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This study explores how two dimensions of employees’ knowledge-hiding behaviours, explicit knowledge hiding and tacit knowledge hiding, influence a firm’s innovation quality. Furthermore, knowledge flow within the firm is examined as a moderator in these relationships. We tested corresponding hypotheses based on a research sample of 791 respondents across different industries and regions of China. Empirical results reveal that both explicit and tacit knowledge-hiding behaviours have inverted U-shaped relationships with innovation quality, and knowledge flow within the firm positively moderates these curvilinear relationships. The theoretical contributions of the study are to provide a more advanced understanding of the link between knowledge-hiding behaviours and innovation quality, as well as the role of knowledge flow within the firm. It is therefore suggested that practitioners encourage effective knowledge flow that helps to reduce individual employees’ intentions of knowledge hiding and strengthen their innovation capability, which in turn promotes a firm’s innovation quality.

Purpose In recent years, integrated reporting has emerged as a tool to provide environmental information in an interconnected way. However, in the academic literature, the amount of environmental information contained in integrated reports has never been analysed. This study, through the stakeholder-agency theory, aims to fill this important gap by examining the impact of the corporate governance mechanisms on the level of environmental information disseminated by the firms through integrated reports. Design/methodology/approach A manual content analysis based on an environmental disclosure index consisting of 30 items was performed to measure the amount of environmental information. In addition, a regression analysis was performed on a sample of 129 international firms to examine the impact of the corporate governance mechanisms on the level of environmental information disseminated through integrated reports. Findings The results show a positive effect of the board size, board gender diversity and corporate social responsibility committee existence on the level of environmental disclosure. Furthermore, they show a non-significant impact of board independence. Originality/value This study enriches the literature in several ways. First, it extends the field of application of the stakeholder-agency theory. Second, this study extends the analysis of environmental disclosure to another document – the integrated report – still unexplored by academic literature. Finally, it shed light on the determinants of environmental disclosure.

Background: The acute effects of exercise on anterior knee laxity (AKL) and anterior knee stiffness (AKS) have been documented in healthy participants, but only limited evidence has been provided for athletes cleared to return to sports after anterior cruciate ligament (ACL) reconstruction (ACLR). Purpose/Hypothesis: The purpose was to determine if 45 minutes of a soccer match simulation lead to acute changes in AKL and AKS in soccer players returning to sport within 12 months after ACLR. We hypothesized that the reconstructed knee of the ACLR group would exhibit an altered response to sport-specific exercise. Study Design: Controlled laboratory study. Methods: A total of 13 soccer players cleared to return to sport after ACLR and 13 healthy control soccer players matched for age, physical activity level, limb dominance, and anthropometric characteristics were recruited. To assess the effects of a standardized soccer match simulation (Soccer Aerobic Field Test [SAFT45]) on AKL and AKS, an arthrometric evaluation was carried out bilaterally before and immediately after SAFT45. To conduct a comprehensive examination of the force-displacement curve, the absolute and side-to-side difference (SSD) values of both AKL and AKS were extracted at 67, 134, and 200 N. Results: The ACLR and control groups showed similar AKL and AKS at baseline ( P > .05). In response to SAFT45, laxity increased bilaterally at all force levels by 14% to 17% only in the control group ( P < .025). Similarly, AKS at 134 and 200 N decreased in response to SAFT45 only in the control group (10.5% and 20.5%, respectively; P < .025). After SAFT45, the ACLR group had 1.9 and 2.5 times higher SSDs of AKS at 67 and 134 N compared with the control group, respectively ( P < .025), as well as a 1.9 times higher SSD of AKS at 134 N compared with baseline ( P = .014). Conclusion: Soccer players at the time of return to sport after ACLR showed an altered mechanical response to a sport-specific match simulation consisting of bilaterally unchanged AKL and AKS. Clinical Relevance: Soccer players showing altered AKL and AKS in response to exercise after ACLR may not be ready to sustain their preinjury levels of sport, thus potentially increasing the risk of second ACL injuries.

Risk adjustment of quality measures using clinical risk factors is widely accepted; risk adjustment using social risk factors remains controversial. We argue here that social risk adjustment is appropriate and necessary in defined circumstances and that social risk adjustment should be the default option when there are valid empirical arguments for and against adjustment for a given measure. Social risk adjustment is an important way to avoid exacerbating inequity in the health care system.

Introduction: There are no studies on the use of dexketoprofen for postoperative pain control in patients undergoing laparoscopic cholecystectomy. Purpose: To assess if the timing of dexketoprofen administration influences the intensity of postoperative pain in patients undergoing laparoscopic cholecystectomy. Materials and methods used: Experimental, longitudinal, double-blind, randomized study. 50 mg of dexketoprofen diluted in 50 ml of 0.9% saline was administered to 50 patients divided into two groups: Pre-operative group: the substance was administered one hour before the beginning of surgery. Trans-operative group: the substance was administered at the moment when the gallbladder was separated from the liver base. The Numerical Pain Scale was evaluated and the number of doses and the total dose of tramadol that the patients received as analgesic rescue was quantified. Results: Administration of dexketoprofen before starting laparoscopic cholecystectomy tends to reduce the intensity of postoperative pain without being statistically significant. Conclusion: The timing of dexketoprofen administration has no impact on postoperative pain in patients operated for laparoscopic cholecystectomy.

In the summer of 2017, the National Quality Forum (NQF) announced the formation of a Scientific Methods Panel (hereafter referred to as "the Panel") as part of a redesign of its endorsement process. NQF created the Panel in response to stakeholder request during a Kaizen improvement event held in May 2017. Given the Panel's role in the endorsement of performance measures used in national payment programs, the objective of this article is to describe the work of the Panel, and to describe its function in the larger context of the NQF measure endorsement process and in the measurement enterprise writ large. This article also serves as an introduction to a series of planned white papers being authored by the panel on specific technical issues in the area of health care performance measurement.

PURPOSEFor the advances of pediatric oncology next-generation sequencing (NGS) research to equitably benefit all children, a diverse and representative sample of participants is needed. However, little is known about demographic and clinical characteristics that differentiate families who decline enrollment in pediatric oncology NGS research.METHODSDemographic and clinical data were retrospectively extracted for 363 pediatric patients (0-21 years) with cancer approached for enrollment in Genomes for Kids (G4K), a study examining the feasibility of comprehensive clinical genomic analysis of tumors and paired normal samples. Demographic and clinical factors that significantly differentiated which families declined were subsequently compared, for 348 families, with enrollment in Clinical Implementation of Pharmacogenetics (PG4KDS), a pharmacogenomics study with more explicit therapeutic benefit examining genes affecting drug responses and metabolism.RESULTSFifty-three families (14.6%) declined enrollment in G4K. Race/ethnicity was the only variable that significantly differentiated study refusal according to multivariable logistic regression, with families of black children more likely to decline enrollment compared with families of non-Hispanic or Hispanic white children. Reasons for declining G4K were generally consistent with other pediatric genomics research: feeling overwhelmed and insurance discrimination fears were most frequently cited. Families of black children were also more likely to decline enrollment in PG4KDS. Thirteen (3.7%) of the 348 families approached for both studies declined PG4KDS.CONCLUSIONRace/ethnicity differentiated study declination across two different pediatric oncology genomics studies, suggesting enrollment disparities in the context of pediatric oncology genomics research. Genomics research participant samples that do not fully represent racial and ethnic minorities risk further exacerbating health disparities. Additional work is needed to understand the nuances of parental decision making in genomic research and facilitate enrollment of diverse patient populations.

