Coherent Group Research Articles

"People Show Up In Different Ways": DACA Recipients' Everyday Activism in a Time of Heightened Immigration-Related Insecurity.

Undocumented young adults have emerged as a coherent political group, forging a large-scale social movement and helping push forward 19 state-level tuition equity laws and Deferred Action for Childhood Arrivals (DACA) in 2012. Yet DACA recipients' status became endangered when President Trump rescinded DACA in September 2017, necessitating even more innovative strategies for contesting their exclusion. Drawing from research conducted in Maryland since 2016, I chronicle DACA recipients' trajectories of political engagement. Though some have participated consistently in public forms of collective action, many never have or have declined in participation due to political apathy, the intense need to protect their identities, and very-real fears about being exposed or deported. Yet these young adults have cultivated complementary forms of everyday activism, operating outside traditional modalities and spaces of political engagement through acts of resistance carried out in everyday life. I contend that against the backdrop of the repressive state in the Trump era, the everyday activism of DACA recipients complements more normative and overt forms of collective action. Everyday activism raises interesting questions about the nature of activism itself, including the extent to which it must be collective, organized, and public, and its place in social justice movements more broadly.

An Evaluation of the Performance of Current Morphea Subtype Classifications

Numerous classification systems for morphea subtypes exist, but none have been systematically evaluated for their ability to categorize patients with morphea into demographically and clinically coherent groups. Although some subtypes, such as linear morphea, are present across all the classification schemes, others list unique subtypes. This creates confusion among investigators and practitioners and impairs accurate categorization of patients for study and clinical evaluation. To evaluate how frequently the commonly used morphea classification systems categorize patients with morphea into clinically relevant subtypes using cross-sectional analysis of 2 large patient cohorts. This cross-sectional study comprised 944 adults and children from 2 prospective cohorts-the Morphea in Adults and Children at the University of Texas Southwestern Medical Center (Dallas, Texas), which enrolled participants from July 20, 2007, to September 21, 2018, and the National Registry for Childhood-Onset Scleroderma at the University of Pittsburgh (Pittsburgh, Pennsylvania), which enrolled participants from October 23, 2002, to November 13, 2018. Patient demographic characteristics, morphea subtype, quality-of-life measures, disease activity, and damage as measured by Localized Scleroderma Cutaneous Assessment Tool scores during initial visits. A total of 944 participants (444 patients with adult-onset morphea and 500 patients with pediatric-onset morphea; 741 female participants [78%]; median age at onset, 16 years [interquartile range, 8-44 years]) were included in this study. Most participants were White (723 [77%]) and had the linear (474 [50%]) or generalized subtype of morphea (244 [26%]). With the use of the previously published Padua criteria, most patients were classified to have linear morphea (474 [50%]), followed by generalized morphea (244 [26%]), plaque morphea (141 [15%]), mixed morphea (38 [4%]), and pansclerotic morphea (3 [0.3%]). Overall, the Padua criteria successfully classified 900 patients (95%) in comparison with the Peterson criteria (533 [56%]) and the European Dermatology Forum classification (487 [52%]). In this cross-sectional study of morphea subtype classification systems, the Padua criteria performed best in classifying patients into subgroups with cohesive demographic and clinical features, supporting its widespread use. However, they have ambiguities that might lead to misclassification, particularly in terms of generalized and pansclerotic morphea and descriptors such as morphea profunda. Consensus-based approaches are needed to address these ambiguities and develop a unified classification scheme.

Swimming Ahead or Treading Water? Disaggregating the Career Trajectories of Women Self‐Initiated Expatriates

AbstractThis paper explores the career choices and trajectories of women self‐initiated expatriates (SIEs). Extant research on these issues has tended to view women expatriates as a coherent group. We used a qualitative approach, involving semi‐structured interviews with 51 women SIEs, to examine women's reasons to relocate, reasons for employment, past and current work as part of their overall career and future career plans. Drawing on literature on career theories, gender work segregation theory and women expatriates, we explore how national and individual factors affect women SIEs’ career choices and career trajectories. In providing a more nuanced discussion of the careers of women SIEs, our key findings are that women's careers differ according to national grouping and marital status, with life stages and happenstance playing a more important role in women's careers than a planned career path.

