Active Measures Research Articles

Optimization of Transformative Leadership to Enhance Organizational Performance: Policing Strategic Analysis at Industrial Revolution 4.0 Era to Maintain Security and Public Order

Abstract The Bojonegoro Resort Police, a middle manager in the Indonesian National Police, proactively adapts to the Fourth Industrial Revolution's challenges, marked by VUCA (Volatility, Uncertainty, Complexity, and Ambiguity). They prioritize staying informed about developments and taking initiative. Strategies for security and public order maintenance, including crime prevention and increased surveillance, are effectively planned and implemented. Qualitative field research explores how transformative leadership optimizes policing and performance. Findings reveal: 1) Leaders model idealized influence and inspire a shared vision; 2) They provide inspirational motivation; 3) Leaders foster intellectual stimulation by promoting skill development and critical thinking; 4) Individualized consideration is shown through active delegation and control measures. In conclusion, the Bojonegoro Resort Police's proactive, transformative leadership helps them navigate the Fourth Industrial Revolution's challenges, enhancing organizational performance in maintaining security and public order.

Moscow and the World: From Soviet Active Measures to Russian Information Warfare

Russia under Vladimir Putin has expanded and moved rapidly to improve its ability to employ “disinformation,” or “information warfare,” as an effective instrument to help it to accomplish its specific foreign policy objectives. Although it has only been since direct Russian involvement in the U.S. presidential election of 2016 that this has been an issue of major public political concern in the United States, a flood of research on this topic has now begun to appear. Despite many years of preparation for cyber conflict against critical U.S. infrastructure and military forces, the U.S. government and cybersecurity industry were unprepared for Russian information operations targeting the 2016 U.S. presidential election. It is clear, however, that the Russian propaganda/disinformation activities in the U.S. are but one part of a policy targeted virtually everywhere across the entire world and that this policy builds upon the earlier propaganda and disinformation activities of Russia’s predecessor state, the USSR. In the present essay, we intend to track the reemergence and development of the information warfare and disinformation component of Russian policy under President Putin, including its largely successful attempt to reintegrate the components of the former Soviet Union and its deep roots in Soviet “active measures,” up until the invasion of Ukraine, when it expanded exponentially. We shall also track the areas of the world targeted, and the increasing breadth of its target audiences and the issues covered.

Computed tomography-based automated measurement of abdominal aortic aneurysm using semantic segmentation with active learning

Accurate measurement of abdominal aortic aneurysm is essential for selecting suitable stent-grafts to avoid complications of endovascular aneurysm repair. However, the conventional image-based measurements are inaccurate and time-consuming. We introduce the automated workflow including semantic segmentation with active learning (AL) and measurement using an application programming interface of computer-aided design. 300 patients underwent CT scans, and semantic segmentation for aorta, thrombus, calcification, and vessels was performed in 60–300 cases with AL across five stages using UNETR, SwinUNETR, and nnU-Net consisted of 2D, 3D U-Net, 2D-3D U-Net ensemble, and cascaded 3D U-Net. 7 clinical landmarks were automatically measured for 96 patients. In AL stage 5, 3D U-Net achieved the highest dice similarity coefficient (DSC) with statistically significant differences (p < 0.01) except from the 2D–3D U-Net ensemble and cascade 3D U-Net. SwinUNETR excelled in 95% Hausdorff distance (HD95) with significant differences (p < 0.01) except from UNETR and 3D U-Net. DSC of aorta and calcification were saturated at stage 1 and 4, whereas thrombus and vessels were continuously improved at stage 5. The segmentation time between the manual and AL-corrected segmentation using the best model (3D U-Net) was reduced to 9.51 ± 1.02, 2.09 ± 1.06, 1.07 ± 1.10, and 1.07 ± 0.97 min for the aorta, thrombus, calcification, and vessels, respectively (p < 0.001). All measurement and tortuosity ratio measured − 1.71 ± 6.53 mm and − 0.15 ± 0.25. We developed an automated workflow with semantic segmentation and measurement, demonstrating its efficiency compared to conventional methods.