PurposeThis study examines the effect that environmental, social and governance (ESG) disclosure generates on the cost of equity capital in the food and beverage (F&B) sector.Design/methodology/approachThis study analyses a sample of 171 international listed firms pertaining to the F&B sector and headquartered in North America, Western Europe and Asia Pacific (developed), forming an unbalanced panel of 1,316 observations, spanning the period 2010–2019. We run a fixed-effects panel regression model to test the relationship between ESG disclosure and the cost of equity capital.FindingsOur empirical outcomes suggest a significant negative relationship between ESG disclosure and the cost of equity capital. We find support for the notion that increased levels of ESG disclosure are linked to an improved access to financial resources for firms.Originality/valueThis is the first study that analyses the impact of ESG disclosure on the cost of equity capital in the F&B sector, taking existing literature a step further into more detailed and specific aspects of the relationship of focus.

Digital transformation has deeply influenced how innovation can rise in the production, distribution and consumption of cultural products. Although data-driven innovation has been proved effective ...

Fiber photometry is widely used in neuroscience labs for in vivo detection of functional fluorescence from optical indicators of neuronal activity with a simple optical fiber. The fiber is commonly placed next to the region of interest to both excite and collect the fluorescence signal. However, the path of both excitation and fluorescence photons is altered by the uneven optical properties of the brain, due to local variation of the refractive index, different cellular types, densities and shapes. Nonetheless, the effect of the local anatomy on the actual shape and extent of the volume of tissue that interfaces with the fiber has received little attention so far. To fill this gap, we measured the size and shape of fiber photometry efficiency field in the primary motor and somatosensory cortex, in the hippocampus and in the striatum of the mouse brain, highlighting how their substructures determine the detected signal and the depth at which photons can be mined. Importantly, we show that the information on the spatial expression of the fluorescent probes alone is not sufficient to account for the contribution of local subregions to the overall collected signal, and it must be combined with the optical properties of the tissue adjacent to the fiber tip.

Digital transformation has triggered a process of concentration in several markets for information goods with digital platforms rising to dominate key industries by leveraging on network externalities and economies of scale in the use of consumer data. The policy debate, therefore, focuses on the market control allegedly held by incumbents who build their competitive advantage on big data. In this paper, we evaluate the risk of abuse of a dominant position by analysing three major aspects highlighted in economic theory: entry barriers, price discrimination, and potential for technological improvement. Drawing on industrial and information economics, we argue that the very nature of big data, on the one hand, prompts market concentration and, on the other, limits the possibility of abuse. This claim is not an a-priori apologia of large incumbents in digital markets, but rather an attempt to argue that market concentration is not necessarily detrimental when it stimulates continuous innovation. Nonetheless, the concentration of power in a few global players should raise other concerns linked with the supranational nature of these firms, which can easily cherry-pick locations to exploit tax competition among countries or more favourable privacy legislation and the fair use of data.

We used 2010-16 Medicare Cost Reports for 10,737 freestanding home health agencies (HHAs) to examine the impact of home health (HH) and nursing home (NH) certificate-of-need (CON) laws on HHA caseload, total and per-patient variable costs. After adjusting for other HHA characteristics, total costs were higher in states with only HH CON laws ($2,975,698), only NH CON laws ($1,768,097), and both types of laws ($3,511,277), compared with no CON laws ($1,538,536). Higher costs were driven by caseloads, as CON reduced per-patient costs. Additional research is needed to distinguish whether this is due to skimping on quality vs. economies of scale.

Fiber photometry is widely used in neuroscience labs for in vivo detection of functional fluorescence from optical indicators of neuronal activity with a simple optical fiber. The fiber is commonly placed next to the region of interest to both excite and collect the fluorescence signal. However, the path of both excitation and fluorescence photons is altered by the uneven optical properties of the brain, due to local variation of the refractive index, different cellular types, densities and shapes. Nonetheless, the effect of the local anatomy on the actual shape and extent of the volume of tissue that interfaces with the fiber has received little attention so far. To fill this gap, we measured the size and shape of fiber photometry efficiency field in the primary motor and somatosensory cortex, in the hippocampus and in the striatum of the mouse brain, highlighting how their substructures determine the detected signal and the depth at which photons can be mined. Importantly, we show that the information on the spatial expression of the fluorescent probes alone is not sufficient to account for the contribution of local subregions to the overall collected signal, and it must be combined with the optical properties of the tissue adjacent to the fiber tip.

International audience; Crosstalk is an important source of error in interpreting surface electromyography (EMG) signals. Here, we aimed at characterizing crosstalk for three groups of synergistic muscles by the identification of individual motor unit action potentials. Moreover, we explored whether spatial filtering (single and double differential) of the EMG signals influences the level of crosstalk. Three experiments were conducted. Participants (total twenty-five) performed isometric contractions at 10% of the maximal voluntary contraction (MVC) with digit muscles and knee extensors, and at 30% MVC with plantar flexors. High-density surface EMG signals were recorded and decomposed into motor unit spike trains. For each muscle, we quantified the crosstalk induced to neighboring muscles and the level of contamination by the nearby muscle activity. We also estimated the influence of crosstalk on the EMG power spectrum and intermuscular correlation. Most motor units (80%) generated significant crosstalk signals to neighboring muscle EMG in monopolar recording mode, but this proportion decreased with spatial filtering (50% and 42% for single and double differential, respectively). Crosstalk induced overestimations of intermuscular correlation and has a small effect on the EMG power spectrum, which indicates that crosstalk is not reduced with high-pass temporal filtering. Conversely, spatial filtering diminished the crosstalk magnitude and the overestimations of intermuscular correlation, confirming to be an effective and simple technique to reduce crosstalk. This paper presents a new method for the identification and quantification of crosstalk at the motor unit level and clarifies the influence of crosstalk on EMG interpretation for muscles with different anatomy.

This feasibility study assessed if the Patient-Reported Outcomes Measurement Information System (PROMIS®) 10-item Global Health Survey (PROMIS-10) could be a reliable and valid patient-reported outcome measure (PROM) for a population of cognitively intact home health (HH) patients. The Centers for Medicare and Medicaid Services (CMS) along with their measurement contractor, Abt Associates, held a field test (2016–2017) to test the feasibility of the PROMIS-10 in in the Outcome and Assessment Information Set (OASIS). Home Health clinician data collectors (registered nurses and physical therapists) were trained to complete the PROMIS-10 along with procedures to facilitate patient self-administration of PROMIS-10. These clinicians provided feedback about their experiences at a focus group at the end of data collection. 213 HH patients comprised the field test sample, 150 of whom completed PROMIS-10 surveys. Clinicians reported they found the PROMIS-10 relevant and acceptable for their HH patients, and noted the surveys provided insight into patients’ views of their health. The PROMIS-10 measured the full range of patient-reported health and was sensitive to change between admission and discharge. The study confirmed that the PROMIS-10 can be implemented in the HH setting, opening the door for consideration for implementing the PROMIS-10 in post-acute care (PAC) settings. This study is a first step toward establishing an assessment that captures the patient’s voice and could be reported by the CMS PAC quality reporting programs.