Integrative clustering methods for multi-omics data.

Integrative analysis of multi-omics data has drawn much attention from the scientific community due to the technological advancements which have generated various omics data. Leveraging these multi-omics data potentially provides a more comprehensive view of the disease mechanism or biological processes. Integrative multi-omics clustering is an unsupervised integrative method specifically used to find coherent groups of samples or features by utilizing information across multi-omics data. It aims to better stratify diseases and to suggest biological mechanisms and potential targeted therapies for the diseases. However, applying integrative multi-omics clustering is both statistically and computationally challenging due to various reasons such as high dimensionality and heterogeneity. In this review, we summarized integrative multi-omics clustering methods into three general categories: concatenated clustering, clustering of clusters, and interactive clustering based on when and how the multi-omics data are processed for clustering. We further classified the methods into different approaches under each category based on the main statistical strategy used during clustering. In addition, we have provided recommended practices tailored to four real-life scenarios to help researchers to strategize their selection in integrative multi-omics clustering methods for their future studies.

High-temperature fluids in granites during the Neoarchaean-Palaeoproterozoic transition: Insight from Closepet titanite chemistry and U-Pb dating (Dharwar craton, India)

The aim of this paper is to determine the composition and age of high-temperature (HT) hydrothermal fluids in Closepet granites (Dharwar craton, India). The magmatic origin of the Neoarchaean Closepet batholith has been recognized and dated many times, whereas a HT fluid system, strong evidence for which has been partly investigated, has never been dated. Titanite was chosen for a geochemical study on its pristine and altered domains to illustrate the fluid composition; the domains were dated to recognize the timing of fluid activity.Titanite presents distinct trace element enrichments in non-altered domains and strong depletions in trace elements in marginal, irregular, patchy zones. The high total rare earth element (REE) concentrations and the marked negative Eu anomalies suggest crystallization from a residual melt. The negative Eu anomalies diminish progressively in the REE patterns of altered parts and become positive. Trace element ratios (Nb/Ta, Y/Ho, and U/Th) indicate fluid-crystal interactions. Strong U/Th fractionation might be linked to the presence of CO2 and Cl−. Zr-in-titanite thermometry yields a crystallization/recrystallization temperature of ~700 °C for both magmatic and altered domains. The titanite factor Ti+4/(Al+3 + Fe+3) reveals an affinity with significant mantle input to the fluid system.Pristine and altered titanite domains have been successfully dated by laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS). Reversely discordant apparent ages suggest interaction with fluids, which modified the Pb composition of the magmatic titanite. The oldest semi-concordant analyses of titanite cores indicate an age of approximately 2500 Ma, which we interpret as the minimum age of magmatic titanite crystallization. Narrow dark rims of titanite with considerably lower Th/U ratios form a more coherent group of analyses defining an upper concordia intercept age of 2345 ± 0.016 Ma, interpreted as the best estimate for the time of complete titanite resetting associated with the metasomatic event. The HT fluid system appears to have remained active into the Palaeoproterozoic.Confirmation by dating that the tested fluids belonged to the Archaean hydrothermal system gives us information about this system at the time, but the information that it worked at least until the Palaeoproterozoic provides additional valuable information about the hydrothermal systems during the Neoarchaean-Palaeoproterozoic transition.