Role performance and factors affecting quality of life in bladder cancer survivors with ileal orthotopic neobladder

ObjectiveBladder cancer survivors with neobladder experience changes in role performance and quality of life (QoL) due to various symptoms and problems, but related studies are limited. Therefore, this study attempted to explore the QoL and factors influencing it in bladder cancer survivors with neobladder. MethodsA cross–sectional descriptive design was used. Data were collected from 100 bladder cancer survivors with a neobladder using the European Organisation for Research and Treatment of Cancer QLQ–C30 and Muscle–Invasive Bladder Cancer Module, the Patient Activation Measure 13, the Enforced Social Dependency Scale, and the Multidimensional Scale of Perceived Social Support. Factors affecting the QoL were identified using multiple regression analysis. ResultsQoL significantly differed by daily pad usage, need for clean intermittent catheterization, and role performance. QoL was correlated with urinary symptoms and problems, future perspective, abdominal bloating and flatulence, body image, role performance, and social support. Role performance, body image, and the need for clean intermittent catheterization were identified as the factors affecting QoL. ConclusionsThe study highlights the importance of bladder cancer survivors continuing their roles at home, at work, and in society after neobladder reconstruction. Specifically, continuing recreational and social activity positively affects QoL, even if the activity range is modified. To help with their role performance, institutional support and changes in social perception are needed. Additionally, education and interventions, including body image enhancement, symptom management, and self–care, should be developed and applied to improve their QoL.

Twenty-four hour physical activity, sedentary behaviour and sleep profiles in adults living with rheumatoid arthritis: a cross-sectional latent class analysis

BackgroundRheumatoid Arthritis (RA), an autoimmune systemic inflammatory disease, affects more than 17 million people globally. People with RA have higher risk of premature mortality; often experience chronic fatigue, pain and disrupted sleep; and are less physically active and more sedentary than healthy counterparts. It remains unclear how people with RA may balance sleep and awake movement activities over 24-hours, or how differences in 24-hour behaviours may be associated with determinants of health, or alignment with published activity guidelines.MethodsCross-sectional exploration of objective measures of 24-hour sleep-wake activities in 203 people with RA. Latent Class Analysis (LCA) derived classes from time, by tertile, in six sleep-awake activities over 24 h. Comparisons of model fit statistics, class separation and interpretability defined best fit for number of classes. Variations in sleep-awake behaviour across classes and association of profile allocation with determinants of health, quality metrics for sleep, sitting and walking and alignment with published guidelines were explored. Multinomial logistic regression identified factors associated with likelihood of profile allocation.ResultsLCA identified 2 to 6 classes and a 4-class model was determined as best fit for 24-hour sleep-awake behaviour profiles. One profile (26%) presented with more balanced 24-hour sleep, sitting and walking behaviours. The other three profiles demonstrated progressively less balanced 24-hour behaviours including: having low (< 7 h), high (> 8 h), or recommended (7–8 h) sleep duration in respective combination with high sitting (> 10 h), limited walking (< 3 h) or both when awake. Age, existing sitting and walking habit strength and fatigue were associated with likelihood of belonging to different profiles. More balanced 24-hour behaviour was aligned with better quality metrics for sleep, sitting and walking and published guidelines.DiscussionFor people living with RA it is important to understand the ‘whole person’ and their ‘whole day’ to define who may benefit from support to modify 24-hour sleep-awake behaviours and which behaviours to modify. Supports should be informed by an understanding of personal or health-related factors that could act as barriers or facilitators for behavioural change, including exploring existing habitual sitting and walking behaviours.Trial registrationsClinicalTrials.gov ID: NCT02554474 (2015-09-16) and ClinicalTrials.gov ID: NCT03404245 (2018-01-11)

Culture Internalization for AKHLAK BUMN: A Uniformized Core Values of All Indonesian State-Owned Enterprises

In today's business landscape, companies must be increasingly agile to meet the demands of developing business potential, changing customer needs, and rising competition. This includes State-Owned Enterprises (SOEs) that aim to deliver social and economic value. Internalization of core values is crucial in creating a culture that drives the company's performance. Therefore, the activation program and measurement methods for culture are key to the success of the transformation. Through the implementation experience, this practitioner study aims to identify the necessary infrastructure for managing the uniformized culture, activation programs, and measurement methods in companies. The core value set by the Ministry of SOEs or AKHLAK BUMN, guides the behavior of employees to support company performance. Implementing core values in each SOE company will facilitate talent mobility and ensure that the transformation process aligns with the ministry's objectives.

