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BackgroundDespite pharmacological treatments, patients undergoing cardiac surgery experience severe anxiety and pain, which adversely affect outcomes. Previous work examining pediatric and nonsurgical adult patients has documented the effectiveness of inexpensive, nonpharmacological techniques to reduce anxiety and pain as well as health care costs and length of hospitalization. However, the impact of nonpharmacological interventions administered by a dedicated comfort coach has not been evaluated in an adult surgical setting. ObjectiveThis trial aims to assess whether nonpharmacological interventions administered by a trained comfort coach affect patient experience, opioid use, and health care utilization compared with usual care in adult cardiac surgery patients. This study has 3 specific aims: assess the effect of a comfort coach on patient experience, measure differences in inpatient and outpatient opioid use and postoperative health care utilization, and qualitatively evaluate the comfort coach intervention. MethodsTo address these aims, we will perform a prospective, randomized controlled trial of 154 adult cardiac surgery patients at Michigan Medicine. Opioid-naive patients undergoing first-time, elective cardiac surgery via sternotomy will be randomized to undergo targeted interventions from a comfort coach (intervention) versus usual care (control). The individualized comfort coach interventions will be administered at 6 points: preoperative outpatient clinic, preoperative care unit on the day of surgery, extubation, chest tube removal, hospital discharge, and 30-day clinic follow-up. To address aim 1, we will examine the effect of a comfort coach on perioperative anxiety, self-reported pain, functional status, and patient satisfaction through validated surveys administered at preoperative outpatient clinic, discharge, 30-day follow-up, and 90-day follow-up. For aim 2, we will record inpatient opioid use and collect postdischarge opioid use and pain-related outcomes through an 11-item questionnaire administered at the 30-day follow-up. Hospital length of stay, readmission, number of days in an extended care facility, emergency room, urgent care, and an unplanned doctor’s office visit will be recorded as the primary composite endpoint defined as total days spent at home within the first 30 days after surgery. For aim 3, we will perform semistructured interviews with patients in the intervention arm to understand the comfort coach intervention through a thematic analysis. ResultsThis trial, funded by Blue Cross Blue Shield of Michigan Foundation in 2019, is presently enrolling patients with anticipated manuscript submissions from our primary aims targeted for the end of 2020. ConclusionsData generated from this mixed methods study will highlight effective nonpharmacological techniques and support a multidisciplinary approach to perioperative care during the adult cardiac surgery patient experience. This study’s findings may serve as the foundation for a subsequent multicenter trial and broader dissemination of these techniques to other types of surgery. Trial RegistrationClinicalTrials.gov NCT04051021; https://clinicaltrials.gov/ct2/show/NCT04051021 International Registered Report Identifier (IRRID)DERR1-10.2196/21350

Are partisans more likely to endorse political violence when politicians accuse their rivals of election improprieties? I theorize that for Republican partisans in the United States, the answer to this question is yes. Republican partisans are primed to believe allegations of cheating by Democrats and view election improprieties through the lens of racial and xenophobic resentments. Allegations of Democratic election fraud prompt them to eschew nonviolent norms of political behavior and endorse political violence. I test these propositions using an original, online survey experiment involving 140 self-identified Republican subjects. I find that exposure to allegations by politicians that Democrats engage in election fraud prompts Republican partisans to increase their support for political violence. Furthermore, using mediation tests, I find that exposing Republicans to allegations of electoral fraud by Democrats reduces their trust of people of different races and religions which, in turn, increases their support for political violence. [ABSTRACT FROM AUTHOR]

Employing two alternative measures of state failure, we investigate how state weakness influences resident terrorist groups' survival. Theoretically, state failure favors resident terrorist groups' survival, while state territorial control fosters resident groups' termination until some control threshold. Empirically, we uncover a robust negative relationship between a country's weakness and its control of terrorism through the lens of the resident terrorist groups' survival prospects. The discovered relationship withstands a host of robustness tests – e.g., alternative estimates and samples. We apply an instrument designed to address endogeneity concerns. In particular, our novel instrument for failed states consists of the interaction between natural disasters and ethnic fractionalization. As a state's percentage of territorial control increases, resident terrorist groups are more prone to ending until some threshold control percent. Our analysis can guide counterterrorism policy by exploiting the nuanced theoretical determinants identified here that foster resident groups' termination in failing states. [ABSTRACT FROM AUTHOR]

Majority respect for the political rights of minorities is an important value undergirding peace and political stability in societies. This study examines whether intolerance for minority political rights affects the likelihood that an individual has engaged in violent activities for political causes. Using public opinion data from 11 Arab countries, the study finds that Muslim residents who interpret Islam to mandate inferior political rights to their non-Muslims compatriots are more likely to have engaged in political violence in the past three years. Moreover, the effect of attitudes toward non-Muslim political rights on engagement in political violence is unaffected by subject support for Islamic government/rule, attitudes about democracy and Islamic government, interpretation of Shari'a and general intolerance of or bigotry against non-Muslims. [ABSTRACT FROM AUTHOR]

As populist parties and politicians have grown in prominence in democracies, scholars have turned their attention to the causes, and consequences, of populist attitudes among citizens. Some preliminary research indicates that individuals with populist attitudes are more likely to express support or tolerance for the use of violence to achieve political objectives. In this study, I examine this relationship further by investigating factors that mediate the effect of populism on endorsement of political violence. Using an original survey of more than 1300 subjects in the United States, I evaluate four elements that theoretically mediate the relationship between populism and support for political violence: economic grievances; distrust of political institutions; perception that social and demographic changes in the United States are threatening; and preferences for politically illiberal or nondemocratic rule. I find that the effect of populism on support for political violence is mediated through fear of social/demographic change and preference for illiberal rule but not through economic grievances or distrust of political institutions. Taken together, over 50% of the effect of populism on support for political violence is mediated through heightened anxiety about social and demographic changes in the U.S. and illiberal attitudes. [ABSTRACT FROM AUTHOR]

In this study I use a survey experiment to test whether the prospect of White demographic decline affects attitudes toward treatment of terrorism suspects. I find that when White subjects are informed that Whites are projected to become a demographic minority in the United States by 2060 they are more likely to approve of the use of torture on terrorism suspects. In contrast, White subjects who are informed that Whites are expected to remain a demographic majority through 2030 are not. I also find that the effect of White decline salience on support for torture of terror suspects is mediated through a heighted perception of threat due to terrorism. [ABSTRACT FROM AUTHOR]