Careful Balance Research Articles

The role of digital transformation in addressing health inequalities in coastal communities: barriers and enablers.

Healthcare systems worldwide are striving for the "quadruple aim" of better population health and well-being, improved experience of care, healthcare team well-being (including that of carers) and lower system costs. By shifting the balance of care from reactive to preventive by facilitating the integration of data between patients and clinicians to support prevention, early diagnosis and care at home, many technological solutions exist to support this ambition. Yet few have been mainstreamed in the NHS. This is particularly the case in English coastal areas which, despite having a substantially higher burden of physical and mental health conditions and poorer health outcomes, also experience inequalities with respect to digital maturity. In this paper, we suggest ways in which digital health technologies (DHTs) can support a greater shift towards prevention; discuss barriers to digital transformation in coastal communities; and highlight ways in which central, regional and local bodes can enable transformation. Given a real risk that variations in digital maturity may be exacerbating coastal health inequalities, we call on health and care policy leaders and service managers to understands the potential benefits of a digital future and the risks of failing to address the digital divide.

Down the drain: The dynamic interplay of governance adjustments addressing setbacks in large public–private projects

AbstractLarge government projects involving public–private collaborations inherently suffer from setbacks such as delays, cost overruns, or failure to meet contracted performance. Such setbacks may effectively be addressed through adjustments to contractual and relational governance; yet to date, the dynamics of governance adjustments and their interplay in addressing setbacks is not well understood. This research presents a dynamic theory of how parties can effectively address project setbacks through adjustments to contractual and relational governance. The dynamic theory was generated using longitudinal case data from two large public–private projects in the Netherlands that faced comparable project setbacks but deployed opposing governance adjustments, leading to drastically different project outcomes (i.e., collapse vs. recovery). This theory was then elaborated through two more cases and evidence from the literature. A system dynamics simulation model was then built that reproduces the different governance adjustments and outcomes observed in the four projects and serves to extend theory building. The refined theory not only shows under what conditions adjustments to contractual or relational governance are most effective, but also that governance adjustment interplay may trigger unintended side effects. As such, the theory explains why the careful balancing of governance adjustments is critical to project outcomes.

Synergistic Microfluidic and Optical Performance Enhancements of Photoelectrodes for Space Applications

The realisation of long-term space missions as well as lunar habitats require reliable and efficient oxygen and chemical producing devices e.g., for life support, fuel generation and in-situ resource utilisation (ISRU). We have recently demonstrated that integrated semiconductor-electrocatalyst systems can be operated in microgravity environments generated for 9.2 s at the Bremen Drop Tower (Center of Applied Space Technology and Microgravity, ZARM) at terrestrial efficiencies, thus opening the possibility of utilising these photoelectrochemical (PEC) devices for chemical synthesis in space. 1,2 , 3 Our findings reveal that by altering the electrocatalyst surface morphology through nanostructuring, we can introduce catalytic hot-spots on the photoelectrode which - through their hydrophilic nature - can also enhance gas bubble detachment in microgravity and thus circumvent the near-absence of buoyancy.1,3 We have found that the surface hydrophilicity and electrocatalyst loading require however careful balancing as the most effective nanostructures for gas bubble desorption can also result in less catalyst material on the photoelectrode surface, which in turn leads to a non-optimal PEC device performance.Here, we present a combined theoretical and experimental microfluidic, optical and photoelectrocatalytic performance analysis of photoelectrodes with integrated, nanostructured electrocatalysts, aiming at providing a guideline for an optimal design for microgravity applications. Focusing on the hydrogen evolution reaction (HER) and a well-investigated photoabsorber for this reaction, p-type InP, we firstly built an optoelectronic model in COMSOL Multiphysics in pursuit of quantifying the optical performance enhancements of Rh and Pt electrocatalyst nanostructures such as nanopyramids, nanowires and sub-wavelength aperture holes.4 We then developed a microfluidic model using the same nanostructure geometries to predict the hydrophilicity of the device surface and subsequently, the gas bubble contact angle. The best-performing nanostructured photoelectrodes predicted in our models where then manufactured, photoelectrochemically tested and fully optically and spectroscopically characterised. Predicted local electric field enhancements through catalytic hotspot formation were moreover experimentally validated using scanning electrochemical cell microscopy (SECCM). Our findings indicate that our developed optoelectronic and microfluidic models can be utilised to design a theoretical framework for identifying ideal electrocatalyst nanostructures for microgravity applications.References Brinkert K, et al. Efficient solar hydrogen generation in microgravity environment. Nature Communications 9, (2018). Brinkert K, Mandin P. Fundamentals and future applications of electrochemical energy conversion in space. npj Microgravity 8, (2022). Akay Ö, et al. Releasing the Bubbles: Nanotopographical Electrocatalyst Design for Efficient Photoelectrochemical Hydrogen Production in Microgravity Environment. Advanced Science 9, 2105380 (2022). Tembhurne S, Haussener S. Integrated Photo-Electrochemical Solar Fuel Generators under Concentrated Irradiation. Journal of The Electrochemical Society 163, H988 (2016). Pan Y, Huang S, Li F, Zhao X, Wang W. Coexistence of superhydrophilicity and superoleophobicity: theory, experiments and applications in oil/water separation. Journal of Materials Chemistry A 6, 15057-15063 (2018).