Clustering of graphs using pseudo-guided random walk

Clustering is an unsupervised learning task that models data as coherent groups. Multiple approaches have been proposed in the past to cluster large volumes of data. Graphs provide a logical mapping of many real-world datasets rich enough to reflect various peculiarities of numerous domains. Apart from k-means, k-medoid, and other well-known clustering algorithms, utilization of random walk-based approaches to cluster data is a prominent area of data mining research. Markov clustering algorithm and limited random walk-based clustering are the prominent techniques that utilize the concept of random walk. The main goal of this work is to address the task of clustering graphs using an efficient random walk-based method. A novel walk approach in a graph is presented here that determines the weight of the edges and the degree of the nodes. This information is utilized by the pseudo-guidance model to guide the random walk procedure. This work introduces the friends-of-friends concept during the random walk process so that the edges’ weights are determined utilizing an inclusive criterion. This concept enables a random walk to be initiated from the highest degree node. The random walk continues until the walking agent cannot find any unvisited neighbor(s). The agent walks to its neighbors if it finds a weight of one or more, otherwise the agent’s stopping criteria is met. The nodes visited in this walk form a cluster. Once a walk comes to halt, the visited nodes are removed from the original graph and the next walk starts in the remaining graph. This process continues until all nodes of the graph are traversed. The focus of this work remains random walk-based clustering of graphs. The proposed approach is evaluated using 18 real-world benchmark datasets utilizing six cluster validity indices, namely Davies-Bouldin index (DBI), Dunn index (DI), Silhouette coefficient (SC), Calinski-Harabasz index (CHI), modularity index, and normalized cut. This proposal is compared with seven closely related approaches from the same domain, namely, limited random walk, pairwise clustering, personalized page rank clustering, GAKH (genetic algorithm krill herd) graph clustering, mixing time of random walks, density-based clustering of large probabilistic graphs, and Walktrap. Experiments suggest better performance of this work based on the evaluation metrics.

Chimeralike states in a minimal network of active camphor ribbons.

A chimeralike state is the spatiotemporal pattern in an ensemble of homogeneous coupled oscillators, described as the emergence of coexisting coherent (synchronized) and incoherent (unsynchronized) groups. We demonstrate the existence of these states in three active camphor ribbons, which are camphor infused rectangular pieces of paper. These pinned ribbons rotate on the surface of the water due to Marangoni effect driven forces generated by the surface tension gradients. The ribbons are coupled via a camphor layer on the surface of the water. In the minimal network of globally coupled camphor ribbons, chimeralike states are characterized by the coexistence of two synchronized and one unsynchronized ribbons. We present a numerical model, simulating the coupling between ribbons as repulsive Yukawa interactions, which was able to reproduce these experimentally observed states.

Default mode and salience network alterations in suicidal and non-suicidal self-injurious thoughts and behaviors in adolescents with depression

Suicidal ideation (SI) and non-suicidal self-injury (NSSI) are two distinct yet often co-occurring risk factors for suicide deaths in adolescents. Elucidating the neurobiological patterns that specifically characterize SI and NSSI in adolescents is needed to inform the use of these markers in intervention studies and to develop brain-based treatment targets. Here, we clinically assessed 70 adolescents—49 adolescents with depression and 21 healthy controls—to determine SI and NSSI history. Twenty-eight of the depressed adolescents had a history of SI and 29 had a history of NSSI (20 overlapping). All participants underwent a resting-state fMRI scan. We compared groups in network coherence of subdivisions of the central executive network (CEN), default mode network (DMN), and salience network (SN). We also examined group differences in between-network connectivity and explored brain-behavior correlations. Depressed adolescents with SI and with NSSI had lower coherence in the ventral DMN compared to those without SI or NSSI, respectively, and healthy controls (all ps < 0.043, uncorrected). Depressed adolescents with NSSI had lower coherence in the anterior DMN and in insula-SN (all ps < 0.030, uncorrected), and higher CEN–DMN connectivity compared to those without NSSI and healthy controls (all ps < 0.030, uncorrected). Lower network coherence in all DMN subnetworks and insula-SN were associated with higher past-month SI and NSSI (all ps < 0.001, uncorrected). Thus, in our sample, both SI and NSSI are related to brain networks associated with difficulties in self-referential processing and future planning, while NSSI specifically is related to brain networks associated with disruptions in interoceptive awareness.

Searching for Errors in Models of Complex Dynamic Systems.

Mathematical modeling is seen as a key step to understand, predict, and control the temporal dynamics of interacting systems in such diverse areas like physics, biology, medicine, and economics. However, for large and complex systems we usually have only partial knowledge about the network, the coupling functions, and the interactions with the environment governing the dynamic behavior. This incomplete knowledge induces structural model errors which can in turn be the cause of erroneous model predictions or misguided interpretations. Uncovering the location of such structural model errors in large networks can be a daunting task for a modeler. Here, we present a data driven method to search for structural model errors and to confine their position in large and complex dynamic networks. We introduce a coherence measure for pairs of network nodes, which indicates, how difficult it is to distinguish these nodes as sources of an error. By clustering network nodes into coherence groups and inferring the cluster inputs we can decide, which cluster is affected by an error. We demonstrate the utility of our method for the C. elegans neural network, for a signal transduction model for UV-B light induced morphogenesis and for synthetic examples.