Poststroke Communication Ability Predicts Patient-Informant Discrepancies in Reported Activities and Participation.

Participation in life situations has been identified by people with aphasia (PWA) as an ultimate outcome of rehabilitation and is often measured with patient-reported outcome measures (PROMs) or informant-reported measures. It is known that PWA and informants do not always produce similar scores on measures of activities and participation. However, systematic differences between PWA and informants and the causes of these differences are not well understood. Here, we investigated these differences as a function of language impairment, perceived level of activity and participation success, and depressive symptoms. Participants were 29 PWA-informant dyads who completed a performance-based language assessment and three measures related to different aspects of activities and participation. Outcome variables were PWA-informant difference scores in the activities and participation measures. PWA ratings of activities and participation were not statistically significantly associated with performance-based language severity. Hierarchical regression models with both language impairment and informant-reported scores as predictor variables explained 53%-71% of the variance in PWA-informant difference scores (all p < .05). In particular, mild communication challenges were associated with the PWA reporting significantly worse participation than the informant perceived. In contrast, more severe communication challenges were associated with the PWA reporting significantly better participation than the informant perceived. These findings highlight the importance of measuring participation by PROM. The PWA's experience of participation is not related to their level of language impairment and is predictably different from their care partners' perspective. As others have also reported, "mild" aphasia is not so mild to the PWA. Similarly, "severe" may not be so severe to the PWA. Further research is needed to connect these findings with counseling and caregiver education. Research on response processes (e.g., response shift) is also warranted.

Projecting heat-related cardiovascular mortality burden attributable to human-induced climate change in China

Cardiovascular disease (CVD) has been found to be particularly vulnerable to climate change and temperature variability. This study aimed to assess the extent to which human-induced climate change contributes to future heat-related CVD burdens. Daily data on CVD mortality and temperature were collected in 161 Chinese communities from 2007 to 2013. The association between heat and CVD mortality was established using a two-stage time-series design. Under the natural forcing, human-induced, and combined scenarios, we then separately projected excess cause-/age-/region-/education-specific mortality from future high temperature in 2010-2100, assuming no adaptation and population changes. Under shared socioeconomic pathway with natural forcing scenario (SSP2-4.5-nat), heat-related attributable fraction of CVD deaths decreased slightly from 3.3% [95% empirical confidence interval (eCI): 0.3, 5.8] in the 2010s to 2.8% (95% eCI: 0.1, 5.2) in the 2090s, with relative change of-0.4% (95% eCI:-0.8, 0.0). However, for combined natural and human-induced forcings, this estimate would surge to 8.9% (95% eCI: 1.5, 15.7), 14.4% (95% eCI: 1.5, 25.3), 21.3% (95% eCI:-0.6, 39.4), and 28.7% (95% eCI:-3.3, 48.0) in the 2090s under SSP1-2.6, SSP2-4.5, SSP3-7.0, and SSP5-8.5 scenarios, respectively. When excluding the natural forcing, the number of human-induced heat-related CVD deaths would increase from approximately eight thousand (accounting for 31% of total heat-related CVD deaths) in the 2010s to 33,052 (68%), 63,283 (80%), 101,091 (87%), and 141,948 (90%) in the 2090s under SSP1-2.6, SSP2-4.5, SSP3-7.0, and SSP5-8.5 scenarios, respectively. Individuals with stroke, females, the elderly, people living in rural areas, and those with lower education level would exhibit heightened susceptibility to future high temperature. In addition, Southern and Eastern regions of China were expected to experience a faster increase in heat-related attributable fraction of CVD deaths. Human activities would significantly amplify the future burden of heat-related CVD. Our study findings suggested that active adaptation and mitigation measures towards future warming could yield substantial health benefits for the patients with CVD. National Natural Science Foundation of China.