UNLOCKING THE ANCIENT WISDOM: AYURVEDIC SECRETS FOR MANAGING SANDHI VATA (OSTEOARTHRITIS)

Discover the fascinating world of Ayurveda as we delve into its age-old wisdom for managing (Sandhivata), commonly known as osteoarthritis. This ancient Indian system of medicine offers holistic approaches to address the root cause of joint degeneration and promote overall well-being. Through a careful balance of Vata Dosha, detoxification therapies, herbal remedies, yoga, and lifestyle modifications, Ayurveda provides a comprehensive and natural way to alleviate joint pain, reduce inflammation, and enhance joint health. Join us on a journey to unlock the hidden secrets of Ayurveda and uncover its potential in managing Sandhivata, offering a ray of hope to those seeking effective and sustainable solutions for this debilitating condition.

Surface Analyses of Thin Multiple Layer Barrier Coatings of Poly(vinyl alcohol) for Paperboard

The hypothesis of the present study is that thin multiple layer coatings on paperboard from the aqueous solutions of poly(vinyl alcohol) (PVOH) at high machine speeds is more effective in terms of barrier properties than one or two thick layers. The objectives included attempts to use surface roughness parameters to understand the coating process and mechanisms behind coating defects. The present study is focused on pilot-scaled PVOH coating onto uncoated paperboard at machine speeds of 400 m/min. The multiple coating operation was carried out in six passes with a dry coat weight of about 1 g/m2 in each layer. The concept of thin multiple coatings resulted in coated surfaces without detected pinholes and with Kit rating 12 after only two thin layers. However, the oxygen transmission rates were still fairly high (100 ± 89 cm3/m2 day atm) after six layers, and some coating defects (such as craters and cracks) could be identified. The analyses of surface structure indicated that the surface properties are affected by water uptake during the coating processes. The compression of paperboard beneath the metering element seemed to be required to achieve homogeneous thin layers. However, an analysis of defects revealed flaws and inhomogeneities near objects protruding from the surface, such as surface fibers and craters, caused by blistering. For rough paperboard substrates, the desired barrier properties may require a careful balance between sufficient compression for fiber coverage and gentle compression in order to avoid defects near craters and surface fibers.

Big data for a deep problem: Understanding the formation of NADES through comprehensive chemical analysis and RDKit

This manuscript offers an in-depth analysis of Natural Deep Eutectic Solvents (NADES) reported over the past decade, derived from an expansive database encompassing 1334 NADES formulations. Key insights generated from this analysis underline the critical role of choline chloride as the predominant hydrogen bond acceptor, and the need for a careful balance in favor of hydrogen bond donors. Furthermore, the analysis underscores the pivotal role played by small molecules (over polymers) in the successful formation of NADES. Considerations around the careful selection and compatibility of NADES components are emphasized, as well as potential complications associated with the incorporation of water, which could potentially destabilize the hydrogen bond network of these eutectic mixtures. This study serves as a guide for researchers to navigate the complex landscape of NADES design and application, acknowledging the remaining challenges and opportunities in this promising field.

The fear of letting go and the Ivory Tower of dental educational training.