Multiple memories can be simultaneously reactivated during sleep as effectively as a single memory

Memory consolidation involves the reactivation of memory traces during sleep. If different memories are reactivated each night, how much do they interfere with one another? We examined whether reactivating multiple memories incurs a cost to sleep-related benefits by contrasting reactivation of multiple memories versus single memories during sleep. First, participants learned the on-screen location of different objects. Each object was part of a semantically coherent group comprised of either one, two, or six items (e.g., six different cats). During sleep, sounds were unobtrusively presented to reactivate memories for half of the groups (e.g., “meow”). Memory benefits for cued versus non-cued items were independent of the number of items in the group, suggesting that reactivation occurs in a simultaneous and promiscuous manner. Intriguingly, sleep spindles and delta-theta power modulations were sensitive to group size, reflecting the extent of previous learning. Our results demonstrate that multiple memories may be consolidated in parallel without compromising each memory’s sleep-related benefit. These findings highlight alternative models for parallel consolidation that should be considered in future studies.

Uncovering and Displaying the Coherent Groups of Rank Data by Exploratory Riffle Shuffling

Let n respondents rank order d items, and suppose that . Our main task is to uncover and display the structure of the observed rank data by an exploratory riffle shuffling procedure which sequentially decomposes the n voters into a finite number of coherent groups plus a noisy group: where the noisy group represents the outlier voters and each coherent group is composed of a finite number of coherent clusters. We consider exploratory riffle shuffling of a set of items to be equivalent to optimal two blocks seriation of the items with crossing of some scores between the two blocks. A riffle shuffled coherent cluster of voters within its coherent group is essentially characterized by the following facts: 1) Voters have identical first TCA factor score, where TCA designates taxicab correspondence analysis, an L1 variant of correspondence analysis; 2) Any preference is easily interpreted as riffle shuffling of its items; 3) The nature of different riffle shuffling of items can be seen in the structure of the contingency table of the first-order marginals constructed from the Borda scorings of the voters; 4) The first TCA factor scores of the items of a coherent cluster are interpreted as Borda scale of the items. We also introduce a crossing index, which measures the extent of crossing of scores of voters between the two blocks seriation of the items. The novel approach is explained on the benchmarking SUSHI data set, where we show that this data set has a very simple structure, which can also be communicated in a tabular form.

Social Control in Late Antiquity: The Violence of Small Worlds ed. by Kate Cooper and Jamie Wood

