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While the concept of economic nationalism is frequently deployed it is poorly defined, posited as the cause of protectionism in some cases while providing a rationale for liberalization in others. This Element provides a more rigorous articulation by analyzing variation in foreign investment regulation in postwar India and Brazil. Conventional approaches cite India's leftist ”socialism” and Brazil's right-wing authoritarianism to explain why India resisted foreign direct investment (FDI) while Brazil welcomed foreign firms in this period. However, this ignores puzzling industry-level variation: India restricted FDI in auto manufacturing but allowed multinationals in oil while Brazil welcomed foreign auto companies but prohibited FDI in oil. This variation is inadequately explained by pluralist theories, structural-material approaches, or constructivist theories. Policymakers' preferences were shaped by contrasting colonial experiences that generated distinct economic nationalisms and policies and patterns of industrialization in both countries. This title is also available as Open Access on Cambridge Core.
This study assesses the relationship between adverse childhood experiences (ACE) occurring before the age of 18 years and patterns of fast-food consumption and sugary beverage consumption in adulthood. The study also examines how perceived stress and socio-economic status (SES) (college educational attainment and income) in adulthood mediate this relationship.
Design:
Using data from the National Longitudinal Study of Adolescent to Adulthood Health (N 8599), multinomial logistic regression analyses were carried out to assess the association between ACE and unhealthy dietary behaviours in adulthood. Karlson–Holm–Breen mediation analysis is used to determine the mediating effects of SES and perceived stress.
Setting:
Persons living in the USA in 2016–2018.
Participants:
Adults (n 8599) aged 33–44 years.
Results:
The findings show an association between four or more ACE and high fast-food (relative risk ratio (RRR) = 1·436, 95 % CI = 1·040, 1·983) and high sugary beverage consumption (RRR = 1·435, 95 % CI = 1·002, 2·055). The association between ACE and high fast-food consumption is partially mediated by college educational attainment, and the association between ACE and high sugary beverage consumption is partially mediated by perceived stress and college educational attainment.
Conclusions:
ACE can have long-term consequences for unhealthy dietary behaviours in adulthood, and this relationship is partially due to a lower likelihood of higher perceived stress and college educational attainment among ACE-exposed persons. Future research is needed to understand further the influence of ACE on dietary patterns over the life course.
Dobbs v. Jackson Women’s Health continues a trajectory of U.S. Supreme Court jurisprudence that undermines the normative foundation of public health — the idea that the state is obligated to provide a robust set of supports for healthcare services and the underlying social determinants of health. Dobbs furthers a longstanding ideology of individual responsibility in public health, neglecting collective responsibility for better health outcomes. Such an ideology on individual responsibility not only enables a shrinking of public health infrastructure for reproductive health, it facilitates the rise of reproductive coercion and a criminal legal response to pregnancy and abortion. This commentary situates Dobbs in the context of a long historical shift in public health that increasingly places burdens on individuals for their own reproductive health care, moving away from the possibility of a robust state public health infrastructure.
Frontal ablation, the combination of submarine melting and iceberg calving, changes the geometry of a glacier's terminus, influencing glacier dynamics, the fate of upwelling plumes and the distribution of submarine meltwater input into the ocean. Directly observing frontal ablation and terminus morphology below the waterline is difficult, however, limiting our understanding of these coupled ice–ocean processes. To investigate the evolution of a tidewater glacier's submarine terminus, we combine 3-D multibeam point clouds of the subsurface ice face at LeConte Glacier, Alaska, with concurrent observations of environmental conditions during three field campaigns between 2016 and 2018. We observe terminus morphology that was predominately overcut (52% in August 2016, 63% in May 2017 and 74% in September 2018), accompanied by high multibeam sonar-derived melt rates (4.84 m d−1 in 2016, 1.13 m d−1 in 2017 and 1.85 m d−1 in 2018). We find that periods of high subglacial discharge lead to localized undercut discharge outlets, but adjacent to these outlets the terminus maintains significantly overcut geometry, with an ice ramp that protrudes 75 m into the fjord in 2017 and 125 m in 2018. Our data challenge the assumption that tidewater glacier termini are largely undercut during periods of high submarine melting.