Systems analysis and improvement approach to optimize tuberculosis (SAIA-TB) screening, treatment, and prevention in South Africa: a stepped-wedge cluster randomized trial

BackgroundThe use of systems engineering tools, including the development and use of care cascades using routinely collected data, process mapping, and continuous quality improvement, is used for frontline healthcare workers to devise systems level change. South Africa experiences high rates of tuberculosis (TB) infection and disease as well as HIV co-infection. The Department of Health has made significant gains in HIV services over the last two decades, reaching their set “90–90-90” targets for HIV. However, TB services, although robust, have lagged in comparison for both disease and infection. The Systems Analysis and Improvement Approach (SAIA) is a five-step implementation science method, drawn from systems engineering, to identify, define, and implement workflow modifications using cascade analysis, process mapping, and repeated quality improvement cycles within healthcare facilities.MethodsThis stepped-wedge cluster randomized trial will evaluate the effectiveness of SAIA on TB (SAIA-TB) cascade optimization for patients with TB and high-risk contacts across 16 clinics in four local municipalities in the Sarah Baartman district, Eastern Cape, South Africa. We hypothesize that SAIA-TB implementation will lead to a 20% increase in each of: TB screening, TB preventive treatment initiation, and TB disease treatment initiation during the 18-month intervention period. Focus group discussions and key informant interviews with clinic staff will also be conducted to determine drivers of implementation variability across clinics.DiscussionThis study has the potential to improve TB screening, treatment initiation, and completion for both active disease and preventive measures among individuals with and without HIV in a high burden setting. SAIA-TB provides frontline health care workers with a systems-level view of their care delivery system with the aim of sustainable systems-level improvements.Trial registrationClinicaltrials.gov, NCT06314386. Registered 18 March 2024, https://clinicaltrials.gov/study/NCT06314386. NCT06314386.

지역사회 연계 환경 프로그램 효과성 연구

Objectives The purpose of this study is to investigate the effectiveness of community-based environmental programs for alternative school children, focusing on environmental behavior, pro-environmental behavior, environmental sensitivity and awareness.&#x0D; Methods The subjects of the study are 19 students from Alternative School A in Seoul. The trends (M, SD) and normality (Kolmogorov-Smirnov, Shapiro-Wilk) of the pre-post mean scores for the research variables, namely environmental behavior, pro-environmental behavior, environmental sensitivity and awareness, were verified using SPSS 23.0. Since normality was not met, the Wilcoxon test, a non-parametric statistical method that analyzes differences between paired pre- and post-samples, was used to verify effectiveness.&#x0D; Results The main results are as follows: First, the trend of research variables was analyzed by differentiating between pre-mean scores (a) and post-mean scores (b), and examining the difference (b-a). The results showed improvement in post-mean scores compared to pre-mean scores for all research variables. Second, the normality of the pre- and post-test mean scores of the study variables was not satisfied, so nonparametric statistical methods were used to test for differences. Third, all study variables showed higher post-test mean scores than pre-test mean scores, and the results were statistically significant.&#x0D; Conclusions The findings of this study suggest that community engagement programs operated by alternative schools should be expanded to support optimized programs by identifying and implementing improvements through continuous monitoring. The proposal focuses on measures for experiential project activities through strengthened collaboration with the local community.&#x0D;

Role of Ozone Hole on Life on Earth and Countermeasures

The purpose of this paper is to investigate the protection of the ozone layer and the extensive effects of the hole diffusion on the life on Earth. First, the ozone layer is a layer in the atmosphere that absorbs ultraviolet radiation from the sun and protects life on earth from ultraviolet damage. UV radiation is destructive to living organisms and can cause health problems such as skin cancer, eye damage and even genetic mutations. Therefore, the existence and health of the ozone layer is directly related to the survival and health of organisms on Earth. Next, we will study the formation and diffusion of the ozone hole. The hole in the ozone layer is caused by the destruction of the ozone layer caused by human activities such as the release of chemicals such as chlorofluorocarbons (CFCS). When these destructive factors enter the atmosphere and are irradiated by ultraviolet light, they break down into active free radicals, which destroy ozone molecules. Over time, these destructive factors accumulate in the atmosphere, causing the ozone layer to gradually thin and eventually form the ozone hole. Finally, we will discuss in detail the effects of these ozone holes on life on Earth. The existence of the ozone hole allows ultraviolet radiation to reach the Earth's surface, posing a direct threat to living organisms. Studies have shown that UV radiation can cause problems such as stunted plant growth, death of Marine life, and skin damage to animals. In addition, ultraviolet light can accelerate the Earth's climate change, causing more extreme weather events, such as floods, droughts and storms, which will have a broader and far-reaching impact on Earth's life. Through the discussion in this paper, we can clearly understand the impact of the ozone hole diffusion on the earth's organisms. In order to protect our home and biodiversity, we must take active measures to reduce the damage of human activities to the atmosphere in order to maintain a healthy and stable ozone layer. This requires our global efforts to take scientific and effective measures to solve this problem. Only in this way can we ensure that life on Earth can continue to live healthy and safe on the blue planet.