Reviewed by: Social Control in Late Antiquity: The Violence of Small Worlds ed. by Kate Cooper and Jamie Wood Kristina Sessa Kate Cooper and Jamie Wood, editors Social Control in Late Antiquity: The Violence of Small Worlds Cambridge: Cambridge University Press, 2020 Pp. xiii + 380. $120.00. In Social Control in Late Antiquity: The Violence of Small Worlds, a group of international scholars brings the insights of past studies on power relations and early Christianity, such as contributions by Michel Foucault, to bear on a set of still relatively understudied contexts: smaller-scale social configurations, such as the household, the schoolroom, and the monastery. Here the emphasis is on [End Page 643] personal relationships (parent-child, slave-master, cleric-parishioner, teacher-student, abbot-monk), and on various forms of social control used within these contexts to shape discourse, behavior, and subjectivity. As stated in the volume's introduction by its editors, Kate Cooper and Jamie Wood, "[s]chools, monasteries, and churches played a pivotal role in enforcing and reproducing the social order, and their work of cultivating obedient subjects often involved symbolic or actual violence" (10). Drawing inspiration from microhistory and the study of "small worlds," the editors explain how the fifteen essays contribute to a singular goal: to elucidate and analyze the ways in which a range of Christian powerbrokers used violence (understood capaciously in both the physical and discursive sense) to "draw members into their communities and to intensify the commitment of new members once they had joined, drawing them into alignment as sharers of an independent subjectivity" (10). Following the editors' introduction, the book's contents are arranged in four parts, each preceded by a succinct summary of the section's general arguments. (In my opinion, sectional mini-introductions should appear in all edited collections, since they both convey general points of interconnection between the essays and provide readers with a sort of "cheat sheet" for what follows.) Part One, "Women and Children First: Autonomy and Social Control in the Late Ancient Household," features four essays that examine violence and social control within the context of the household (understood primarily as a social relationship), with essays on the monastic confinement of female family members (Hillner); Gregory of Nyssa's highly personal take on the corporeal punishment of children (Limberis); the household master-slave relationship in the preaching of John Chrysostom (Tallon); and Augustine on concubinage, and the framing of his remarkably nuanced, if not utterly idiosyncratic, understanding of male-female sexual partnerships (Cooper). Part Two, "'Slaves, Be Subject to Your Masters': Discipline and Moral Autonomy in a Slave Society," features three essays that interrogate discourses and material practices of humiliation and subordination within the context of the eastern Mediterranean monastery. Slavery in these essays is explored in both the concrete legal sense and a more abstracted, symbolic sense, so as to apply to the subjectivity of both the technically free and unfree. (Indeed, several authors underscore the fluid semantic overlap of these categories, especially within a monastic setting.) Thus, there is an essay on the discursive impact of slavery in the formation of the Syrian monastic subject and body (de Wet); an essay that explores the hermeneutic complexity of using early Christian sources to reconstruct the intersection of asceticism and slavery (Larsen); and a chapter on children in Egyptian monasteries, whose upbringing and employment within this particular ascetic space sometimes blurred the boundaries between filii and famuli (Giorda). Part Three, "Knowledge, Power, and Symbolic Violence: The Aesthetics of Control in Christian Pedagogy," tackles the important question of social control, subject formation, and the use of violence (not always symbolic) in schools and other teaching contexts, such as the church service. In what is the longest section with five essays, we read about John Chrysostom's employ of the "strategic utility of fear" to generate a particular type of ethical self and a more coherent group [End Page 644] identity (Leyerle, 173); the parallel uses of violence and humility in the training of both elite laymen in rhetorical schools and Christian ascetics in monastic contexts (Wood); Eusebius's acts of intellectual violence to pagan philosophical texts in the Praeparatio evangelica through his strategic "poaching" of pagan sources (Johnson...

Controlled Islanding Based on the Coherency of Generators and Minimum Electrical Distance

Inter-area oscillations and cascading failures are the most serious threats to the security of the electric power system. Uncontrolled islanding will occur in the event of an unstable inter-area oscillation or a progressive cascading failure. The establishment of uncontrolled islands with a deficiency in load-generation balance is the main reason for system blackout. Controlled islanding has been proposed as a preventive strategy for reducing the risk of blackout in this regard. A new algorithm for applying the controlled islanding strategy is proposed in this paper, based on load coherency and nearest electrical distances between coherent groups of generators. Coherent generators as the main core for controlled islands are identified in this method, which is based on the correlation coefficients between generators and the DBSCAN clustering algorithm. The sub-networks are then created by applying mixed-integer linear programming to each coherent group. Once this is accomplished, non-linear programming is used to construct the stable sub-networks associated with islands that meet the requirements of load-generation balance, voltage limitations, and transmission limits. The proposed scheme is implemented on the small-scale IEEE 39-bus system and a large-scale realistic power system which is the Iran power grid. The results demonstrate that the proposed method is capable of being implemented in a real power system.

De Radegonde à Audéarde : les premières fondations monastiques féminines d’Aquitaine du Nord (VIe-début du XIe siècle).