Clinical training in dental education is complex and happens mostly within a well-controlled environment such as a university dental clinic where oral health care services are delivered; it is mostly student-centered. While such training is important, it is also possible to augment and enhance it by training predoctoral dental students outside such a clinic within off-site community-based placements using a more person-centered approach. However, there seems to exist a reluctance in recognizing and utilizing the work produced in these off-site placements holistically as an integral part of students' clinical assessment. Community-based clinical experience adds value to the training of our predoctoral dental students. This perspective describes the benefits of community placements and recognizes their importance in the clinical and professional development of a future graduate. It also presents a way to assess students' performance that by-and-large mirrors that of the university dental clinic while striking a balance between student-centered education and person-centered care. In this perspective, we argue that the clinical work delivered at a community placement ought to be weighted equitably with the clinical work delivered at a university clinic when assessing students' competency as a whole. Our message is to keep a balance of student-centered education and person-centered care to the benefit of all those involved.

Monte Carlo Simulation of Phase Transition in Classical Ising Model

Phase transitions are widespread physical phenomena in nature and the phase transition of ferromagnetic substances which can be described by Ising model is an important part of physics. This paper discusses the phase transition of the low-dimensional Ising model. For one-dimensional Ising model, the exact solution is given and no phase transition is found when there is no external magnetic field. For two-dimensional Ising model, Monte Carlo method along with importance sampling, careful balance conditions and the Metropolis algorithm is introduced to numerically simulate it. The trends of order parameters like magnetization, specific heat and magnetic susceptibility are analyzed and the mutation of some order parameters is found around critical temperature. The influences of external magnetic field and the scale of system are discussed and critical temperature of phase transition is explored by several methods, which is eventually found around 2.269 ( kBT/J). Lastly, compared with theoretical values, the disadvantages are pointed out and optimization suggestions are raised for improvement.

Prospective of an Inland Waterway System of Shipping Canals in Skikda (Algeria)

Sustainable development projects require careful balancing of economic interests and ecological needs. The case of Skikda, a city in northeast Algeria, located on the Mediterranean coast, illustrates the challenges connected with such a development. The ancient city coexists with a young hydrocarbon port and industrial pole that serves as a transfer hub in the flow of petroleum between hinterland and sea. The installation of the port and petrochemical refining plants on the banks of the estuary of the Safsaf River presents many challenges to local citizens and the ecosystem, including pollution of the water system, groundwater, and river water, and damage to the area’s ancient heritage. This study argues that we need new and less polluting forms of intermodality between hinterland and seaport to make urban mobility more sustainable. It asks whether and how the existing rivers and wadis (river channels that are dry except during rainy periods) can be transformed into artificial canals for river navigation to improve the transport fluidity and sustainability of Skikda. To answer this question, the study adopts a prospective approach using the MICMAC scenario method. This approach entails, first, presenting and evaluating the potentialities of the existing rivers of Skikda using QGIS, and second, discussing and proposing scenarios for transforming these rivers into urban waterways, that is, artificial canals for inland navigation. The prospect of inland waterway transport in Skikda may be a radical scenario, yet, despite its hydraulic capacity and advantages, this system is not receiving attention in Algeria. We suggest that water transport can breathe sustainable blue life into a vulnerable industrial port city, transforming its challenges into opportunities.

The Future of Earth Imaging

Abstract Imaging of Earth’s interior has led to a large number of successful discoveries of plausible structures and associated geophysical processes. However, due to the limitations of geophysical data, Earth imaging has many trade-offs between the underlying features, and most approaches apply smoothing to reduce the effect of such trade-offs. Unfortunately, this smoothing often results in blurry images that are not clear enough either to infer the geologic processes of interest or to make quantitative inferences about the various geologic properties. Here, we first summarize some of the basic issues that make Earth imaging so difficult and explain how Earth imagers must choose between more open-ended discovery-oriented goals and more specific, scientific-inference-oriented goals. We discuss how the choice of the optimal imaging framework depends crucially on the desired goal, and particularly on whether plausible discovery or inference is the desired outcome. We argue that as Earth imaging has become more mature, sufficiently many plausible structures have been imaged that it is becoming more crucial for Earth imaging to serve the inference goal and would benefit from an inference-oriented imaging framework, despite the additional challenges in posing imaging problems in this manner. Examples of inference-oriented imaging frameworks are provided and contrasted with discovery-oriented frameworks. We discuss how the success of the various frameworks depends critically on the data quality and suggest that a careful balance must be struck between the ambition of the imager and the reality of the data. If Earth imaging is to move beyond presenting qualitatively plausible structures, it should move toward making quantitative estimates of the underlying geologic processes inferred through a self-consistent framework.