The Belle II Silicon Vertex Detector (SVD) was installed recently and has been prepared for physics run at SuperKEKB factory, Tsukuba, Japan. For a reliable operation and data taking of the SVD, a sophisticated and robust run and slow control system has been implemented, which utilizes the Experimental Physics and Industrial Control System (EPICS) framework. EPICS uses client/server and publish/subscribe techniques to communicate between the various sub-systems and computers. The information exchange between the different pieces of software and computers is done by process variables (PVs). These PVs are provided by input/output controllers (IOCs), which communicate and interface with the hardware components. The Belle II SVD slow and run control comprises five groups of subsystems, which are SVD DAQ controller, Flash ADC controller, environmental monitors and interlocks, power supplies and EPICS infrastructure services. In this paper we describe the tasks and the implementation of the individual sub-systems, the interaction between them and the global Belle II run and slow control as well as the first experience from commissioning and initial operation of the SuperKEKB accelerator.

This paper shows the hardware and the procedure utilized to test all components of the readout system (cables, FADC boards, junction boards) of the Belle II Silicon Vertex Detector after the series production. For the FADC board special testing hardware and firmware were designed and created to check all digital and analog inputs and outputs as well as all data interconnections on the board. The main FPGA on the FADC board generates digital signals which are converted to periodic analog differential alternating voltages up to 40 MHz on the FADC board tester, which then are fed into the analog inputs of the FADC board. Histograms and scans of the samples are recorded by using random equivalent-time sampling or sequential equivalent-time sampling, allowing to characterize the behavior of the system with a much higher bandwidth than the ADCs could do with conventional measurements. Small changes of parameters of the assembly (like using a cable of different length) lead to significant changes of the measured values, creating a sensitive testing instrument. The shapes of the distributions are analyzed and compared to references by software which then decides if a test is passed or not. The commissioning setup of the whole readout chain, with all the final components including the final detector, has been tested in three phases. The respective graphs of the signal-to-noise ratios of the strips of a detector module and histograms of the noise development of the whole detector show very high consistency of the SVD readout system.

Introduction: Age, gender, body mass index percentiles and the adherence to Mediterranean diet were investigated as potential predictor factors in this assessment. Aim: To assess the parental perception of children's weight status. Methods: This cross-sectional observational study was carried out during a corporate wellness program (Ferrari Formula Benessere) implemented by Ferrari S.p.A. and managed by Med-Ex s.r.l. The children’s real weight status was assessed through Body Mass Index percentiles (ArthroPlus software—WHO). Results: 328 children (66.4%) were normal-weight, 10 were underweight (2%), 66 were overweight (13.4%) and 90 were obese (18.2%). 289 children (59%) were classified correctly by parents, while 205 children (41%) were not. 64 of 66 overweight children and 90 of 90 children with obesity have been completely underestimated (53 of 90 children with obesity were judged normal weight). The parents’ probability to estimate children’s weight status correctly decreased increasing body mass index percentiles paradoxically [OR = 0.96 (0.95–0.97)] and was lower in boys [OR = 0.65 (0.44–0.98)]. Although not statistically significant, children with higher adherence to Mediterranean diet seems to have higher probability to be correctly estimated [low adherence: reference, medium adherence: OR = 1.06 (0.61–1.85), high adherence: OR = 1.48 (0.81–2.75)]. Conclusions: A high percentage of children is overweight or obese and almost half of parents classified their weight status incorrectly. Increasing children’s body mass index percentiles decreases the probability to be correctly classified.

Objectives: Little is known about sex workers’ experiences of cervical cryotherapy. We sought to understand sex workers’ perspectives of ‘screen and treat’ programmes and their management of the World Health Organization post-treatment guidance to abstain from sex or use condoms consistently for 4 weeks. We explored contraceptive preferences and use of menstrual regulation services. Methods: We conducted semi-structured interviews with 16 sex workers and six brothel leaders in an urban brothel complex in Bangladesh between October and November 2018. All had undergone cryotherapy. We conducted a thematic analysis using deductive coding, informed by a priori themes, and inductive data-driven coding. Results: Most sex workers could not abstain from sex during the healing period. Consistent condom use was challenging due to economic incentives attached to condomless sex and coercive behaviours of clients. The implications of non-adherence among high-risk groups such as sex workers are not known. Use of short-acting methods of contraception was common, and discontinuation was high due to side effects and other perceived health concerns. The majority of sex workers and brothel leaders had utilized menstrual regulation services. Barriers to accessing timely menstrual regulation and other sexual and reproductive health services included limited mobility, economic costs, and discriminatory attitudes of health care workers. Conclusion: Service innovations are required to enable sex workers to abstain or use condoms consistently in the post-cryotherapy healing phase and to address sex workers’ broader sexual and reproductive health needs. Further research is required to assess the risk of HIV and other sexually transmitted infection transmission following cryotherapy among high-risk groups.

Computer physics communications 259, 107610 (2021). doi:10.1016/j.cpc.2020.107610, This paper describes the track-finding algorithm that is used for event reconstruction in the Belle II experiment operating at the SuperKEKB B-factory in Tsukuba, Japan. The algorithm is designed to balance the requirements of a high efficiency to find charged particles with a good track parameter resolution, a low rate of spurious tracks, and a reasonable demand on CPU resources. The software is implemented in a flexible, modular manner and employs a diverse selection of global and local track-finding algorithms to achieve an optimal performance., Published by North Holland Publ. Co., Amsterdam