A few decades after the work of Jean Verdon and Élisabeth Magnou-Nortier, this article intends to revisit the sources available to study the female religious communities of Aquitaine (mainly located in the north) prior to the 11th century. In all, a dozen textual files composed of diplomatic acts, authentic, interpolated or false, historical or legendary accounts, and various mentions, contemporary or late, are critically re-read. Among the best documented establishments, we note, besides the exceptional case of the powerful abbey Sainte-Croix de Poitiers, of Merovingian foundation, various ephemeral foundations, such as Sainte-Eulalie de Bordeaux or Sarrazac. The most coherent group is formed by the small aristocratic foundations of the end of the tenth or beginning of the eleventh century, with variable destinies, but whose patrimonial and family character is clearly visible : Saint-Sauveur du Bugue, Saint-Silvain de Lamonzie in Périgord, Saint-André (future Saint-Jean de Bonneval) near Thouars in Poitou

Synthetic measures in benchmarking of the New Silk Road countries

China’s last 40 years of development became a unique phenomenon in the economic history. This country, classified in the late 1970s as one of the world’s poorest economies, has transformed into the largest in the world, focused to change the global status quo. One Belt One Road initiative seems to be in line with these geopolitical aspirations. This project, called now the Belt and Road Initiative (BRI), brings together countries with different levels of development and different levels of Chinese investment expectations. The aim of this research is to compare countries belonging to the BRI project to aggregate them into coherent groups in terms of socio-economic development, in order to identify development gaps between China and these countries. Evaluation is provided for years 2004 – 2018 by constructed vector synthetic measures with China as a pattern. The research shows that China still ranks as an average developed country in terms of socio-economic measures, and China’s global aspirations will be financed at the expense of this development.

In the Best Interest of Children: A Proposal for Corporate Guardians Ad Litem

Children are corporate stakeholders without a direct voice in corporate decision-making. Other stakeholders, like employees, customers, and suppliers, can and do influence corporate strategy, but children lack the organization, standing, and legal capacity to assert similar influence. Instead of treating children as a coherent stakeholder group with rights and interests to be respected and supported, firms tend to view children only as potential victims or coveted consumers. Yet, that view is short sighted. Recent international norm-building related to children’s rights and business point toward a more comprehensive consideration of children’s interests in the broad range of business activities. Moreover, children’s best interests substantially overlap with sustainable business practices and implicate human rights generally. Firms must develop expertise in order to identify and give voice to the best interest of children, a capacity which most currently lack. This Article introduces the first corporate model that can effectively advocate for children’s best interests, which is an adapted version of the long-utilized guardian ad litem model used in family court proceedings. Courts appoint guardians ad litem when their decisions impact children who cannot adequately represent themselves because they lack the sophistication or capacity to advocate or state their own best interests. Guardians ad litem serve as objective and impartial officials whose duty is to protect and advocate for the best interest of the children—and they serve only the children. This Article therefore asserts that companies should embed “corporate guardians ad litem” within their organizations to ensure that the best interests of children are considered in the development of corporate strategy and decision-making. The Article introduces three versions of the corporate guardian ad litem, namely, director-level, officer-level, and project-level.

Memorabilia of Birth and Death as Evidence of Jewish Folk Customs

Engraved silver plates bearing the names of deceased parents and the Hebrew dates of their deaths, termed yortsayt plaques, and coins altered to display the Hebrew letter heh are two coherent groups of Jewish artifacts previously unrecognized as distinct categories. The yortsayt memorabilia are from Russian Poland and date from the late nineteenth through the mid-twentieth centuries. The heh-inscribed coins were a form of childbirth amulet originating in western Europe from the seventeenth century onward. These previously inadequately documented artifacts are described and illustrated here, and a discussion of their distribution and presumptive usage is offered.

Identification of Low-Frequency Oscillation Modes Using PMU Based Data-Driven Dynamic Mode Decomposition Algorithm

Power system inter-area oscillations curtail the power transferring capabilities of the transmission lines in a large interconnected power system. Accurate identification of dominant modes and associated contributing generators is important to avoid power system failures by taking appropriate remedial measures. This paper proposes a multi-channel Improved Dynamic Mode Decomposition (IDMD) algorithm-based modal analysis technique using Synchrophasors measurement. First, a reduced-order dynamic power system model is estimated and using this model dominant oscillation modes, corresponding modes shapes, damping ratio, coherent group of generators, participation factors are determined. To improve the accuracy data stacking technique is used to capture detailed information of the system. An optimal hard threshold technique is utilized to select the most optimal model order to avoid uncertainties due to the presence of high level of measurement noise. The study results show that the proposed algorithm gives an accurate and robust solution even in systems having high level of noise in the measurement data. The performance of the proposed technique is tested on simulated data from two-area four-machine system and wNAPS 41-bus 16-generator system with PMU measurements corrupted with different levels of measurement noise. To further strengthen the viewpoint, the proposed method is validated on real-time PMU measurement from ISO New England data to validate the accuracy of the proposed work.