Vying for and forgoing visibility: female next gen leaders in family business with male successors

PurposeThe purpose of this paper is to examine the identity work undertaken by female next generation to navigate (in)visibility in family businesses with male successors. To enhance understanding of gendered identity work in family businesses, the authors offer important insights into how female next generation use (in)visibility to establish legitimacy and exercise power and humility in partnership with male next generation in their family business.Design/methodology/approachThis empirical qualitative paper draws upon in-depth interviews with 14 next generation female leaders.FindingsThis study offers a model to show how female next generation establish their legitimacy amongst male next generation in power via a careful balancing act between vying for visibility (trouble) and forgoing visibility (exclusion). These female next generation gained acceptance by endorsing their own leadership identity and exercising humility in partnership or by endorsing their brother's leadership identity and exercising power in partnership.Practical implicationsThis study highlights the need for the incumbent generation to prepare successors, regardless of gender, via equal opportunities for business exposure and leadership preparation. This study also shows that vocalizing female-centric issues and highlighting hidden power imbalances should be led by the entire management team and not simply delegated to a “family woman” in the management team to spearhead.Originality/valueThis study advances understanding of gender dynamics and identity in the family business literature by identifying specific strategies utilized by female next generation to navigate (in)visibility in family businesses with male successors.

Comparing subtotal parathyroidectomy and total parathyroidectomy with autotransplantation in renal transplant recipients.

Both subtotal parathyroidectomy (SPTX) and total parathyroidectomy with autotransplantation (TPTX + AT) are considered acceptable surgical approaches for renal patients. It is common that parathyroid surgery is performed in patients before they undergo kidney transplantation and there is currently no evidence considering the best surgical approach in this subset of patients. Two cohorts were identified of consecutive patients who underwent parathyroidectomy for renal hyperparathyroidism by two surgeons at a single institution over equivalent time periods (SPTX and TPTX + AT). A retrospective chart review was performed to assess these techniques, including outcomes following kidney transplantation. There were 125 patients analysed, with 56 patients who underwent SPTX and 69 who underwent TPTX + AT. Both cohorts effectively reduced PTH post operatively. There were 22 patients in the SPTX cohort and 26 in the TPTX + AT cohort that subsequently received kidney transplants. There were no cases of recurrent hyperparathyroidism and one of hypoparathyroidism (4.5%) in the SPTX patients post-transplant. There was one case of recurrent hyperparathyroidism (3.8%) and four of persistent hypoparathyroidism (15.4%) in the TPTX + AT patients post-transplant. Surgery for renal hyperparathyroidism requires a careful balance of the extent of parathyroid resection to prevent persistent/recurrent disease and avoid permanent hypoparathyroidism. SPTX may be a more appropriate option in kidney transplant candidates in order to minimise the risk of long-term hypoparathyroidism.

Balancing conservation and welfare in ex situ management of the extinct‐in‐the‐wild sihek: sex‐ and age‐specific causes of mortality and contributions to population growth rate

AbstractEx situ threatened species management has both conservation and welfare objectives and these objectives often align, but can diverge. Areas of agreement can present win‐wins for achieving welfare and conservation objectives, while identifying areas of divergence is important to ensure management strategies achieve balance across objectives. We examined welfare and conservation objectives in the ex situ population of Extinct in the Wild sihek (Guam kingfisher, Todiramphus cinnamominus) by quantifying mortality rates, determining sex‐ and age‐specific causes of mortality and identifying associated welfare domains, as well as quantifying sex‐ and age‐specific differences in reproductive value and contributions to variation in population growth rate (λ). Females had significantly higher mortality rates than males, potentially impacting population viability and suggesting females may be more vulnerable to experiencing lower welfare than males. Mitigating causes of female mortality would therefore present a clear win‐win for both welfare and conservation objectives. Both causes of mortality and contributions to variation in λ were found to differ across sex‐ and age‐classes. In particular, nutritional and metabolic diseases tended to impact younger age‐classes and these age‐classes had large contributions to variation in λ. Mitigation of these diseases could therefore also present a win‐win for welfare and conservation objectives. However, we also identified a potential divergence between objectives: a major cause of female mortality was reproductive disease with older aged females primarily affected, but older aged females contributed little to variation in λ and had low reproductive value. Developing mitigation strategies for reproductive disease could therefore aid welfare objectives but have little benefit for conservation objectives, suggesting careful balancing across objectives is required. Our results highlight the need to explicitly consider conservation and welfare objectives in threatened species management, in particular in the context of an increasing conservation need for ex situ population management, coupled with increasing social concern for animal welfare.

