-mg d-amphetamine or placebo. To evaluate potential effects on learning, impulsivity, and perseveration, participants were additionally tested on the Iowa Gambling Task (IGT) and Wisconsin Card Sorting Task (WCST). Results: Participants receiving placebo exhibited the classic vigilance decrement, demonstrated by a significant reduction in attention (D’) across the task. This vigilance decrement was not observed, however, after either dose of amphetamine. Consistent with enhanced vigilance, the 20-mg dose also reduced reaction time variability across the task and the ADHD confidence index. The effects of amphetamine appeared to be selective to vigilance since no effects were observed on the IGT, WCST, or response inhibition/perseveration measures from the CPT. Conclusions: The present data support the premise that amphetamine improves vigilance irrespective of disease state. Given that amphetamine is a norepinephrine/dopamine transporter inhibitor and releaser, these effects are informative regarding the neurobiological substrates of attentional control. (JINS, 2018, 24, 283–293)
Although procedural sedation for cardioversion is a common event in emergency departments (EDs), there is limited evidence surrounding medication choices. We sought to evaluate geographic and temporal variation in sedative choice at multiple Canadian sites, and to estimate the risk of adverse events due to sedative choice.
This is a secondary analysis of one health records review, the Recent Onset Atrial Fibrillation or Flutter-0 (RAFF-0 [n=420, 2008]) and one prospective cohort study, the Recent Onset Atrial Fibrillation or Flutter-1 (RAFF-1 [n=565, 2010 – 2012]) at eight and six Canadian EDs, respectively. Sedative choices within and among EDs were quantified, and the risk of adverse events was examined with adjusted and unadjusted comparisons of sedative regimes.
In RAFF-0 and RAFF-1, the combination of propofol and fentanyl was most popular (63.8% and 52.7%) followed by propofol alone (27.9% and 37.3%). There were substantially more adverse events in the RAFF-0 data set (13.5%) versus RAFF-1 (3.3%). In both data sets, the combination of propofol/fentanyl was not associated with increased adverse event risk compared to propofol alone.
There is marked variability in procedural sedation medication choice for a direct current cardioversion in Canadian EDs, with increased use of propofol alone as a sedation agent over time. The risk of adverse events from procedural sedation during cardioversion is low but not insignificant. We did not identify an increased risk of adverse events with the addition of fentanyl as an adjunctive analgesic to propofol.
We consider a continuous review (s, S) model of perishable items with lost sales. Once items are perished the entire inventory drops instantaneously to zero. The total cost includes the cost of: ordering, unsatisfied demand, units destroyed, holding, and fixed cost of perishability. Both the time to perishability and the lead times are assumed to be exponentially distributed while two cases of demand distribution are considered: Poisson and compound Poisson with general demand sizes. We study the average cost criterion and provide computational results on the problem of finding the optimal re-order level, s, and order up-to level, S. None of the known work on the subject is as general as the model presented here. Our analysis leads to several insights on the optimal (s, S) policies for perishable items in the presence of lead times. For example, we demonstrate that the effectiveness of a heuristic that ignores perishability (and is also analyzed here) decreases with the demand variability and that the cost may either increase or decrease with this variability.
This paper is devoted to the performance analysis and optimization of blood testing procedures. We present a queueing model of two queues in series, representing the two stages of a blood-testing procedure. Service (testing) in stage 1 is performed in batches, whereas it is done individually in stage 2. Since particular elements of blood can only be stored and used within a finite time window, the sojourn time of blood units in the system of two queues in series is an important performance measure, which we study in detail. We also introduce a profit objective function, taking into account blood acquisition and screening costs as well as profits for blood units, which were found uncontaminated and were tested fast enough. We optimize that profit objective function w.r.t. the batch size and the length of the time window.
We consider a Cramér–Lundberg insurance risk process with the added feature of reinsurance. If an arriving claim finds the reserve below a certain threshold γ, or if it would bring the reserve below that level, then a reinsurer pays part of the claim. Using fluctuation theory and the theory of scale functions of spectrally negative Lévy processes, we derive expressions for the Laplace transform of the time to ruin and of the joint distribution of the deficit at ruin and the surplus before ruin. We specify these results in much more detail for the threshold set-up in the case of proportional reinsurance.
