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The fluxes and transformations of nitrogen (N) were investigated from 1985 through 1987 at the Emerald Lake watershed (ELW), a 120 ha high-elevation catchment located in the southern Sierra Nevada, California, USA. Up to 90% of annual wet deposition of N was stored in the seasonal snowpack; NO3- and NH4+ were released from storage in the form of an ionic pulse, where the first fraction of meltwater draining from the snowpack had concentrations of NO3- and NH4+ as high as 28 μeq L-1 compared to bulk concentrations of

Previous research has explored the affiliation and distancing strategies employed in published memoirs of gender transition. In this article, we are particularly interested in elucidating the ways in which individuals construct identities and characterize their sexualities, and how sociohistorical constraints might influence what is expressed with respect to this in personal narratives of transition. Using the memoirs of Lili Elbe (Hoyer, 1933) and Joy Ladin (2013) as conceptual brackets, this article investigates the complex relationship between the development and articulation of trans* identities and lesbian sexualities within the context of published memoirs of gender transition. [ABSTRACT FROM AUTHOR]

BackgroundSince the emergence of COVID-19, health care workers and first responders have been at a high risk for mental health symptoms owing to their exposure to the virus and increased work stress during the pandemic. Although interventions exist to address mental health issues following exposure to disasters, emergencies, and humanitarian crises, considerably less is known about web-based unguided interventions to help mitigate the negative impacts of such events. Additionally, in contexts in which emergencies reduce access to in-person care, remote forms of support are critical, yet there are limited studies on the use of such interventions. Evidence-based, easy-to-use, scalable interventions are direly needed for this population. ObjectiveThis study aimed to develop and test the feasibility of an unguided electronic mental health program, COVID-19 Anxiety and Stress Resilience Training (COAST), tailored to first responders and health care personnel, based on scientific evidence and empirically based techniques. MethodsWe developed COVID-19–specific training modules focusing on several domains that are previously reported as key to resilience and stress recovery: self-efficacy, mindfulness, sleep quality, and positive thinking. The program was made available to 702 first responders between May and August 2020, during the COVID-19 pandemic. Sociodemographic, work-, and COVID-19–related information was collected, and psychometric questionnaires were completed. We examined user acceptance and user activity, including module choice and participant feedback. ResultsIn total, 52 of 702 (7%) first responders to whom we reached out used the program at least once. COAST use was independent of age, sex, or baseline levels of self-efficacy, mindful awareness, sleep quality, and positive thinking (for all, P>.39). First responders who had tested positive and those who had been quarantined were more likely to engage in the program. A click count analysis per module showed that participants used the self-efficacy and mindfulness modules most often, with 382 and 122 clicks, respectively, over 15 weeks. Overall, first responders expressed satisfaction with the program. ConclusionsEngagement of first responders in the multimodule web-based COAST program was feasible and the first responder cohort expressed overall satisfaction with the program. Those in more difficult circumstances, including those in quarantine and those who tested positive, may be more likely to engage in such programs. Further controlled studies could pave the way for efficacy studies and the development of additional modules, including just-in-time interventions or blended interventions combining individual use of an unguided self-help intervention, such as COAST, with subsequent individual psychotherapy for those who continue to experience stress and psychological symptoms.

BackgroundThe linking of administrative data across agencies provides the capability to investigate many health and social issues with the potential to deliver significant public benefit. Despite its advantages, the use of cloud computing resources for linkage purposes is scarce, with the storage of identifiable information on cloud infrastructure assessed as high risk by data custodians. ObjectiveThis study aims to present a model for record linkage that utilizes cloud computing capabilities while assuring custodians that identifiable data sets remain secure and local. MethodsA new hybrid cloud model was developed, including privacy-preserving record linkage techniques and container-based batch processing. An evaluation of this model was conducted with a prototype implementation using large synthetic data sets representative of administrative health data. ResultsThe cloud model kept identifiers on premises and uses privacy-preserved identifiers to run all linkage computations on cloud infrastructure. Our prototype used a managed container cluster in Amazon Web Services to distribute the computation using existing linkage software. Although the cost of computation was relatively low, the use of existing software resulted in an overhead of processing of 35.7% (149/417 min execution time). ConclusionsThe result of our experimental evaluation shows the operational feasibility of such a model and the exciting opportunities for advancing the analysis of linkage outputs.