Identifying the most effective ways to support career development of early stage investigators in clinical and translational science should yield benefits for the biomedical research community. Institutions with Clinical and Translational Science Awards (CTSA) offer KL2 programs to facilitate career development; however, the sustained impact has not been widely assessed.
Methods:
A survey comprised of quantitative and qualitative questions was sent to 2144 individuals that had previously received support through CTSA KL2 mechanisms. The 547 responses were analyzed with identifying information redacted.
Results:
Respondents held MD (47%), PhD (36%), and MD/PhD (13%) degrees. After KL2 support was completed, physicians’ time was divided 50% to research and 30% to patient care, whereas PhD respondents devoted 70% time to research. Funded research effort averaged 60% for the cohort. Respondents were satisfied with their career progression. More than 95% thought their current job was meaningful. Two-thirds felt confident or very confident in their ability to sustain a career in clinical and translational research. Factors cited as contributing to career success included protected time, mentoring, and collaborations.
Conclusion:
This first large systematic survey of KL2 alumni provides valuable insight into the group’s perceptions of the program and outcome information. Former scholars are largely satisfied with their career choice and direction, national recognition of their expertise, and impact of their work. Importantly, they identified training activities that contributed to success. Our results and future analysis of the survey data should inform the framework for developing platforms to launch sustaining careers of translational scientists.
To describe the perceived qualities of successful palliative care (PC) providers in the emergency department (ED), barriers and facilitators to ED–PC, and clinicians’ perspectives on the future of ED–PC.
Method
This qualitative study using semi-structured interviews was conducted in June–August 2020. Interviews were analyzed via a two-phase Rapid Analysis. The study's primary outcomes (innovations in ED–PC during COVID) are published elsewhere. In this secondary analysis, we examine interviewee responses to broader questions about ED–PC currently and in the future.
Results
PC providers perceived as successful in their work in the ED were described as autonomous, competent, flexible, fast, and fluent in ED language and culture. Barriers to ED–PC integration included the ED environment, lack of access to PC providers at all times, the ED perception of PC, and the lack of a supporting financial model. Facilitators to ED–PC integration included proactive identification of patients who would benefit from PC, ED-focused PC education and tools, PC presence in the ED, and data supporting ED–PC. Increased primary PC education for ED staff, increased automation, and innovative ED–PC models were seen as areas for future growth.
Significance of results
Our findings provide useful information for PC programs considering expanding their ED presence, particularly as this is the first study to our knowledge that examines traits of successful PC providers in the ED environment. Our findings also suggest that, despite growth in the arena of ED–PC, barriers and facilitators remain similar to those identified previously. Future research is needed to evaluate the impact that ED–PC initiatives may have on patient and system outcomes, to identify a financial model to maintain ED–PC integration, and to examine whether perceptions of successful providers align with objective measures of the same.
Insomnia is a common major health concern, which causes significant distress and disruption in a person's life. The objective of this paper was to evaluate a 6-week version of Mindfulness-Based Therapy for Insomnia (MBTI) in a sample of people attending a sleep disorders clinic with insomnia, including those with comorbidities. Thirty participants who met the DSM-IV-TR diagnosis of insomnia participated in a 6-week group intervention. Outcome measures were a daily sleep diary and actigraphy during pre-treatment and follow-up, along with subjective sleep outcomes collected at baseline, end-of-treatment, and 3-month follow-up. Trend analyses showed that MBTI was associated with a large decrease in insomnia severity (p < .001), with indications of maintenance of treatment effect. There were significant improvements in objective sleep parameters, including sleep onset latency (p = .005), sleep efficiency (p = .033), and wake after sleep onset (p = .018). Significant improvements in subjective sleep parameters were also observed for sleep efficiency (p = .005) and wake after sleep onset (p < .001). Overall, this study indicated that MBTI can be successfully delivered in a sleep disorders clinic environment, with evidence of treatment effect for both objective and subjective measures of sleep.
