Level Of Participation Research Articles

Engaging practitioners in developing a guide for citizen participation in community health promotion

Abstract Background Community health promotion aims to improve the living conditions in municipalities, cities, or regions to support health maintenance or promotion. Participation is a fundamental element in health promotion, as it enables community members to engage in decision-making, program development, and tailored health initiatives. This project focused on crafting a practical guide for citizen participation in community health promotion, involving experts and future users. Methods We conducted a literature review to identify existing guidelines and materials pertinent to community health promotion, with a focus on practical guidance for municipal practitioners. To delve deeper into the topic, we conducted interviews with 6 experts in the field of participation and community health promotion as well as with 6 practitioners working in “healthy municipalities” in Lower Austria. The guide was developed collaboratively, with two workshops being held to gather input on the draft concept of the guide and to prioritize topics. Moreover, experts and practitioners were involved to provide feedback on the drafted guidance document. Results Discrepancies emerged between theoretical concepts and real-life implementation of community participation. While the literature delineates up to 12 participation levels, practitioners identified three: contributing ideas, advising and co-deciding, and actively participating in planning and implementation. Informing the target group was conceptualized as a preliminary stage and basic requirement for citizen participation. Above all, practitioners sought low-key suggestions and short descriptions of methods that they could use directly in their everyday context. Conclusions Involving practitioners and potential users enhanced the accessibility and utility of the guide. Their input ensured that the guide remained practical, relevant and informative without excessive academic or theoretical abstraction. Key messages • Involving health promotion practitioners helped shaping the practical guide in a way to be most useful for the intended audience. • Experts and practitioners have different views regarding the theoretical distinctions of levels of participation in community health promotion.

Canagliflozin reduces oral loop diuretic intensification in patients with type 2 diabetes: a participant level pooled analysis of CREDENCE and CANVAS

Abstract Background Patients with type 2 diabetes often have coexistent heart failure or chronic kidney disease (CKD) that require treatment with loop diuretics; however, the prognostic implications of oral loop diuretic intensification are not well characterized. The sodium glucose cotransporter-2 inhibitor canagliflozin reduces the risk of hospitalization for heart failure or cardiovascular death and CKD progression among patients with type 2 diabetes at high cardiovascular risk or with concomitant CKD. Purpose To assess the prognostic implications of oral loop diuretic intensification and the treatment effects of canagliflozin versus placebo on loop diuretic use in high-risk patients with type 2 diabetes. Methods This was a post-hoc participant-level pooled analysis of the CANVAS Program and CREDENCE trial which enrolled patients with type 2 diabetes at high cardiovascular risk or with CKD. Oral loop diuretic intensification was defined as a composite of new loop diuretic initiation (among patients not receiving loop diuretics at baseline) or loop diuretic dose increase (among patients receiving loop diuretics at baseline). We assessed the association between the requirement for loop diuretic intensification and the incidence of subsequent all-cause death. The effect of canagliflozin versus placebo on the composite of loop diuretic intensification as well as its components were evaluated. We further examined the effect of canagliflozin on an expanded post hoc composite of cardiovascular death, hospitalization for heart failure or loop diuretic intensification. Results 2,263 (15.6%) of 14,543 patients were treated with loop diuretics at baseline. Over a median follow-up of 2.2 years, 1,264 patients (9.4%) required oral loop diuretic intensification, of which 981 (77.6%) patients required initiation of oral loop diuretics and 283 (22.4%) required oral loop diuretic dose increase. Patients requiring oral loop diuretic intensification experienced rates of subsequent mortality that were 3.5-fold higher (5.9[5.4-6.5] per 100 patient-years) than those not requiring oral loop diuretic intensification (1.7[1.6-1.9] per 100 patient-years). Treatment with canagliflozin reduced the need for oral loop diuretic intensification by 41% (HR 0.59; 95%CI: 0.53-0.66) including both new diuretic initiation (HR 0.65; 95%CI: 0.57-0.74) and diuretic dose increase (HR 0.42; 95%CI: 0.33-0.54); Figure 1. Treatment with canagliflozin similarly reduced an expanded composite of worsening heart failure inclusive of cardiovascular death, heart failure hospitalization or diuretic intensification (HR 0.64; 95%CI: 0.58-0.70). Conclusion Among high-risk patients with T2D, new oral loop diuretic intensification was frequent and associated with an increased risk of subsequent mortality. Treatment with canagliflozin significantly reduced the need for loop diuretic intensification.