The persistence of quadriceps weakness represents a major concern following anterior cruciate ligament reconstruction (ACLR). The underlying adaptations occurring in the activity of spinal motoneurons are still unexplored. This study examined the discharge patterns of large populations of motor units (MUs) in the vastus lateralis (VL) and vastus medialis muscles following ACLR. Nine ACLR individuals and 10 controls performed unilateral trapezoidal contractions of the knee extensor muscles at 35%, 50% and 70% of the maximal voluntary isometric force (MVIF). High-density surface electromyography (HDsEMG) was used to record the myoelectrical activity of the vasti muscles in both limbs. HDsEMG signals were decomposed with a convolutive blind source separation method and MU properties were extracted and compared between sides and groups. The ACLR group showed a lower MVIF on the reconstructed side compared to the contralateral side (28.1%; P 0.001). This force deficit was accompanied by reduced MU discharge rates (∼21%; P 0.05), lower absolute MU recruitment and derecruitment thresholds (∼22% and ∼22.5%, respectively; P 0.05) and lower input-output gain of motoneurons (27.3%; P = 0.009). Deficits in MU discharge rates of the VL and in absolute recruitment and derecruitment thresholds of both vasti MUs were associated with deficits in MVIF (P 0.05). A strong between-side correlation was found for MU discharge rates of the VL of ACLR individuals (P 0.01). There were no significant between-group differences (P 0.05). These results indicate that mid- to long-term strength deficits following ACLR may be attributable to a reduced neural drive to vasti muscles, with potential changes in excitatory and inhibitory synaptic inputs. KEY POINTS: Impaired expression and control of knee extension forces is common after anterior cruciate ligament reconstruction and is related to high risk of a second injury. To provide novel insights into the neural basis of this impairment, the discharge patterns of motor units in the vastus lateralis and vastus medialis were investigated during voluntary force contractions. There was lower knee extensor strength on the reconstructed side with respect to the contralateral side, which was explained by deficits in motor unit discharge rate and an altered motoneuronal input-output gain. Insufficient excitatory inputs to motoneurons and increased inhibitory afferent signals potentially contributed to these alterations. These results further our understanding of the neural underpinnings of quadriceps weakness following anterior cruciate ligament reconstruction and can help to develop effective rehabilitation protocols to regain muscle strength and reduce the risk of a second injury.

Background Barriers to successful return to previous level of activity following Anterior Cruciate Ligament Reconstruction (ACLR) are multifactorial and recent research suggests that athletic performance deficits persist after completion of the rehabilitation course in a large percentage of patients. Research question Do technology-based biomechanical assessments reveal underneath differences in both recreational and competitive athletes in Return to Play after ACL-Reconstruction? Methods Thirty soccer athletes (26.9 ± 5.7 years old, male) with ACL injury were surgically treated with all-inside technique and semitendinosus tendon autograft. Before 2 years from surgery, they were called back for clinical examination, self-reported psychological scores, and biomechanical outcomes (balance, strength, agility and velocity, and symmetry). Athletes were classified into recreational (n = 15) and competitive (n = 15) according to the self-reported Return to Play Level based on the TALS post-injury. Nonparametric statistical tests have been adopted for group comparisons in terms of age, concomitant presence of meniscus tear, injury on dominant leg, presence of knee laxity, presence of varus/valgus, body sides, and return to different levels of sports. Results Competitive athletes showed better in terms of strength (45.3 ± 5.4 W kg−1 vs 39.3 ± 3.4 W kg−1, P ≤ 0.01) associated with good self-reported outcomes (TLKS, CRSQ) and low fear of reinjury (TSK). However, all the athletes had a functional deficit in at least one subtest, and a safe return to sports could not have been recommended. Our findings confirmed that demographics, physical function, and psychological factors were related to playing the preinjury level sport at mean 2 years after surgery, supporting the notion that returning to sport after surgery is multifactorial. Significance A strict qualitative and quantitative assessment of athletes’ status should be performed at different follow-ups after surgery to guarantee a safe and controlled RTP.

The newly discovered coronavirus (SARS-CoV-2) has caused an infectious disease of pandemic proportion called coronavirus 2019 disease (COVID-19). The absence of an effective vaccine for the COVID-19 disease has led many National and International authorities to take some prompt strict measurements to reduce the risk of infection, including closing non-essential activities and forcing individuals to stay at home. Accordingly, several sport events have been canceled and/or postponed and, hundreds of thousands of amateur and professional athletes worldwide have abruptly been forced to train at home. As a consequence, athletes had to face an unprecedented and relatively long-term reduction or cessation in their training routine along with a substantial cutting of their physical daily activities. Such changes may result in a significant decay of the quantity and worsening of the quality of training stimuli, making athletes exposed to some potential levels of detraining (i.e., “partial or complete loss of training-induced anatomical, physiological and performance adaptations”; Mujika and Padilla, 2000b) and to increased risks of injury. Thus, sport scientists, coaches and exercise physiologists worldwide had to deal with a novel challenge consisting in how to minimize potential detraining effects induced by home confinement. Detraining prevention can be defined as a set of physical training strategies aimed at limiting and/or counteracting detraining effects. The prevention of detraining processes is a fairly new concept, which so far has mainly been addressed in the field of occupational physiology. For instance, a large body of literature has focused on understanding strategies used to counteract detraining processes associated with prolonged exposure to microgravity in astronauts (Hargens et al., 2013; Hackney et al., 2015). Some studies have also investigated the effects of reduced training stimuli on physical performance in athletes (Neufer, 1989; Rietjens et al., 2001; Garcia-Pallares et al., 2009, 2010; Ormsbee and Arciero, 2012; Joo, 2018). However, these are limited and controversial and they can only provide indirect information on detraining prevention strategies. For example, whereas 21 days of training-stimuli reduction (continuous and intermittent endurance training, 3 days/week) seem to counteract detraining effects (Rietjens et al., 2001), impairments on endurance performance, resting metabolic rate, body weight and composition have been found following 35–42 days of light-moderate exercise (

Wearable microfluidic system enables remote analysis of sweat rate and chloride loss for assessing personalized fluid needs., Advanced capabilities in noninvasive, in situ monitoring of sweating rate and sweat electrolyte losses could enable real-time personalized fluid-electrolyte intake recommendations. Established sweat analysis techniques using absorbent patches require post-collection harvesting and benchtop analysis of sweat and are thus impractical for ambulatory use. Here, we introduce a skin-interfaced wearable microfluidic device and smartphone image processing platform that enable analysis of regional sweating rate and sweat chloride concentration ([Cl−]). Systematic studies (n = 312 athletes) establish significant correlations for regional sweating rate and sweat [Cl−] in a controlled environment and during competitive sports under varying environmental conditions. The regional sweating rate and sweat [Cl−] results serve as inputs to algorithms implemented on a smartphone software application that predicts whole-body sweating rate and sweat [Cl−]. This low-cost wearable sensing approach could improve the accessibility of physiological insights available to sports scientists, practitioners, and athletes to inform hydration strategies in real-world ambulatory settings.

We have previously published equations to estimate whole‐body (WB) sweat sodium concentration ([Na+]) from regional (REG) measures; however, a cross‐validation is needed to corroborate the applicability of these prediction equations between studies. The purpose of this study was to determine the validity of published equations in predicting WB sweat [Na+] from REG measures when applied to a new data set. Forty‐nine participants (34 men, 15 women; 75 ± 12 kg) cycled for 90 min while WB sweat [Na+] was measured using the washdown technique. REG sweat [Na+] was measured from seven regions using absorbent patches (3M Tegaderm + Pad). Published equations were applied to REG sweat [Na+] to determine predicted WB sweat [Na+]. Bland–Altman analysis of mean bias (raw and predicted minus measured) and 95% limits of agreement (LOA) were used to compare raw (uncorrected) REG sweat [Na+] and predicted WB sweat [Na+] to measured WB sweat [Na+]. Mean bias (±95% LOA) between raw REG sweat [Na+] and measured WB sweat [Na+] was 10(±20), 0(±19), 9(±20), 22(±25), 23(±24), 0(±15), −4(±18) mmol/L for the dorsal forearm, ventral forearm, upper arm, chest, upper back, thigh, and calf, respectively. The mean bias (±95% LOA) between predicted WB sweat [Na+] and measured WB sweat [Na+] was 3(±14), 4(±12), 0(±14), 2(±17), −2(±16), 5(±13), 4(±15) mmol/L for the dorsal forearm, ventral forearm, upper arm, chest, upper back, thigh, and calf, respectively. Prediction equations improve the accuracy of estimating WB sweat [Na+] from REG and are therefore recommended for use when determining individualized sweat electrolyte losses., Published prediction equations improve the accuracy of estimating whole‐body sweat [Na+] from regional measures, especially for the dorsal forearm, upper arm, chest, and upper back. Therefore, it is recommended that appropriate regression equations are applied when using the regional absorbent patch method to determine individualized sweat electrolyte losses.