Balancing Cyber-security and Privacy: Legal and Ethical Considerations in the Digital Age

In today’s digital world the need to maintain cyber-security and protect sensitive information is more important than ever. However, this must be balanced against the right to privacy, which is also a fundamental human right. This article provides an overview of the legal and ethical considerations involved in balancing cyber-security and privacy in the digital age. It explores the challenges of implementing effective cyber-security measures while respecting privacy rights, and discusses the current legal framework for cyber-security and privacy in various jurisdictions. The article also considers the ethical implications of balancing these two important values and suggests ways in which cyber-security and privacy concerns can be reconciled in a general context. By highlighting the importance of a careful balance between cyber-security and privacy, this article aims to raise awareness of the need for ethical and legal considerations in the development of digital technologies and their regulation.

Factors Contributing to Successful Spontaneous Dog-Human Cooperation.

Dogs' ability to cooperate with humans is widely acknowledged, but the factors influencing their spontaneous cooperative tendencies are largely unknown. We investigated whether breed function, training experience, and owner-reported social motivation level contribute to spontaneous dog-owner cooperation. Family dogs (N = 100) of three breed groups (non-working dogs, cooperative/independent working breeds) with various training experiences were tested in an 'out-of-reach' task with their owners as their partners, who never directly asked for help during the test. We measured dogs' behaviour along three main components of successful cooperation: paying attention, understanding the problem, and willingness to cooperate. Breed groups had no significant effect on dogs' behaviour. No factor was associated with the behavioural variables related to not understanding the task. Dogs with high training levels and high social motivation showed more attention-related behaviours and were more likely to help the owner (training level and social motivation were not correlated with each other). Our results highlight the importance of training experience and social motivation in dogs' attentiveness and spontaneous cooperativity. This also points to the need for careful sample balancing and experimental procedures that do not rely on specific trained skills.

The path towards increasing RAMS for novel complex missions based on CubeSat technology

The paper presents the initial outcomes of a project, currently ongoing under the supervision of the European Space Agency, having the main objective to specify and design a Fault Detection Isolation and Recovery (FDIR) system by making use of relevant RAMS (Reliability, Availability, Maintainability, Safety) analyses for missions in non-deterministic environment with limited resources. The initial project tasks have been to select a study case represented by a CubeSat complex mission, analyse in detail both its mission and system requirements and, based on them, define a set of relevant RAMS analyses to be carried out in the second phase of the project, as inputs for the development of a FDIR concept aimed at a careful balance of the limited spacecraft resources in case of critical failures. Two possible study cases have been identified: LUMIO, a 12U CubeSat mission for the observation of micro-meteoroid impacts on the Lunar farside, and M-ARGO, a 12U deep-space CubeSat which will rendezvous with a near-Earth asteroid and characterize its physical properties for the presence of in-situ resources. Although both missions are characterized by a high level of autonomy and complexity in a harsh environment, LUMIO has been eventually selected as study case for the project. In the paper, the challenges and features of this mission are shortly presented. The specificities of the RAMS analysis and FDIR concept for this specific class of small satellite missions (including the selected study case) are highlighted in the paper, looking in particular at aspects such as the improvement of reliability while maintaining the CubeSat philosophy, the tuning of mission and system requirements in view of facilitating the design and implementation of the FDIR concept, and the current gaps within the RAMS/FDIR body of knowledge. The conclusions drawn during this first project phase provide a real view of how systems engineering must work in tandem with RAMS analyses and FDIR to achieve a more robust and functional mission architecture, thus improving the mission reliability.