School-level competition for US high school extracurricular resources

ABSTRACT In the United States, families know that extracurricular activities serve as a qualitative distinction in postsecondary admissions and merit-based aid awards, leading to competition in their participation and leadership positions. Despite the extensive literature supporting extracurricular activities, there is an incomplete picture of how school characteristics influence high school students’ participation and holding of leadership positions within extracurricular activities. Using the US Education Longitudinal Study of 2002, our study explores how the school characteristics of socioeconomic status, test scores, class size, school urbanicity, and school control shape twelfth-grade participation and holding leadership positions in ten school-sponsored extracurricular areas. From our results, we offer recommendations on how schools can create equitable participation levels and discuss the ever-expanding role of extracurricular activities in defining merit.

Community Engagement in the Management of Urban Green Spaces: Prospects from a Case Study in an Emerging Economy

Urban green spaces (UGSs) play a vital role in enhancing the quality of life in cities, particularly in rapidly urbanizing regions such as the Metropolitan Region of São Paulo (MRSP). However, significant challenges related to equitable management and access persist, often exacerbated by socio-environmental inequalities. While much of the existing literature on UGS management focuses on developed economies, there is a gap in our understanding of how community engagement influences UGS outcomes in emerging economies, which face unique socio-economic and infrastructural constraints. This study addresses this gap by investigating the impact of community engagement on UGS management in the MRSP, specifically examining how increased participation correlates with improved UGS access and reduced socio-environmental inequality. Utilizing survey data from 33 municipal environmental departments across the MRSP, this research applied correlation tests, generalized linear models, and a non-parametric analysis of variance to evaluate the relationships between community engagement, UGS coverage, and inequality. The findings reveal a moderate positive correlation between community engagement and UGS coverage, alongside a negative correlation with socio-environmental inequality. Increased levels of community participation were associated with greater access to UGSs and a reduction in disparities across socio-economic groups. These results underscore the potential of fostering community involvement in UGS management to promote urban equity and environmental sustainability in emerging economies, particularly through institutional support and transparent information sharing. Future research should focus on longitudinal studies to better understand the long-term effects of sustained community engagement and incorporate qualitative data from community members to provide a more comprehensive analysis of participatory processes. Additionally, expanding the scope of analysis to include informal and private green spaces will offer a more holistic understanding of urban greening dynamics.

Community-Based Tourism Implementation as Mediator on the Relationship between Community Participation and Socio-Economic Sustainability of Tourism

This study explored the mediating effect of community-based tourism implementation on the relationship between community participation and the socio-economic sustainability of tourism in Marilog District. This study employed a quantitative method and stratified random sampling to select the 380 respondents. The survey was distributed to two areas in Marilog District: Barangay Baganihan and Barangay Datu Salumay. The data was evaluated to ascertain whether the variables had a statistical relationship. This study used non-experimental quantitative research, the descriptive-correlation approach, and mediation analysis. The weighted mean, Pearson product-moment correlation coefficient, multiple regression analysis, and path analysis were used to analyze the data. The result revealed that the respondents have high levels of community participation, socio-economic sustainability, and community-based tourism implementation. The relationship between community participation and socio-economic sustainability, community participation and community-based tourism implementation, and socio-economic sustainability and community-based tourism implementation were statistically significant. However, the indirect effect of community participation in socio-economic sustainability through community-based tourism implementation is insignificant and statistically supported by this study, indicating no significant mediation. The study findings’ implications are presented.