The impact of policy legacies on the implementation of Citizen Income in Italy: A policy feedback perspective

AbstractThe Citizen Income (Reddito di cittadinanza—RdC) is the most extensive program to fight poverty ever adopted in Italy. RdC is a Minimum Income Scheme that grants a cash amount to beneficiaries but obliges some specific groups to participate in active measures and in social inclusion programs. After 4 years of implementation, RdC seems not to have fully achieved its goals and scholars blame policy legacies as one of the main causes of its failures. Drawing on the literature on policy feedback, the paper proposes an analytical framework that identifies the mechanisms related to resources, incentives, and meanings affecting policy actors (public administration, organized civil society, and citizens). The framework is then applied to the case of RdC to detect through what specific mechanisms deriving from past anti‐poverty, active, and social policies impacted on the implementation of the RdC. The paper is moreover aimed at advancing the debate about policy legacies and their effects on current policies through the elaboration of a framework specifying the mechanisms through which policy feedback produces change or stability.

The impact of environmental regulation on green investment efficiency of thermal power enterprises in China-based on a three-stage exogenous variable model

Due to the increased frequency of extreme weather events and the implementation of the China’s dual-carbon target, thermal power companies have been under pressure to construct green infrastructure and to actively pursue low-carbon transformation in response to stricter environmental regulations. This research thus selects 30 listed thermal power enterprises in China as study objects and assesses their green investment efficiency in the low-carbon transition process using three-stage DEA evaluation model with environmental regulation as an exogenous variable. Based on this, a benchmark regression model is used to corroborate the relationship between environmental regulation and green investment. Simultaneously, we carry out analysis to compare the correlation between thermal power firms’ green investment efficiency and their focus on green investments. The results show in terms of total efficiency that environmental regulation significantly improves the total efficiency of 80% of thermal power enterprises compared to the absence of this exogenous variable. With the addition of environmental regulation, firms’ total efficiency declines gradually in general from 2018 to 2022, with the mean value of efficiency falling by 0.068. In terms of stage-specific efficiency, the efficiency of the green investment stage of the majority of firms is between 0.3 and 0.6, which is much lower than that of the operational stage and the market performance stage. In terms of sub-indicator efficiency, both green investment efficiency and social donation efficiency among thermal power enterprises show obvious polarization, with 30% of them having an efficiency of 1 and 30% less than 0.1. In terms of green investment focus, thermal power unit renovation has a more obvious role in boosting the green investment efficiency of thermal power enterprises than do wind power and photovoltaic projects. Therefore, both governmental departments and thermal power enterprises need to take active measures in order to achieve green transformation from the perspective of green investment efficiency. Through the segmentation of important projects of green investment, this paper provides a reasonable investment direction reference for the sustainable transformation of China’s thermal power industry. It also provides a rich and novel theoretical basis for the Chinese government to further improve the relevant environmental protection laws and regulations of thermal power industry.

Achieving sustainable medical tourism: unpacking privacy concerns through a tripartite game theoretic lens.

Medical tourism has grown significantly, raising critical concerns about the privacy of medical tourists. This study investigates privacy issues in medical tourism from a game theoretic perspective, focusing on how stakeholders' strategies impact privacy protection. We employed an evolutionary game model to explore the interactions between medical institutions, medical tourists, and government departments. The model identifies stable strategies that stakeholders may adopt to protect the privacy of medical tourists. Two primary stable strategies were identified, with E6(1,0,1) emerging as the optimal strategy. This strategy involves active protection measures by medical institutions, the decision by tourists to forgo accountability, and strict supervision by government departments. The evolution of the system's strategy is significantly influenced by the government's penalty intensity, subsidies, incentives, and the compensatory measures of medical institutions. The findings suggest that medical institutions are quick to make decisions favoring privacy protection, while medical tourists tend to follow learning and conformity. Government strategy remains consistent, with increased subsidies and penalties encouraging medical institutions towards proactive privacy protection strategies. We recommend policies to enhance privacy protection in medical tourism, contributing to the industry's sustainable growth.