In this article we investigate how power relates to the production of creative identities and outcomes. We report on an in-depth case study of an award-winning creative architecture firm. Our data show how talk about creativity and the creative identities of architects can be analysed as effects of power. Theoretically, our study represents an investigation into the disciplining of professional architects' discourse about their selves, their organization, and their work. This article adds to debates on creative industries, demonstrating that creativity is deeply embedded in organizationally based relations of power. [ABSTRACT FROM AUTHOR]

This article provides a detailed review of the association of major depression with coronary heart disease (CHD), examines the biological variables underpinning the linkage and discusses the clinical implications for treatment. When considering the co-morbidity between major depressive disorder (MDD) and CHD it is important to differentiate between (i) the prevalence and impact of MDD in those with existing CHD and (ii) MDD as a risk factor for the development of CHD. Whether the same biological mechanisms are at play in these two instances remains unknown. Depression is common in patients with CHD. Importantly, depression in these patients increases mortality. There is also consistent evidence that MDD is a risk factor for the development of CHD. The relative risk of developing CHD is proportional to the severity of depression and is independent of smoking, obesity, hypercholesterolaemia, diabetes mellitus and hypertension. There is a clear need to identify the underlying neurochemical mechanisms responsible for MDD and their linkage to the heart and vascular system. Of particular interest are activation of stress pathways, including both the sympathetic nervous system and hypothalamic-pituitary-adrenal axis, and inflammatory-mediated atherogenesis. Elevated sympathetic activity, reduced heart rate variability and increased plasma cortisol levels have been documented in patients with MDD. In addition to direct effects on the heart and vasculature, activation of stress pathways may also be associated with increased release of inflammatory cytokines such as interleukin-6 and tumour necrosis factor-alpha. Elevated levels of C-reactive protein are commonly observed in patients with MDD. The majority of investigations examining treatment of depression following myocardial infarction have focused on safety and efficacy; there is little evidence to indicate that treating depression in these patients improves survival. Given that strategies for preventive therapy remain incompletely formulated, future research should focus on generating a better understanding of the neurobiology of MDD and heart disease as a basis for rational and effective therapy. [ABSTRACT FROM AUTHOR]

In this article, we analyse the principal antagonistic discourses on which managers in a large UK-based engineering company drew in their efforts to construct versions of their selves. Predicated on an understanding that subjectively construed discursive identities are available to individuals as in-progress narratives that are contingent and fragile, the research contribution we make is threefold. First, we argue that managers may draw on mutually antagonistic discursive resources in authoring conceptions of their selves. Second, we contend that rather than being relatively coherent or completely fluid and fragmented managers' identity narratives may incorporate contrasting positions or antagonisms. Third, we show that managers' identity work constituted a continuing quest to (re)-author their selves as moral beings. Antagonisms in managers' identities, we suggest, may appropriately be analysed as the complex and ambiguous effects of organizationally based disciplinary practices and individuals' discursive responses to them. [ABSTRACT FROM AUTHOR]

This article analyses the agreed and discrepant sensemaking of members of a project team. Embedded in a narratological approach to sensemaking research, we argue that before scholars may be able to understand in detail how agreements are reached and action becomes coordinated, we need first to take seriously the proposition that sensemaking occurs in the context of individuals' idiosyncratic efforts at identity construction. This, we suggest, means attending to the narratives that actors tell about their work and self both for others and their selves. The key research contribution that we make is to demonstrate how work on `impression management' and `attributional egotism' may be employed in order to account for discrepant sensemaking. This is important in the context of a literature that has left relatively unexplored the reasons why people interpret differently experiences they have in common. [ABSTRACT FROM AUTHOR]

Objective: To compare patient reports about hospital care between western New York State and southern Ontario using a random intercept model.Method: Cross-sectional survey of 3923 patients who received medical or surgical care between August and October 2004 at 28 hospitals (14 hospitals per jurisdiction). Thirty-five questions were combined to calculate eight indicators with scores ranging from 0 to 100 (best care experience). For each indicator, a model was built where the region (western New York vs. southern Ontario) was included as a fixed effect with hospital as random within region. A number of patient characteristics were also included as fixed effects.Results: The effect of the region was statistically significant (P < 0.05) only for the models predicting the 'continuity and transition', 'involvement of family' and 'physical comfort' indicator scores. The differences were 10.66, 4.05 and -3.23 points, respectively. In all three models, the random intercepts were not statistically significant, indicating that the differences above did not vary by hospitals. The model predicting 'overall impression' scores, however, showed a random intercept statistically significant (P = 0.026). The individual-level explained proportion of variance ranged from 5.68 to 11.22%, and the hospital-within-region-level explained proportion of variance ranged from 2.19 to 52.28%.Conclusion: The difference observed on the 'continuity and transition' indicator might be the only one somewhat meaningful, and might be explained by health maintenance organization reimbursements' mechanisms and hospital quality improvement initiatives available in western New York, as well as by the fact that occupancy rates in western New York border the 60% compared with the 95% in southern Ontario. [ABSTRACT FROM AUTHOR]