Intestinal Parasites and Hematological Parameters in Children Living in Ambatoboeny District, Madagascar

Madagascar is one of the poorest countries in the world. The country’s extreme weather conditions, poor sanitation, and weak economy facilitate the spread of parasitic diseases. Infections with intestinal parasites are particularly dangerous for children because they can cause malnutrition and anemia, which, in turn, have a negative effect on children’s cognitive functions and physical development. The aim of the present study was to analyze the prevalence of intestinal parasites and to assess hematological parameters in a group of children living in northern Madagascar. The screening was conducted in May 2024 in the Clinique Medicale Beyzym in Manerinerina, the Ambatoboeny district. It involved a sample of 208 children aged 0–17 years. Single stool samples were collected from all study participants. The samples were fixed in SAF fixative and then transported from Africa to Europe for further diagnostics at the Department of Epidemiology and Tropical Medicine, the Military Institute of Medicine–the National Research Institute in Poland. First, the samples were analyzed by light microscopy methods using three different diagnostic techniques (direct smear, decantation with distilled water, and the Fülleborn method). Next, they were tested by molecular biology methods (real-time PCR). Blood samples for the assessment of hematological parameters were collected at the healthcare center in Madagascar. The prevalence of intestinal parasites in the study sample was 61.5%. Helminths were found in 15.2% of the investigated children, and Giardia intestinalis (20.5%) was found to be the most prevalent parasite in the study population. Most infections were caused by potentially pathogenic stramenopila Blastocystis spp. (32.0%). Mean Hb, HCT, MCV, MCH, and MCHC levels in the study participants were below normal values. However, no correlation was found between the presence of a parasitic infection and low hematological parameters, which are a clinical sign of anemia. High rates of infections with intestinal parasites in children living in northern Madagascar support the necessity to introduce long-term preventive measures, which would limit the spread of parasitic diseases in the Malagasy population. Low hematological parameters in non-infected children may be indicative of persistent malnutrition or infection with other parasites, e.g., malaria or schistosomiasis.

Human-Autonomy Teaming in a Cooperative Gamified Testbed: How Can AI Teammates Support Teamwork Processes?

When Artificial Intelligence (AI) agents are incorporated into teams, they are expected to possess teaming capabilities beyond their advanced technological skills. Human-Autonomy Teams (HATs) are AI agents and humans working interdependently toward shared goals. Teams engage in processes, including goal specification, planning, mission analysis, coordination, monitoring, and backup behaviors. Participation of AI agents in teamwork processes can elevate HAT effectiveness and enhance the involvement of the agents as teammates. This study explored three levels of support for teamwork processes from AI agents: passive, reactive, and proactive. The study was conducted in HiveMind, a cooperative gamified testbed. The proactive agent scored higher on several assessment metrics, including effective communication, interdependence, and teaming. Furthermore, participants reported positive perceptions of the agent’s proactive support and initiative taking. The study’s findings suggest that AI teammates’ level of participation in teamwork processes influences human teammate’s perceptions and teaming experiences with their AI teammate.

From Workfare to Economic and Sociopolitical Stability? Evidence from a Randomized Trial in Eastern Congo

Abstract Did a workfare program in Eastern Congo have a lasting impact on economic and sociopolitical outcomes? Men and women in Eastern Congo were randomly assigned to 2,674 four-month job offers, or to the job offer plus a savings incentive, hard-skills training, or both. Eighteen months after the program, labor market and savings outcomes have improved, but there is no change across 12 other economic and sociopolitical outcome families. Regarding labor market outcomes, the most intensive treatment—the job offer plus the savings incentive and hard-skills training—outperforms treatments with only one add-on. This indicates that the savings incentive and hard-skills training, when combined, can create a synergistic impact greater than the sum of their individual effects. The results are mainly driven by female beneficiaries, who start at much lower levels of labor market participation and earnings than men.