Over recent decades there have been various influences on health services for people with an intellectual disability (PWID). Chief of these has been the move from institutional care – where annual check-ups by medical officers were common practice – to community care, delivered by general practitioners (GPs) and community disability teams (CIDTs); also known as community learning disability teams.
There has also been a dramatically increased life expectancy, especially for those with more severe intellectual disability. Between 2001 and 2021, the population of PWID aged over 60 is expected to increase by 36%. It can be expected that increasingly complex physical health problems will be seen, related to having an intellectual disability and being elderly.
Finally, there is better understanding of physical health problems in this group, as genetic research and epidemiological surveys have increased clinicians’ knowledge; they have also increased patients’ and carers’ expectations of better management of health problems.
People with an intellectual disability are some of the most vulnerable members of our society and are often dependent on others for their support. Generally, they are of low socioeconomic status, with only 17% in paid work; have poor coping strategies; and are often excluded from society as 5% are without family or friends. Moreover, 23% experience physical and 47% verbal abuse. These factors coupled, with difficulties in communicating needs and accessing resources, have led to significant health inequalities.
People with intellectual disability are 58 times more likely to die before the age of 50 than the rest of the population4 and overall mortality rates are 3 times higher for people with moderate to severe intellectual disability; they also have higher rates of preventable deaths. There are a number of factors, discussed below, that might contribute to this, including the possibility of clinicians missing physical health problems because they dismiss behaviours that could be communicating illness or pain as solely due to the intellectual disability (‘diagnostic overshadowing’). In some cases there may also be therapeutic negativism or nihilism, with clinicians pursuing neither investigations nor vigorous treatment, for a variety of reasons (Box 27.1).
Research in the area of social networks and health has demonstrated that lay social network members play a critical role in the early stages of the illness career, influencing key decisions and pathways to formal care. Here, we revisit and extend this body of work, examining how the lay social network context can moderate the influence of treatment experiences on recovery outcomes as the illness career unfolds. To achieve this goal, we address two research questions, drawing on a longitudinal sample of people making their initial contact with the mental health treatment system: First, we explore how treatment experiences, lay social network characteristics, and recovery outcomes change over 2 years, beginning with the point of entry into treatment. Second, we examine whether the relationship between perceived treatment experiences and recovery outcomes is contingent on characteristics of the lay network context in which clients are socially embedded, focusing on the network's cultural orientation toward medical professionals. We find that positive treatment interactions facilitate improved self-esteem, mastery, role functioning, recovery optimism, and global functioning when the lay network culture is pro-medical, but largely have null effects on the recovery process when the lay network is more hostile to medical professionals.
Long-acting injectable formulations of antipsychotics are treatment alternatives to oral agents.
To assess the efficacy of aripiprazole once-monthly compared with oral aripiprazole for maintenance treatment of schizophrenia.
A 38-week, double-blind, active-controlled, non-inferiority study; randomisation (2:2:1) to aripiprazole once-monthly 400 mg, oral aripiprazole (10–30 mg/day) or aripiprazole once-monthly 50mg (a dose below the therapeutic threshold for assay sensitivity). (Trial registration: clinicaltrials.gov, NCT00706654.)
A total of 1118 patients were screened, and 662 responders to oral aripiprazole were randomised. Kaplan–Meier estimated impending relapse rates at week 26 were 7.12% for aripiprazole once-monthly 400mg and 7.76% for oral aripiprazole. This difference (−0.64%, 95% CI −5.26 to 3.99) excluded the predefined non-inferiority margin of 11.5%. Treatments were superior to aripiprazole once-monthly 50mg (21.80%, P⩽0.001).
Aripiprazole once-monthly 400mg was non-inferior to oral aripiprazole, and the reduction in Kaplan–Meier estimated impending relapse rate at week 26 was statistically significant v. aripiprazole once-monthly 50 mg.
We consider a production–inventory control model with two reflecting boundaries, representing the finite storage capacity and the finite maximum backlog. Demands arrive at the inventory according to a Poisson process, their i.i.d. sizes having a common phase-type distribution. The inventory is filled by a production process, which alternates between two prespecified production rates ρ1 and ρ2: as long as the content level is positive, ρ1 is applied while the production follows ρ2 during time intervals of backlog (i.e., negative content). We derive in closed form the various cost functionals of this model for the discounted case as well as under the long-run-average criterion. The analysis is based on a martingale of the Kella–Whitt type and results for fluid flow models due to Ahn and Ramaswami.