This article analyses how participants in a not-for-profit service organization (the 'Incubator') drew on understandings of 'ethics' in order to make sense of their individual and collective selves. Identities are theorized as being constituted within discursive regimes, and notions of ethics are conceived as discursive resources on which individuals and groups may draw in their attempts to author versions of their self and organizational narratives. We show how conceptions of ethics were a rich vein on which organizational members drew to elaborate narratives that legitimated particular modes of working and which cohered an otherwise quite disparate community of individuals. The research contribution of this article is twofold. First, we discuss how a discourse focused on ethics may be a strategic resource for identity work. Second, we analyse how talk and writing about issues of ethics are implicated in relations of power and ongoing struggles for control over organizations conceived as discursive spaces. In so doing, this article advances our understanding of ethics as discursively complex constructions, which require the micro-analysis of language practices in situated contexts for action [ABSTRACT FROM AUTHOR]

Rationale: Acute mountain sickness (AMS) may affect individuals who (rapidly) ascend to altitudes higher than 2,000-3,000 m. A more serious consequence of rapid ascent may be high-altitude pulmonary edema, a hydrostatic edema associated with increased pulmonary capillary pressures. Acetazolamide is effective against AMS, possibly by increasing ventilation and cerebral blood flow (CBF). In animals, it inhibits hypoxic pulmonary vasoconstriction. Objectives: We examined the influence of acetazolamide on the response to hypoxia of ventilation, CBF, and pulmonary vascular resistance (PVR). Methods: In this double-blind, placebo-controlled, randomized study, nine subjects ingested 250 mg acetazolamide every 8 h for 3 d. On the fourth test day, we measured the responses of ventilation, PVR, and CBF to acute isocapnic hypoxia (20 min) and sustained poikilocapnic hypoxia (4 h). Ventilation was measured with pneumotachography. Hypoxia was achieved with dynamic end-tidal forcing. The maximum pressure difference across the tricuspid valve (DeltaPmax, a good index of PVR) was measured with Doppler echocardiography. CBF was measured by transcranial Doppler ultrasound. Results: In normoxia, acetazolamide increased ventilation and reduced DeltaPmax, but did not influence CBF. The ventilatory and CBF responses to acute isocapnic hypoxia were unaltered, but the rise in DeltaPmax was reduced by 57%. The increase in DeltaPmax by sustained poikilocapnic hypoxia observed after placebo was reduced by 34% after acetazolamide, the ventilatory response was increased, but the CBF response remained unaltered. Conclusions: Acetazolamide has complex effects on ventilation, PVR, and CBF that converge to optimize brain oxygenation and may be a valuable means to prevent/treat high-altitude pulmonary edema. [ABSTRACT FROM AUTHOR]

BACKGROUND: Little performance measurement has been undertaken in the area of oncology, particularly for surgery, which is a pivotal event in the continuum of cancer care. This work was conducted to develop indicators of quality for colorectal cancer surgery, using a 3-step modified Delphi approach. METHODS: A multidisciplinary panel, comprising surgical and methodological co-chairs, 9 surgeons, a medical oncologist, a radiation oncologist, a nurse and a pathologist, reviewed potential indicators extracted from the medical literature through 2 consecutive rounds of rating followed by consensus discussion. The panel then prioritized the indicators selected in the previous 2 rounds. RESULTS: Of 45 possible indicators that emerged from 30 selected articles, 15 were prioritized by the panel as benchmarks for assessing the quality of surgical care. The 15 indicators represent 3 levels of measurement (provincial/regional, hospital, individual provider) across several phases of care (diagnosis, surgery, adjuvant therapy, pathology and follow-up), as well as broad measures of access and outcome. The indicators selected by the panel were more often supported by evidence than those that were discarded. CONCLUSIONS: This project represents a unique initiative, and the results may be applicable to colorectal cancer surgery in any jurisdiction. [ABSTRACT FROM AUTHOR]

This article outlines a narratological approach to understanding how middle managers and senior managers in a UK National Health Service (NHS) hospital made sense of the introduction of a series of interventions, led by senior managers. The research contribution this article makes is fourfold. First, it illustrates the role of individual and group narratives in processes of collective sensemaking. Second, it discusses the importance of work narratives in the efforts of individuals and groups to define their shared identities. Third, it outlines a view of organizations as storytelling milieux in which group narratives play important hegemonic and legitimatory roles. Finally, our focus on narratives, and the plurivocal understandings of actions and events they often encompass, is, we maintain, one useful means by which polysemy can be read back into case study research. [ABSTRACT FROM AUTHOR]