Ethical Issues in Neurotrauma: Challenges and Solutions

AbstractNeurotrauma is a medical field that deals with the treatment and prevention of serious injuries to the brain, spinal cord, or peripheral nerves. It presents complex ethical issues that require careful consideration and balance between individual autonomy, public health, patient preferences, and clinical outcomes. In this review, we examine several ethical dilemmas in neurotrauma, including the prevention of traumatic events, obtaining informed consent and respecting patient preferences in situations of impaired cognition and communication, determining the appropriate use of life-saving interventions, and communicating with patients and families about prognosis and outcomes. Our analysis highlights the need for a nuanced and evidence-based approach that takes into account the unique circumstances of each patient and balances the potential benefits and risks of various interventions.

On time: developmental timing within and across species.

Organisms across species differ in the relative size and complexity of their tissues to serve the specific purposes of the host. Correct timing is a crucial ingredient in the development of tissues, as reaching the right size and complexity requires a careful balance between cellular proliferation and differentiation. Premature or delayed differentiation, for instance, can result in tissue imbalance, malformation or malfunction. Despite seemingly rigid constraints on development, however, there is flexibility in both the timing and differentiation trajectories within and between species. In this Spotlight, we discuss how time is measured and regulated in development, and question whether developmental timing is in fact different between species.

Extending contestation: opposition party strength and dissenting civil society engagement with autocratic elections

ABSTRACT How does the strength of political-party opposition affect government-critical civil society organisations (CSOs)’ engagement with autocratic elections? The question is particularly pertinent in the current context of deepening autocratization and repression of civic dissent. In this article, I explore the argument that strong opposition parties or coalitions facilitate CSOs’ acts of dissent by offering robust dual electoral contestation: they credibly compete for power and forcefully politicise electoral regulation. Strong opposition parties thereby change the incentives for dissent and make civic activism more possible and meaningful. The article investigates this through a qualitative comparison of two cases of autocratisation: Kenya with a strong opposition, and Uganda with a weak one. The analysis largely supports the argument. However, the comparison also demonstrates that even with a strong opposition, autocratisation makes CSO dissent a dangerous activity that requires a careful balancing between rewards and risks.

Post-Acute Care Setting After Hip Fracture Hospitalization and Subsequent Opioid Use in Older Adults.

Pain management in post-acute care (PAC) requires careful balance, with both opioid use and inadequate pain treatment linked to poor outcomes. We describe opioid use among older adults following discharge from PAC for hip fracture in skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs). Retrospective cohort. Medicare beneficiaries with Medicare Provider Analysis (MedPAR) claims, aged 66years and older with a hip fracture hospitalization between 2012 and 2018 followed by PAC in SNFs or IRFs and then discharge to the community. Individuals were followed from PAC discharge for up to 1 year to assess opioid use. Covariate-standardized risk ratios (RR) and risk differences (RD) for opioid use within 7 days of PAC discharge were estimated via parametric g-formula with modified Poisson regression, and hazard ratios (HRs) for any post-PAC opioid use and long-term opioid use via Fine-Gray sub-distribution hazards regression. Of 101,021 individuals, 80% (n= 80,495) were discharged from SNFs and 20% (n= 20,526) from IRFs. Opioids were dispensed to 50,433 patients (50%) overall and the 1-year cumulative incidence was notably higher in IRF (68%) than SNF (46%) patients. The adjusted risk of discharge from PAC with an opioid was 41% lower after SNFs versus IRFs [RR: 0.59; 95% confidence limits (CLs): 0.57-0.61; and RD:-0.16; 95% CLs:-0.17 to-0.15]. The adjusted rate of any opioid use in the year after PAC discharge was 44% lower (HR: 0.56; 95% CLs: 0.54-0.57) and of long-term opioid use was 17% lower (HR: 0.83; 95% CLs: 0.80-0.87) after SNFs versus IRFs. Opioid use is highly prevalent upon discharge from PAC after hip fracture, with lower use after SNF versus IRF care. Future research should assess the benefits and harms of post-PAC opioid prescribing and whether care practices during PAC can be improved to optimize long-term opioid use.