02 Youth perspectives on virtual healthcare appointments in Nova Scotia – a qualitative study

Abstract Background With the onset of the COVID-19 pandemic, public safety measures required healthcare providers to look for alternative ways of delivering care in a safe and timely fashion. This led to an escalated use of virtual appointments to continue to provide patient care. For future decision-making regarding virtual care in our community, we must consider the youth perspective to ensure our healthcare delivery meets the needs of this patient population. Objectives Our study aims to determine the perspectives of local youth patients on their experience with virtual and in-person paediatric clinic appointments. Design/Methods Participants were recruited from general and subspecialty paediatrics clinics at the IWK Health Centre, in Nova Scotia, Canada. Eligibility criteria included attending both a virtual and in-person appointment from 2019-2022. Participants completed a semi-structured interview and provided their perspective on comfort level, accessibility, participation, and general preferences between virtual and in-person clinics. Transcribed data was analyzed using thematic analysis with both inductive and deductive approaches to identify themes. Results 12 participants aged 14-18 provided interviews. Participants represented clinical areas of general paediatrics, rheumatology, diabetes clinic and gender clinic. Virtual appointments were preferred for convenience, flexibility, and efficiency during shorter conversations. In-person appointments were preferred for physical concerns, communication and relationship building. Some youth appreciated talking face-to-face for the ease of communication, feeling able to “get the point across” in this setting. The value of the in-person connection with their healthcare team was expressed by some youth, and building this relationship held importance. When appointments provided education, youth preferred for that information to be delivered in-person. Participants overall felt more comfortable during virtual appointments, and participation levels varied based on the individual and not based on an appointment being virtual versus in-person. Accessibility issues were predominantly associated with in-person appointments, with barriers including access to transportation, time spent attending appointment, and the cost of travelling to a tertiary care centre. Conclusion Youth patients have unique and individual preferences for virtual versus in-person appointments. This study provided insight into situations when each appointment type should be considered and emphasizes the importance of including the youth in the decision-making process around appointment scheduling when possible.

Examining Leisure Re-Engagement and Its Relationship With Self-Regulation After Traumatic Brain Injury: A Cross-Sectional Study.

Engagement in leisure activities is a significant contributor to health. Individuals with traumatic brain injury (TBI) report not returning to pre-injury levels of leisure participation. Self-regulation (SR) is a possible factor of limited re-engagement. This study aimed to examine leisure re-engagement patterns and the impact of SR on these patterns. Fifty-five adults with TBI were included in a cross-sectional study. Participants completed a leisure activity survey, rating engagement before and after injury. Participants and an informant completed the Frontal Systems Behavior Scale (FrSBe) to assess SR. Leisure was significantly lower after injury than before injury, t(54) = 3.83, p < .001. The FrSBe apathy score was significantly associated with lower re-engagement (eta = 0.42) and may predict engagement after injury (ΔR2 = .09, p < .05). Apathy may contribute to difficulty re-engaging in leisure activities. Re-engagement in leisure activities should be a focus of occupational therapy intervention after TBI.

Joint position and force senses in young female tennis players and untrained adolescents.

The aim of the study was to determine the differences between tennis players and untrained peers in the development of upper limb proprioception in 10-15-year-olds. A group of 67 girls (12.75 ± 1.46 years old), including 33 tennis players and 34 age-matched untrained controls, was divided into three age groups: A1, 10-11-years-old; A2, 12-13-years-old; and A3, 14-15-years-old. Joint position sense (JPS) and force sense (FS) were assessed by reproducing memorized target angle or torque value of three joints: glenohumeral, elbow, and radiocarpal. The JPS error for the elbow joint in group A1 was 71% and 80% higher (p < 0.01) than that in groups A2 and A3, respectively, and the performance of all tennis players was 27.5% (p = 0.01) better than that of untrained controls. For FS, proprioception of only the more demanding task tested (reproduction of 50% maximal voluntary contraction) and specific function (elbow and radiocarpal extension, and glenohumeral internal rotation) showed development with age. The error values for elbow extension (A1, A2) and the glenohumeral joint (A3) of tennis players were lower than those of age-matched controls. We conclude that the development of FS in the upper limb varied and was related to the specific functions and joints. The 10-13-year-old tennis players showed elbow extensor FS performance at the level of the older participants, while the 14-15-year-old tennis players were characterized with superior FS internal rotation performance in the glenohumeral joint.