BACKGROUND Home-health-care utilization after total knee arthroplasty (TKA) is increasing. Recent publications have suggested that supervised rehabilitation is not needed to optimize functional recovery after TKA; however, few studies have evaluated patients in home-health-care settings. The objectives of this study were to (1) determine whether physical therapy (PT) utilization is associated with functional improvements for patients in home-health-care settings after TKA and (2) determine which factors are related to utilization of PT. METHODS This study was an analysis of Medicare home-health-care claims data for patients treated with a TKA in 2012 who received home-health-care services for postoperative rehabilitation. Multivariable linear regression models were used to evaluate relationships between PT utilization and recovery in activities of daily living (ADLs). Negative binomial regression models were used to determine factors associated with PT utilization. RESULTS Records from 5,967 Medicare beneficiaries were evaluated. Low home-health-care PT utilization (≤5 visits) was associated with less improvement in ADLs compared with 6 to 9 visits, 10 to 13 visits, or ≥14 visits. Compared with low home-health-care utilization, utilization of 6 to 9 visits was associated with a 25% greater improvement in ADLs over the home-health-care episode (p < 0.0001); 10 to 13 visits, with a 40% greater improvement (p < 0.0001); and ≥14 visits, with a 50% greater improvement (p < 0.0001). The findings remained robust following adjustments for medical complexity, baseline functional status, and home-health-care episode duration. After adjustment, lower PT utilization was observed for patients receiving home health care from rural agencies (10.7% fewer visits, 95% confidence interval [CI] = 7.9% to 13.7%), those with depressive symptoms (4.8% fewer visits, 95% CI = 1.3% to 8.3%), and those with any baseline dyspnea (5.3% fewer visits, 95% CI = 3.1% to 7.5%). CONCLUSIONS Low home-health-care PT utilization was significantly associated with worse recovery in ADLs after TKA for Medicare beneficiaries, after controlling for medical complexity, baseline function, and home-health-care episode duration. Patients who are served by rural agencies or who have higher medical complexity receive fewer PT visits after TKA and may need closer monitoring to ensure optimal functional recovery. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Adverse reactions to hormonal contraceptives are a common patient concern. Alopecia, an adverse reaction to androgen activity caused by the progestin component of hormonal contraceptives, can cause considerable psychosocial distress for women. This article discusses how to identify the level of androgen activity in certain progestins, how increased androgen activity can lead to hair loss, and alternatives for patients experiencing androgenic alopecia due to high androgen index contraceptives.

Objective To investigate the effects of passive cyclic loading (CYC) on anterior tibial translation (ATT), knee extensor and flexor muscle strength and activation in soccer players. Design Cross-sectional study. Setting: Functional Assessment Laboratory; Participants: Eight healthy competitive soccer players. Interventions: The knee of the dominant limb was subjected to 10 min of CYC at 200 N force. Main outcomes measures ATT was measured before and after CYC. Percentage of variation was used to estimate ACL creep. Knee extension and flexion maximal voluntary contractions (MVCs) were assessed both before and after CYC. EMG amplitudes of both Biceps Femoris (BF) and Vastus Lateralis (VL) were recorded during both MVCs and CYC. Results There was a 20.7% increase in ATT after CYC application ( p 0.001) . Post-CYC agonist and antagonist BF activations were 37.7% and 18.4% lower than pre-CYC ones during MVCs (p 0.05) . BF EMG activity in the last 30s of CYC was 19.9% higher than in the first 30s (p 0.05). Conclusion The increased ATT and the variations in neuromuscular activation of the BF in response to loading may expose the knee at higher injury risk by increasing joint instability. Further studies are required to thoroughly investigate these aspects in both laboratory and real-field settings.

This study determined the relations between regional (REG) and whole body (WB) sweating rate (RSR and WBSR, respectively) as well as REG and WB sweat Na+concentration ([Na+]) during exercise. Twenty-six recreational athletes (17 men, 9 women) cycled for 90 min while WB sweat [Na+] was measured using the washdown technique. RSR and REG sweat [Na+] were measured from nine regions using absorbent patches. RSR and REG sweat [Na+] from all regions were significantly ( P < 0.05) correlated with WBSR ( r = 0.58–0.83) and WB sweat [Na+] ( r = 0.74–0.88), respectively. However, the slope and y-intercept of the regression lines for most models were significantly different than 1 and 0, respectively. The coefficients of determination ( r2) were 0.44–0.69 for RSR predicting WBSR [best predictors: dorsal forearm ( r2 = 0.62) and triceps ( r2 = 0.69)] and 0.55–0.77 for REG predicting WB sweat [Na+] [best predictors: ventral forearm ( r2 = 0.73) and thigh ( r2 = 0.77)]. There was a significant ( P < 0.05) effect of day-to-day variability on the regression model predicting WBSR from RSR at most regions but no effect on predictions of WB sweat [Na+] from REG. Results suggest that REG cannot be used as a direct surrogate for WB sweating responses. Nonetheless, the use of regression equations to predict WB sweat [Na+] from REG can provide an estimation of WB sweat [Na+] with an acceptable level of accuracy, especially using the forearm or thigh. However, the best practice for measuring WBSR remains conventional WB mass balance calculations since prediction of WBSR from RSR using absorbent patches does not meet the accuracy or reliability required to inform fluid intake recommendations.NEW & NOTEWORTHY This study developed a body map of regional sweating rate and regional (REG) sweat electrolyte concentrations and determined the effect of within-subject (bilateral and day-to-day) and between-subject (sex) factors on the relations between REG and the whole body (WB). Regression equations can be used to predict WB sweat Na+concentration from REG, especially using the forearm or thigh. However, prediction of WB sweating rate from REG sweating rate using absorbent patches does not reach the accuracy or reliability required to inform fluid intake recommendations.