Ready to roll: Strategies and actions to enhance organizational readiness for implementation in community mental health.

Organizational readiness for implementation (ORI) is a barrier to disseminating recovery-oriented evidence-based practices for people with severe mental illnesses. However, there is a knowledge gap regarding implementation strategies and specific actions related to those strategies that may enhance ORI across organizations. The Transtheoretical Model (TTM) is a well-established stage-based model used to support organizational change. In TTM, the first three stages-Pre-contemplation, Contemplation, and Preparation-represent the pre-implementation phase, during which ORI should be developed. This study explored ORI enhancement strategies reported as useful by different stakeholders in the field of community mental health (CMH) and tested the applicability of the TTM readiness stages as an organizing framework to direct ORI development. The study included the following two phases: (1) a qualitative exploration of ORI enhancement actions reported by various stakeholders in the CMH field (N = 16) based on their experience in successful implementation projects and (2) a consolidation process performed by the research team to create coherent groups of actions and their overarching implementation strategies per readiness stage. A comprehensive list of strategies and related actions was created. The strategies and actions correspond with each of the first three stages of the TTM. Stakeholders differed in their methods of facilitating engagement across the organization and in their level of involvement in developing ORI. This study is a first step in conceptualizing a systematic process for developing ORI using the TTM as a theoretical framework. Future studies should test the transferability and effectiveness of this repository to other implementation efforts, expend the lists per stage, and further explore differences between stakeholders' role in ORI development. Interventions that were proven effective in supporting the recovery of people with mental illnesses are not sufficiently available in the field of community mental health. One barrier to getting those interventions implemented is the lack of willingness and preparedness of organizations to change their practice, also referred to as organizational readiness for implementation (ORI). Little is known about how to enhance ORI to increase the availability of interventions. This study explored actions used to enhance ORI by people in different roles who successfully implemented new recovery-oriented interventions in community mental health settings. The actions were organized into three stages of readiness development based on the Transtheoretical Model (TTM) of behavioral change. Differences were found between administrators, consultants, supervisors, and providers in the type and number of strategies they described. The results show the applicability of the TTM as an organizing framework for ORI development and provide sets of strategies and specific actions to support different readiness needs across the organization.

The multimorbidity dead end: how we got here and possible ways out.

Patients and physicians alike struggle to grasp how risk factors, treatments, and diseases interact within the same person. When seeing a frustrated 70-year-old man with hypertension, insomnia, and severe osteoarthritis in primary care, what strategy will help him most? The common definition for multimorbidity, using the number of diagnoses, is useful for epidemiologists but not clinicians in their management of individual patients. Maybe we can rethink our approach. We try to help patients using common scripts for diagnosis and treatment. Prospective cohorts and experimental trials provide average prognoses and expected effects of interventions for those with clearly defined diseases who we think of as standard patients. Health systems rely on common definitions for everything from patient discussion forums to billing. However, with ageing patients and improved detection, we rarely see standard patients in primary care. A 1976 German publication coined ‘Multimorbidity’ to describe the co-occurrence of multiple diseases or medical problems.1 Other terms followed, such as comorbid and polypathy. Observational cohorts based on the number of physical or mental morbidities have shown that patients with multiple diagnoses, on average, experience more fragmented care, suffer from more treatment side effects, and have a lower quality of life than those with one or no diagnoses.2 An implicit question underlying this concept is whether there are latent, causal links and interactions between coexisting medical problems. One method is to identify clinically coherent patient groups with the same diseases and, theoretically, common goals for treatment. Initial epidemiological studies found certain …