Interprofessional follow-up for people at risk of type 2 diabetes in primary healthcare – a randomized controlled trial with embedded qualitative interviews

Objective To examine the effects of an empowerment-based interprofessional lifestyle intervention program among people at risk of type 2 diabetes on knowledge, skills, and confidence in self-management, health, psychological well-being, and lifestyle characteristics, and to explore the participants’ perceptions of participating in the intervention. Design and methods In line with the Medical Research Council complex interventions research methods framework, we conducted a randomized controlled trial with embedded qualitative interviews in primary healthcare clinics in Norway between 2019–2021. Of the patients at risk (The Finnish Diabetes Risk Score Calculator (FINDRISC) ≥15 or Body Mass Index (BMI) ≥30) 142 accepted the invitation, and 14 participants from the intervention group participated in individual interviews after the 12-month follow-up. Our primary outcome was the Patient Activation Measure (PAM-13). Secondary outcomes were EQ-5D-5L, EQ-VAS, WHO-Overall health, WHO-Overall QOL, weight, height, waist circumference, and regularity of physical activity. We used thematic analysis to analyse the qualitative data. Results There was no clinically relevant differences of neither the primary nor the secondary endpoints between intervention and control group. As to the qualitative data, we identified two distinct features: ‘Meaningful perspectives on lifestyle changes’ and ‘Lifestyle change is not a linear process due to challenges faced along the way’ putting ownership of their choices in life into picture. Conclusion The negative results of the RCT stand in contrast to the findings given by the participants voices, perceiving the intervention as a key eye opener placing their health challenges in perspective. How to interpret these seemingly conflicting findings of participants being seen, heard, and understood, helping them to take more conscious ownership of their choices in life, and at the same time demonstrating no improvements in symptoms or measures, is a dilemma that needs further exploration. We should be careful to implement interventions that do not demonstrate any effects on the quantitative outcomes.

Impact of climate change and oligotrophication on quality and quantity of lake primary production: A case study in Lake Biwa

Global climate change and anthropogenic oligotrophication are expected to reshape the dynamics of primary production (PP) in aquatic ecosystems; however, few studies have explored their long-term effects. In theory, the PP of phytoplankton in Lake Biwa may decline over decades due to warming, heightened stratification, and anthropogenic oligotrophication. Furthermore, the PP of large phytoplankton, which are inedible to zooplankton, along with biomass-specific productivity (PBc), could decrease. In this study, data from 1976 to 2021 and active fluorometry measurements taken in 2020 and 2021 were evaluated. Quantitatively, the temporal dynamics of mean seasonal PP during 1971–2021 were assessed according to the carbon fixation rate to investigate relationships among environmental factors. Qualitatively, phytoplankton biomass, PP, and PBc were measured in two size fractions [edible (S) or inedible (L) for zooplankton] in 2020 and 2021, and the L:S balance for these three measures was compared between 1992 (low-temperature/high-nutrient conditions) and 2020–2021 (high-temperature/low-nutrient conditions) to assess seasonal dynamics. The results indicated that climate change and anthropogenic oligotrophication over the past 30 years have diminished Lake Biwa's PP since the 1990s, impacting the phenology of PP dynamics. However, the L:S balance in PP and PBc has exhibited minimal change between the data from 1992 and the 2020–2021 period. These findings suggest that, although climate change and oligotrophication may reduce overall PP, they may not markedly alter the inedible/edible phytoplankton balance in terms of PP and PBc. Instead, as total PP declines, the production of small edible phytoplankton may decrease proportionally, potentially affecting trophic transfer efficiency and material cycling in Lake Biwa.

Government Spending Between Active and Passive Monetary Policy: An Invariance Result

Abstract This paper develops a new approach to analyze the relationship between the government spending multiplier and monetary policy. We embed measures of monetary policy activism into a nonlinear SVAR model. Our model allows the central bank to adjust its monetary policy regime in response to the economic conditions that arise after government spending shocks. We find that, regardless of the monetary policy regime at the time of a spending shock, the central bank adjusts its regime quickly and responds actively towards inflation only a few quarters after the shock hits the economy. This rapid response of monetary policy leaves medium-run multipliers ultimately unaffected by whether the initial regime was active or passive. For both initial regimes, our five-year multiplier estimates lie between 1.2 and 1.5. An apparent exception to this result is the zero lower bound period between 2008Q4 and 2015Q4-during which monetary policy kept nominal interest rates at zero. Our multiplier point estimates for that era are consistently larger than unity.