Background The prevalence of diabetes is increasing rapidly. Previous research has demonstrated the efficacy of a diabetes prevention program (DPP) in lifestyle modifications that can prevent or delay the onset of type 2 diabetes among individuals at risk. Digital DPPs have the potential to use technology, in conjunction with behavior change science, to prevent prediabetes on a national and global scale. Objective The aim of this study is to investigate the effects of a digital DPP (Virgin Pulse [VP] Transform for Prediabetes) on weight and physical activity among participants who had completed 12 months of the program. Methods This study was a secondary analysis of retrospective data of adults with prediabetes who were enrolled in VP Transform for Prediabetes for 12 months of the program. The program incorporates interactive mobile computing, remote monitoring, an evidence-based curriculum, behavior tracking tools, health coaching, and online peer support to prevent or delay the onset of type 2 diabetes. Results The sample (N=1095) was comprised of people with prediabetes who completed at least 9 months of the VP Transform for Prediabetes program. Participants were 67.7% (n=741) female, with a mean age of 53.6 (SD 9.75) years. After 12 months, participants decreased their weight by an average of 10.9 lbs (5.5%; P Conclusions These results suggest that VP Transform for Prediabetes is effective at preventing type 2 diabetes through a significant reduction in body weight and increase of physical activity. Furthermore, these results suggest that the DPP remains effective 12 months after beginning the program. A prospective randomized controlled clinical study is warranted to validate these findings.

The “chip-on-sensor” concept of this detector minimizes the distance of the signal propagation from the double-sided silicon detector strips to the readout chips and thus reduces noise from strip capacitance. One half of the detector is built, the second half is being assembled at the time of writing. Prototypes have been tested in several test beams as well as in the so-called Phase 2 setup inside the detector structure. First results from a commissioning run of the Belle-II prototype SVD detector are presented. The measured signal-to-noise and timing performance are found to be according to design specifications.

The aim of this paper is to explore sustainability reporting in the Italian environment, with a special attention to the determinants of disclosure quality. More specifically, this paper’s objective is to test the impact on the quality of sustainability reporting made by elements through which legitimacy can be connected, with particular reference to firm size. The choice of analysing the Italian companies lies in the fact that in this country, in a particular way, and more in general, in the non-Anglophone countries, there is no consolidated literature on the subject. The statistical analysis we carried out on this paper, in order to test the research hypotheses, is based on a linear regression model. Particularly relevant is the finding, liked to size, of the inverted U-shaped relationship. Previous contributions had highlighted a positive relationship between size and quality of sustainability reporting, connected to higher pressures by the external context on the bigger firms. Instead, our study has highlighted an inversion of such relationship (from positive to negative), starting from a certain value of market capitalization. The finding of the statistical insignificance of the relationship between industry and sustainability reporting is also very interesting.

This article contributes to the literature on the association between class position and cultural tastes by analyzing a unique historical data set and asking whether there were significant class differences in the consumption of music in the 19th century. Archival data from a publisher in Milan are used to analyze the characteristics of customers who purchased sheet music between 1814 and 1823. To avoid contemporary depictions of cultural hierarchies (e.g. ‘highbrow’, ‘lowbrow’ and ‘omnivorous’ tastes), we offer a new method for considering both the quantitative and qualitative dimensions of music consumption. Considering both the aggregate level of music consumption and the evolution of individual patterns over time, we find little evidence that musical tastes were aligned with class position. This finding calls for more research on the origins of the strong link between social structure and cultural preferences in general, or between class position and musical tastes in particular, which we witness today.

The neural factors underlying the persistency of quadriceps weakness after anterior cruciate ligament reconstruction (ACLR) have been only partially explained. This study examined muscle fiber conduction velocity (MFCV) as an indirect parameter of motor unit recruitment strategies in the vastus lateralis (VL) and medialis (VM) muscles of soccer players with ACLR. High-density surface electromyography (HDsEMG) was acquired from VL and VM in nine soccer players (22.7 ± 2.9 years; BMI: 22.08 ± 1.72 kg·m-2 ; 7.7 ± 2.2 months post-surgery). Voluntary muscle force and the relative myoelectrical activity from the reconstructed and contralateral sides were recorded during linearly increasing isometric knee extension contractions up to 70% of maximal voluntary isometric force (MVIF). The relation of MFCV and force was examined by linear regression analysis at the individual subject level. The initial (intercept), peak (MFCV70 ), and rate of change (slope) of MFCV related to force were compared between limbs and muscles. The MVIF was lower in the reconstructed side than in the contralateral side (-%20.5; P .05). MFCV70 and MFCV slope were lower in the reconstructed side compared to the contralateral for both VL (-28.5% and -10.1%, respectively; P < .001) and VM (-22.6% and -8.1%, respectively; P < .001). The slope of MFCV was lower in the VL than VM, but only in the reconstructed side (-12.4%; P < .001). These results suggest possible impairments in recruitment strategies of high-threshold motor units (HTMUs) as well as deficits in sarcolemmal excitability, fiber diameter, and discharge rate of knee extensor muscles following ACLR.

In this project, we are developing a custom adaptive optics system integrated with multiphoton microscopy for visualizing plant-microbe-mineral interactions in the rhizosphere to shrdy sustainable food, hrel production, and environmental processes.

The parental influence on children’s cardiometabolic risk factors (CMRF) and cardiorespiratory fitness (CRF) has been only marginally investigated. Hence, this study aimed to investigate whether parental CMRF and CRF were associated with those of their school-aged children. This cross-sectional analysis included 53 Italian school-children along with their parents. CMRF were assessed by measuring the waist circumference (WC) and by computing the waist-to-height ratio (WHtR), whereas CRF was estimated with the six-minute walking test (6MWT). A multiple stepwise backward elimination regression analysis was performed to investigate associations between parental and children’s features. Both parental WC and WHtR were associated with children’s ones (R2 = 0.28, p = .005; R2 = 0.18, p = .041). Maternal WC and WHtR strongly predicted primary-school children’s CMRF (R2 = 0.54, p = .005; R2 = 0.67, p = .001). No significant parental influence was observed for CRF. This study investigated, for the first time, the associations between parental CMRF and CRF, and those of their children. Our results suggest that children’s WC and WHtR, but not CRF, can be predicted by their parent’s parameters. Maternal CMRF may have a stronger influence on children’s ones, compared to fathers, particularly during primary-school years.

Native AVF represents the best vascular access for patients undergoing chronic hemodialysis treatments. Accordingly to KDOQI 2006, constant site cannulation technique (or butthonhole, BH) can reduce infiltration events, cannulation pain, make self cannulation process easier and maintain a better vein outflow integrity. Nursing staff need to be trained in order to acquire and improve AV cannulation skills. The objective of this study is to demonstrate benefits of buttonhole technique for AVF cannulations in chronic hemodialysis patients by a case report experience in our centre. Based on our experience, only if adequate training will be provided to nursing staff and greater emphasis will be given to patients empowerment and AV self management, BH technique could bring greater advantages and less complications for both patients and staff. BH technique, if properly applied, can reduce infiltration risk, bleeding and pain while preserving vein physiology.