Clinical and Translational Science Award (CTSA) TL1 trainees and KL2 scholars were surveyed to determine the immediate impact of the COVID-19 pandemic on training and career development. The most negative impact was lack of access to research facilities, clinics, and human subjects, plus for KL2 scholars lack of access to team members and need for homeschooling. TL1 trainees reported having more time to think and write. Common strategies to maintain research productivity involved time management, virtual connections with colleagues, and shifting to research activities not requiring laboratory/clinic settings. Strategies for mitigating the impact of the COVID-19 pandemic on training and career development are described.
Ice mélange has been postulated to impact glacier and fjord dynamics through a variety of mechanical and thermodynamic couplings. However, observations of these interactions are very limited. Here, we report on glaciological and oceanographic data that were collected from 2016 to 2017 at LeConte Glacier and Bay, Alaska, and serendipitously captured the formation, flow and break-up of ephemeral ice mélange. Sea ice formed overnight in mid-February. Over the subsequent week, the sea ice and icebergs were compacted by the advancing glacier terminus, after which the ice mélange flowed quasi-statically. The presence of ice mélange coincided with the lowest glacier velocities and frontal ablation rates in our record. In early April, increasing glacier runoff and the formation of a sub-ice-mélange plume began to melt and pull apart the ice mélange. The plume, outgoing tides and large calving events contributed to its break-up, which took place over a week and occurred in pulses. Unlike observations from elsewhere, the loss of ice mélange integrity did not coincide with the onset of seasonal glacier retreat. Our observations provide a challenge to ice mélange models aimed at quantifying the mechanical and thermodynamic couplings between ice mélange, glaciers and fjords.
Reconstructions of prehistoric vegetation composition help establish natural baselines, variability, and trajectories of forest dynamics before and during the emergence of intensive anthropogenic land use. Pollen–vegetation models (PVMs) enable such reconstructions from fossil pollen assemblages using process-based representations of taxon-specific pollen production and dispersal. However, several PVMs and variants now exist, and the sensitivity of vegetation inferences to PVM selection, variant, and calibration domain is poorly understood. Here, we compare the reconstructions, parameter estimates, and structure of a Bayesian hierarchical PVM, STEPPS, both to observations and to REVEALS, a widely used PVM, for the pre–Euro-American settlement-era vegetation in the northeastern United States (NEUS). We also compare NEUS-based STEPPS parameter estimates to those for the upper midwestern United States (UMW). Both PVMs predict the observed macroscale patterns of vegetation composition in the NEUS; however, reconstructions of minor taxa are less accurate and predictions for some taxa differ between PVMs. These differences can be attributed to intermodel differences in structure and parameter estimates. Estimates of pollen productivity from STEPPS broadly agree with estimates produced for use in REVEALS, while comparison between pollen dispersal parameter estimates shows no significant relationship. STEPPS parameter estimates are similar between the UMW and NEUS, suggesting that STEPPS parameter estimates are transferable between floristically similar regions and scales.
In order to conduct translational science, scientists must combine domain-specific expertise with knowledge on how to identify and cross translational hurdles, and insights on positioning discoveries for the next translational stage. Expert educators from the Clinical and Translational Science Awards (CTSA) Consortium identified 97 knowledge, skills, and abilities (KSAs) important to include in training programs for translational scientists. To assist educators and trainees to use these KSAs, a conceptual model called “Personalized Pathways” was developed that prioritizes KSAs based on trainee background, research area, or phenotype, and expertise on the research team.
Purpose:
To understand how CTSA educators prioritize specific KSAs when developing personalized training plans for different translational phenotypes and to identify areas of similarity and difference across phenotypes.