Measuring the Impact of Primary Care Team Composition on Patient Activation Utilizing Electronic Health Record Big Data Analytics.

Team-based care has been linked to key outcomes associated with the Quadruple Aim and a key driver of high-value patient-centered care. Use of the electronic health record (EHR) and machine learning have significant potential to overcome previous barriers to studying the impact of teams, including delays in accessing data to improve teamwork and optimize patient outcomes. This study utilized a large EHR dataset (n=316,542) from an urban health system to explore the relationship between team composition and patient activation, a key driver of patient engagement. Teams were operationalized using consensus definitions of teamwork from the literature. Patient activation was measured using the Patient Activation Measure (PAM). Results from multilevel regression analyses were compared to machine learning analyses using multinomial logistic regression to calculate propensity scores for the effect of team composition on PAM scores. Under the machine learning approach, a causal inference model with generalized overlap weighting was used to calculate the average treatment effect of teamwork. Seventeen different team types were observed in the data from the analyzed sample (n=12,448). Team sizes ranged from 2 to 5 members. After controlling for confounding variables in both analyses, more diverse, multidisciplinary teams (team size of 4 or more) were observed to have improved patient activation scores. This is the first study to explore the relationship between team composition and patient activation using the EHR and big data analytics. Implications for further research using EHR data and machine learning to study teams and other patient-centered care are promising and could be used to advance team science.

The impact of extinction timing on pre-extinction arousal and subsequent return of fear.

Exposure-based therapy is effective in treating anxiety, but a return of fear in the form of relapse is common. Exposure is based on the extinction of Pavlovian fear conditioning. Both animal and human studies point to increased arousal during immediate compared to delayed extinction (>+24 h), which presumably impairs extinction learning and increases the subsequent return of fear. Impaired extinction learning under arousal might interfere with psychotherapeutic interventions. The aim of the present study was to investigate whether arousal before extinction differs between extinction groups and whether arousal before extinction predicts the return of fear in a later (retention) test. As a highlight, both the time between fear acquisition and extinction (immediate vs. delayed) and the time between extinction and test (early vs. late test) were systematically varied. We performed follow-up analyses on data from 103 young, healthy participants to test the above hypotheses. Subjective arousal ratings and physiological arousal measures of sympathetic and hypothalamic pituitary adrenal axis activation (tonic skin conductance and salivary cortisol) were collected. Increased pre-extinction arousal in the immediate extinction group was only confirmed for subjective arousal. In linear regression analyses, none of the arousal measures predicted a significant return of fear in the different experimental groups. Only when we aggregated across the two test groups, tonic skin conductance at the onset of extinction predicted the return of fear in skin conductance responses. The overall results provide little evidence that pre-extinction arousal affects subsequent extinction learning and memory. In terms of clinical relevance, there is no clear evidence that exposure could be improved by reducing subjective or physiological arousal.

Water and Chlorine in the Martian Subsurface Along the 27 km Traverse of NASA's Curiosity Rover According to DAN Measurements: 2. Results for Distinct Geological Regions

AbstractThis paper is Part II of a double‐paper series that presents the abundance of water and chlorine along with other neutron‐absorbing elements in the shallow subsurface of Gale crater based on measurements by the Dynamic Albedo of Neutron (DAN) instrument onboard NASA's Curiosity rover. Initial results were represented as pixels on map data products from both DAN active and passive measurements made along the 27‐km traverse of the rover, corresponding to the mission period from landing on the martian surface in August 2012 through December 2021. In Part II, the contents of water and chlorine along with other neutron absorbers are studied separately for distinct geological regions along the traverse. Mean values and sample variances of these values are presented for each region. Water‐equivalent hydrogen (WEH) measurements show variability within the Jura member of the Murray formation and increase within the Carolyn Shoemaker formation. A large fraction of stratigraphic units (e.g., Bradbury, Sheepbed, Pahrump Hills and others) have mean WEH values between 2 and 3 wt.%, while units in the second part of the traverse (Jura, Knockfarrill Hill, Glasgow, Pontours) have mean values of WEH above 3 wt.%. The mean absorption‐equivalent chlorine value has no large variations for all tested geologic units; it is equal to around 1% for all of them.