Background Nurse turnover is a critical issue around the world. Finding factors that can increase job persistence in nursing can have a positive impact on both the quality and cost of health care. Resilience and grit have been studied as factors that help an individual persist in the pursuit of their goals. Resilience and grit are related terms that have frequently been used interchangeably, although some studies suggest that they are different constructs. Determining if they are different constructs is important as we seek to develop qualities in new nurses that increase their job persistence and satisfaction. Objectives The purpose of this study was to explore the relationship between resilience and grit in pre-licensure nursing students. Design/setting This descriptive correlational study was conducted at a midsize private University in the United States. Participants The convenience sample consisted of students from 3 pre-licensure programs: Traditional Bachelor of Science in Nursing (TBSN), Accelerated Bachelor of Science in Nursing (ABSN) and Direct Entry Masters of Science in Nursing (DEMSN). The final sample was 348 students: 79% TBSN, 7% ABSN and 14% DEMSN. Methods Resilience was measured with the Conner-Davidson Resilience 10 item scale. Grit was measured utilizing the Short Grit Scale. Results Inspection of the interfactor correlations suggest that resilience and grit scales are distinct, though tend to correlate well. Notably, the relationship between resilience and the persistent effort component of grit was moderate. That correlation was higher than the relationship between the consistent interest component of grit and resilience. Conclusion This study concludes that grit and resilience are related concepts but are not synonymous. Being mindful of the difference in these two attributes may be important in the development of educational offerings in both Schools of Nursing and in new nurse residency programs to increase retention in nursing.

Clinical genomic studies of pediatric cancer have primarily focused on specific tumor types or high-risk disease. In the Genomes for Kids study (NCT02530658) we used a three-platform sequencing approach, including whole genome (WGS), whole exome (WES) and RNA sequencing, to examine tumor and paired germline genomes from prospectively identified children with cancer. The goal of the study was to assess the potential of comprehensive next generation sequencing to elucidate the molecular mechanisms underlying tumor formation and investigate the potential of this information to influence clinical decision-making.The cohort, with a median age of 6 yrs, range 0 - 26 yrs, included 301 patients with newly diagnosed (85%) or relapsed/refractory (15%) cancers, unselected for tumor type or stage. Patients with hematologic malignancies accounted for 41% of cases, 31% had CNS tumors, and 28% had other non-CNS solid tumors. This cohort also included 18 patients with very rare tumor types, defined here as occurring in less than 2 cases per million person per year.Two hundred fifty three patients (84%) had sufficient tumor for three-platform sequencing and all 301 had adequate paired germline samples. Following analysis, 86% of patients harbored diagnostic (53%), prognostic (57%), therapeutically relevant (25%), and/or cancer predisposing (18%) variants. The inclusion of WGS enabled detection of oncogenic gene fusions, as well as 22 cases in which oncogenes were activated through enhancer hijacking, a particularly frequent occurrence in hematologic malignancies. In addition, WGS effectively detected clinically relevant small intragenic deletions (15% of tumors) and a variety of mutational signatures, which were not detectable through analysis of whole exome data. Evaluation of 56 pathogenic germline variants in the context of paired tumor sequence data helped establish the disease relevance of several genes that are not typically associated with the cancer type in question, providing critical insights on a case-by-case basis. Examples include a pathogenic germline variant in MUTYH in a patient with retinoblastoma whose tumor exhibited a mutation signature associated with reactive oxygen species indicative of loss of MUTYH function; and conversely, a likely pathogenic variant in PMS2 in a rare brain cancer, which did not exhibit a mutation signature associated with microsatellite instability. This study successfully demonstrated the power of this three-platform approach to interrogate and interpret the full range of genomic variants across newly diagnosed as well as relapsed/refractory pediatric cancers. As a result of these findings, we have incorporated this three-platform approach into our routine real-time clinical service at St. Jude Children's Hospital. Citation Format: David A. Wheeler, Scott Newman, Joy Nakitandwe, Chimene A. Kesserwan, Elizabeth M. Azzato, Michael C. Rusch, Sheila Shurtleff, Armita Bahrami, Brent Orr, Jeffery M. Klco, Dale J. Hedges, Kayla V. Hamilton, Scott G. Foy, Michael N. Edmonson, Andrew Thrasher, Jiali Gu, Lynn W. Harrison, Lu Wang, Roya Mostafavi, Manish Kubal, Jamie Maciaszek, Michael Clay, Annastasia Ouma, Antonina Silkov, Yanling Liu, Zhaojie Zhang, Yu Liu, Samuel W. Brady, Xin Zhou, Mark Wilkinson, Delaram Rahbarinia, Jay Knight, Jian Wang, Charles G. Mullighan, Rose B. McGee, Emily A. Quinn, Elsie L. Gerhardt, Leslie M. Taylor, Regina Nuccio, Jessica M. Valdez, Stacy J. Hines-Dowell, Alberto Pappo, Giles Robinson, Liza-Marie Johnson, Ching-Hon Pui, David W. Ellison, James R. Downing, Jinghui Zhang, Kim E. Nichols. Genomes for Kids: Comprehensive DNA and RNA sequencing defining the scope of actionable mutations in pediatric cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 642.

This work is focused on the measurement uncertainty impact on load flow analysis in medium voltage (MV) distribution networks. In more detail, the paper presents the uncertainty evaluation of a simplified load flow algorithm, which is based on the load power measurements at each secondary substation and one voltage measurement at the slack bus (i.e. the voltage at the MV bus bars of the primary substation). To reduce the costs of the monitoring system, the load flow algorithm makes use of LV load power measurements for all the substations except those of MV users, where MV transducers are usually already installed. The uncertainties on the algorithm input quantities (load powers and slack bus voltage) are calculated, considering the actual values of the loads power factors and currents and the accuracy specifications of the measurement instruments installed in the distribution network. Starting from the input quantities uncertainties, the power flows uncertainties are obtained applying the Monte Carlo analysis. The analysis is carried out on a real test system, i.e. the distribution network of Favignana Island. The compatibility is also shown between the algorithm power flow estimations and the power measurements.

BACKGROUND The incorporation of genomic testing to identify targetable somatic alterations and predisposing germline mutations into the clinical setting is becoming increasingly more common. Despite its potential usefulness, to the authors' knowledge physician confidence with regard to understanding and applying genomic testing remains unclear, particularly within the realm of pediatric oncology. METHODS Before initiating an institutional feasibility study regarding the integration of clinical genomic testing, the authors surveyed pediatric oncologists regarding their confidence around understanding of genomic testing, perceived usefulness of test results, preferences around the disclosure of germline test results, and possible risks and benefits of testing. RESULTS Among survey respondents (52 of 88 contacted; response rate of 59%), only a minority were confident in interpreting, using, and discussing somatic (35%) or germline (27%) genomic test results. Providers who were confident in interpreting somatic results were significantly more likely to anticipate using the results to plan the treatment of patients with relapsed or refractory cancers (P = .009). Similarly, providers who reported confidence in interpreting germline results were significantly more likely to discuss and use these results as part of clinical care (P

This paper presents a simplified approach for load flow analysis in medium voltage (MV) distribution networks. It is a power summation Backward/Forward (B/F) algorithm, based on measurements of active and reactive powers at low voltage (LV) side of MV/LV distribution substations. The proposed solution allows achieving good accuracy, computational efficiency and fast convergence. In order to verify the algorithm performances, simulation studies are carried out in the case of a real test system, i.e. the distribution grid of Favignana Island (Mediterranean Sea, Italy). The compatibility between simulations results and power measurements at the MV bus bars of the generating substation shows the effectiveness of the proposed solution.