Methods:
A web-based, cross-sectional survey of CTSA educators was done. For a selected phenotype, respondents recommended one of four levels of mastery for each of the 97 KSAs. Results were tabulated by frequency, weighted by importance, and divided into tertiles representing high, middle, and lower priority KSAs. Agreement across phenotypes was compared using Krippendorff’s alpha.
Results:
Ten KSAs were high training priority for Preclinical, Clinical, and Community-Engaged phenotypes. These address research methods, responsible conduct of research, team building, and communicating research results. Nine KSAs were in the next tertile for priority reflecting KSAs in biostatistics, bioinformatics, regulatory precepts, and translating implications of research findings.
Conclusion:
A smaller set of KSAs can be prioritized for training Preclinical-, Clinical-, and Community-Engaged researchers. Future work should explore this approach for other phenotypes.
Over the past few years, platform firms such as Amazon, Google, Facebook and Uber (and their global counterparts and competitors such as Alibaba and Tencent in China) have emerged at the vanguard of international business. These firms represent revolutionary forms of oligopolistic capital and may hold major implications for industry organization, market structure and perhaps even the future of the corporate organizational form. However, despite their ubiquity, understanding the rise of these firms is anything but straightforward. On the one hand, their rapid growth is predicated on new disruptive technologies that generate market value through machine learning algorithms and big data. Yet, on the other hand, the success of their business models is fundamentally predicated on the now-familiar structural and institutional transformations of the global economy that have occurred during the past few decades of neoliberal globalization. These include changes in trade, investment, and labor laws and policies that have facilitated global capital flows and rendered workers vulnerable in countries around the world.
Indeed, a core feature of platform firm strategy has been to leverage the material power of their large size to take advantage of high levels of global liquidity to capture surplus finance and rapidly capitalize much more quickly than conventional multinational corporations in manufacturing and extractive industries. Further, unlike conventional firms, multisided platforms deploy novel techniques of aggregating and deploying labor on demand while leveraging the power of network effects to rapidly grow their consumer base and build scale. This may have allowed these firms to generate technical efficiencies, but it also enabled them to amass significant political power through both large size and pervasive presence across markets. Platforms have also developed mechanisms for co-opting and directly deploying their consumers as resources in aggressive efforts to challenge conventional regulation at the urban, national and global scale. These dynamics challenge simple narratives of innovation-led growth in platform firms in favor of explanations that are informed by the political economy. In other words, the technological and political are deeply intertwined. This essay seeks to critically assess the growth of platform firms and markets in this latest development in global capitalism.
Community stroke rehabilitation (CSR) is an effective program for survivors to recover at home supported by a multidisciplinary team. A home-based, specialized CSR program was delivered in Windsor, Ontario, to stroke patients who faced barriers to accessing outpatient services following inpatient rehabilitation. Preliminary results show program patients made significant functional improvements from baseline to program discharge. A subgroup analysis revealed that, after adjusting for age and resource intensity, moderate to severe stroke patients made greater functional gains compared to mild stroke patients. The individualized focus of CSR delivered in the home provides an effective model of rehabilitation for continued stroke care in the community.
This chapter demonstrates how the tools of law and political economy bring to bear new challenges in the growing use of economic and social rights. In 2013, the government of India enacted new food security legislation. The Right to Food Act aims to provide impoverished consumers with adequate food grains at a reasonable price, expanding a long-standing Indian subsidy program in the language of human rights. This new right to food is widely hailed by activists and policy makers, but largely coincided with the entry of large multinational retail chains in the food retail market, potentially catalyzing significant shifts in food distribution. This chapter examines India’s new right to food, then, to unpack larger debates about the structure of the food economy in India, including by unpacking a complex interplay of conflicts and interests among producers and consumers, rural and urban citizens, small and large capital. The industrialization and consolidation of production and distribution systems finds justification simultaneously in the language of large-scale efficiency and market liberalization as well as in the language of accountability in economic and social rights.