Obstructive sleep apnoea (OSA) is characterized by repetitive interruptions of breathing, causing Chronic Intermittent Hypoxia (CIH) that can be involved in the development and progression of cardiovascular diseases. There is evidence showing a close relationship between OSA and atherosclerosis, even in patients who do not show co-morbidities such as hypertension, diabetes, high levels of lowdensity lipoprotein cholesterol (LDL-C), cigarette smoking and obesity, which can activate the endothelium. This endothelium activation due to CIH and specific to OSA seems to be dependent on a different pathway. The current first line therapy for OSA is the application of the continuous positive airway pressure (CPAP), but it alone is not enough to reduce cardiometabolic risk in patients with OSA. In contrast, statins, via their pleiotropic property, might be able to change inflammation and early atherosclerosis, lipid profile and cardiovascular outcomes in OSA. The role of statins in OSA patients with or without any co-morbidities could potentially prevent coronary vascular risk and stroke and in the future, represent an additional treatment option along with CPAP therapy. Strengthening the prevention strategies against atherosclerosis in OSA should be one of the focal aims for healthcare programs of the future.

The Internet facilitates connections between a range of Dutch actors with a stake in the energy transition, including governments, environmental organizations, media outlets and corporations. These connections tease a hyperlink network affecting public access to information on energy transition issues. Despite its societal relevance, however, the characteristics of this network remain understudied. The main goals of this study are to shed some light on the topological characteristics of the Dutch energy transition hyperlink network and reveal the main topics discussed in the network. To do so, we longitudinally collected data from the interactions between key Dutch actors with a stake in the energy transition. Then, these data were analyzed by employing a mixed-method approach, social network analysis and topic modeling. The results of the social network analyses reveal the existence of a sparse network in which few private companies and associations emerge as the most authoritative actors and brokers. Furthermore, our analyses show substantial differences among the communication agendas of the organizations of the Dutch energy transition hyperlink network, while public institutions focus on global, national and local policy issues, private companies, associations and NGOs pay much more attention to employment issues.

Objective To use patient-level clinical variables to develop and validate a parsimonious model to predict hospital readmissions from home healthcare (HHC) in Medicare fee-for-service beneficiaries. Design Retrospective analysis using multivariable logistic regression and gradient boosting machine (GBM) learning to develop and validate a predictive model. Setting/participants/meaurements A 5% national sample of patients, aged 65 years or older, with Medicare fee-for-service who received skilled HHC services within 5 days of hospital discharge in 2012 (n = 43 407). Multiple data sets were merged, including Medicare Outcome and Assessment Information Set, Home Health Claims, Medicare Provider Analysis and Review, and Master Beneficiary Summary Files, to extract patient-level variables from the first HHC visit after discharge and measure 30-day readmission outcomes. Results Among 43 407 patients with inpatient hospitalizations followed by HHC, 14.7% were readmitted within 30 days. Of the 53 candidate variables, seven remained in the final model as individually predictive of outcome: Elixhauser comorbidity index, index hospital length of stay, urinary catheter presence, patient status (ie, fragile health with high risk of complications or serious progressive condition), two or more hospitalizations in prior year, pressure injury risk or presence, and surgical wound presence. Of interest, surgical wounds, either from a total hip or total knee arthroplasty procedure or another surgical procedure, were associated with fewer readmissions. The optimism-corrected c-statistics for the full model and parsimonious model were 0.67 and 0.66, respectively, indicating fair discrimination. The Brier score for both models was 0.120, indicating good calibration. The GBM model identified similar predictive variables. Conclusion Variables available to HHC clinicians at the first postdischarge HHC visit can predict readmission risk and inform care plans in HHC. Future analyses incorporating measures of social determinants of health, such as housing instability or social support, have the potential to enhance prediction of this outcome. J Am Geriatr Soc 67:2505-2510, 2019.

Key Points Question What is the effect of adding structured nurse assessment of patient readiness for discharge to standard medical-surgical unit discharge practices on 30-day return to hospital? Findings In this multisite cluster randomized clinical trial, when patient self-assessments were combined with readiness assessment by nurses, high-readmission units showed a reduction in 30-day hospital returns. Mixed results were observed for nurse assessments only and for low-readmission units. Meaning Adding a structured discharge readiness assessment by the discharging nurse that includes patient self-assessment to standard practice for hospital discharge may reduce readmissions and emergency department or observation visits., This cluster randomized clinical trial investigates the effect of unit-based protocols for ensuring patient readiness for discharge on hospital readmission rates., Importance The downward trend in readmissions has recently slowed. New enhancements to hospital readmission reduction efforts are needed. Structured assessment of patient readiness for discharge has been recommended as an addition to discharge preparation standards of care to assist with tailoring of risk-mitigating actions. Objective To determine the effect of unit-based implementation of readiness evaluation and discharge intervention protocols on readmissions and emergency department or observation visits. Design, Setting, and Participants The Readiness Evaluation and Discharge Interventions (READI) cluster randomized clinical trial conducted in medical-surgical units of 33 Magnet hospitals between September 15, 2014, and March 31, 2017, included all adult (aged ≥18 years) patients discharged to home. Baseline and risk-adjusted intent-to-treat analyses used difference-in-differences multilevel logistic regression models with controls for patient characteristics. Interventions Of 2 adult medical-surgical nursing units from each hospital, 1 was randomized to the intervention and 1 to usual care conditions. Using the 8-item Readiness for Hospital Discharge Scale, the 33 intervention units implemented a sequence of protocols with increasing numbers of components: READI1, in which nurses assessed patients to inform discharge preparation; READI2, which added patient self-assessment; and READI3, which added an instruction to act on a specified Readiness for Hospital Discharge Scale cutoff score indicative of low readiness. Main Outcomes and Measures Thirty-day return to hospital (readmission or emergency department and observation visits). Intervention units above median baseline readmission rate (>11.3%) were categorized as high-readmission units. Among the 33 intervention units, 17 were low-readmission units and 16 were high-readmission units. Results The sample included 144 868 patient discharges (mean [SD] age, 59.6 [17.5] years; 51% female; 74 605 in the intervention group and 70 263 in the control group); 17 667 (12.2%) were readmitted and 12 732 (8.8%) had an emergency department visit or observation stay. None of the READI protocols reduced the primary outcome of return to hospital in intent-to-treat analysis of the full sample. In exploratory subgroup analysis, when patient self-assessments were combined with readiness assessment by nurses (READI2), readmissions were reduced by 1.79 percentage points (95% CI, −3.20 to −0.40 percentage points; P = .009) on high-readmission units. With nurse assessment alone and on low-readmission units, results were mixed. Conclusions and Relevance Implemented in a broad range of hospitals and patients, the READI interventions were not effective in reducing return to hospital. However, adding a structured discharge readiness assessment that incorporates the patient’s own perspective to usual discharge care practices holds promise for mitigating high rates of return to the hospital following discharge. Trial Registration ClinicalTrials.gov Identifier: NCT01873118