We present a workflow to track icebergs in proglacial fjords using oblique time-lapse photos and the Lucas-Kanade optical flow algorithm. We employ the workflow at LeConte Bay, Alaska, where we ran five time-lapse cameras between April 2016 and September 2017, capturing more than 400 000 photos at frame rates of 0.5–4.0 min−1. Hourly to daily average velocity fields in map coordinates illustrate dynamic currents in the bay, with dominant downfjord velocities (exceeding 0.5 m s−1 intermittently) and several eddies. Comparisons with simultaneous Acoustic Doppler Current Profiler (ADCP) measurements yield best agreement for the uppermost ADCP levels (~ 12 m and above), in line with prevalent small icebergs that trace near-surface currents. Tracking results from multiple cameras compare favorably, although cameras with lower frame rates (0.5 min−1) tend to underestimate high flow speeds. Tests to determine requisite temporal and spatial image resolution confirm the importance of high image frame rates, while spatial resolution is of secondary importance. Application of our procedure to other fjords will be successful if iceberg concentrations are high enough and if the camera frame rates are sufficiently rapid (at least 1 min−1 for conditions similar to LeConte Bay).
A new family of six ionenes containing aromatic amide linkages has been synthesized from ready available starting materials at scales up to ∼50 g. These ionene-polyamides are all constitutional isomers and vary only in the regiochemistry of the amide linkages (para, meta) and xylyl linkages (ortho, meta, para) which are present in the polymer backbone. This paper details the synthesis of these ionenes and associated characterizations. Ionene-polyamides exhibit relatively low melting points (∼150 oC) allowing them to be readily processed into films and other objects. These ionene-polyamide materials are being developed for further study as polymer membranes for the separations of gases such as CO2, N2, CH4 and H2.
Examining the influence of campaign tone on individual turnout in the 1990 U.S. Senate elections, this note revisits Kahn and Kenney's conclusion that the political profile of citizens (as based on partisanship, level of political interest, and level of political expertise) conditions their responsiveness. Implementing an appropriate modeling strategy for making group comparisons, our analyses do not provide statistical support for the conditional effects that they highlight. More generally, our results do reinforce Kahn and Kenney's finding that negativity in tone of news coverage mobilizes citizens, but they do not reveal significant turnout influence for television advertising tone.
The number of pediatric antimicrobial stewardship programs (ASPs) is increasing and program evaluation is a key component to improve efficiency and enhance stewardship strategies.
OBJECTIVE
To determine the antimicrobials and diagnoses most strongly associated with a recommendation provided by a well-established pediatric ASP.
DESIGN AND SETTING
Retrospective cohort study from March 3, 2008, to March 2, 2013, of all ASP reviews performed at a free-standing pediatric hospital.
METHODS
ASP recommendations were classified as follows: stop therapy, modify therapy, optimize therapy, or consult infectious diseases. A multinomial distribution model to determine the probability of each ASP recommendation category was performed on the basis of the specific antimicrobial agent or disease category. A logistic model was used to determine the odds of recommendation disagreement by the prescribing clinician.
RESULTS
The ASP made 2,317 recommendations: stop therapy (45%), modify therapy (26%), optimize therapy (19%), or consult infectious diseases (10%). Third-generation cephalosporins (0.20) were the antimicrobials with the highest predictive probability of an ASP recommendation whereas linezolid (0.05) had the lowest probability. Community-acquired pneumonia (0.26) was the diagnosis with the highest predictive probability of an ASP recommendation whereas fever/neutropenia (0.04) had the lowest probability. Disagreement with ASP recommendations by the prescribing clinician occurred 22% of the time, most commonly involving community-acquired pneumonia and ear/nose/throat infections.
CONCLUSIONS
Evaluation of our pediatric ASP identified specific clinical diagnoses and antimicrobials associated with an increased likelihood of an ASP recommendation. Focused interventions targeting these high-yield areas may result in increased program efficiency and efficacy.