Association of IL-6 G-174C (rs1800795) variant with the susceptibility to hepatocellular carcinoma in patients with chronic hepatitis

AimAn ineffective immune response resulting from dysregulation of cytokine production might encourage viral persistence and cause chronic viral hepatitis to worsen. This study examined the relationship between alterations in interleukin-6 (IL-6) levels and the IL-6 − 174 G > C (rs1800795) polymorphism, as well as how this polymorphism affects the development and progression of chronic hepatitis brought on by hepatitis B (HBV) and hepatitis C (HCV) into hepatocellular carcinoma (HCC).Patients and methodsWhole blood samples from 126 Egyptian patients with HCC (111 with HCV and 15 with HBV), as well as 126 age- and sex-matched healthy individuals, were used to extract DNA. Using PCR-based allele-specific amplification (ASA), the existence of the IL-6 G-174C polymorphism was investigated. Additionally, each participant's serum IL-6 levels were determined using an enzyme-linked immunosorbent assay (ELISA).ResultsThe primary observations revealed that HCC patients had greater serum levels of IL-6 compared to the control groups (p < 0.001). Patients with the variant (CG and GG) genotype in the HCC group were found to have more disease severity indicated by higher levels of alpha-fetoprotein (AFP) and a higher ascites grade, as well as increased inflammatory activity as defined by higher levels of IL-6 and C-reactive protein (CRP) (p < 0.001 for both) in comparison to patients with the wild-type (CC) genotype (p < 0.001 and p = 0.002, respectively).ConclusionThe rs1800795 SNP in the IL-6 gene was associated with increased inflammatory activity and high levels of IL-6, indicating that this SNP may play a role in the development of HCC in Egyptian patients with chronic viral hepatitis.

Association between sore throat and early immune responses against COVID-19 before and after the emergence of the Omicron variant.

Sore throat is a prevalent symptom of coronavirus disease 2019 (COVID-19), particularly when caused by the Omicron variants. However, the association between sore throat and immune responses to different severe acute respiratory syndrome coronavirus 2 variants remains unclear. This study aimed to elucidate the characteristics of immune responses associated with sore throat in patients with COVID-19 before and after the emergence of Omicron. In this prospective observational study, we enrolled patients with COVID-19 hospitalized between December 2020 and April 2022, which covered the pre-Omicron and Omicron (BA.1 variant) endemic periods. Sore throat was assessed using a daily questionnaire, including an analog scale for sore throat grade (0 to 3) from admission until discharge. Serum levels of immune indicators were assessed using enzyme-linked immunosorbent assay. A total of 47 patients infected with Omicron and 136 patients infected with preceding variants were included in the analyses. The frequency of sore throat was significantly higher in participants infected with Omicron than that in those infected with preceding variants (66% vs. 42%, P<0.005). Sore throat was associated with nasopharyngeal viral load, interleukin-6 (IL-6)/interferon-α (IFN-α) levels in participants infected with preceding variants, whereas, it was associated with age, the body mass index, and interferon-λ1 (IFN-λ1) in participants infected with Omicron. Infection with the Omicron variant is characterized by increased sore throat frequency and altered associations between sore throat and several immune indicators, including IFN-α, IL-6, and IFN-λ1.

Coordinator and Young Adult Perceptions in Attracting and Retaining Chicago Youth in Out-of-School Time Programming

Youth from families with greater economic means have seen an increase in their participation in extracurricular activities, while the participation levels of youth from working class families have decreased. Knowing the benefits to youth participation in extracurricular activities, communities where youth of marginalized backgrounds reside have an obligation to engage their youth in activities offered through school and community out-of-school time programs. Interviews and focus groups with program coordinators and young adults were conducted to identify how youth in Chicago have been attracted, engaged, recruited, and retained in out-of-school time programs. Program aspects and strategies used to connect with youth and their families emerged, some of which have been previously found in the relevant literature to be positively related to youth outcomes, and some of which are specific to youth who identify as Latine and youth who identify as male. Practical implications and suggestions for future research are further discussed.

A Place of Last Drink Initiative: Effects on Various Types of Crime

Background Place of last drink (POLD) is a law enforcement strategy designed to decrease the service of alcohol to intoxicated patrons (i.e., overservice). When officers respond to an alcohol-related incident, they inquire about and record the place where the involved individuals last drank alcohol; this information can help identify licensed alcohol establishments that show a pattern of overserving alcohol. We evaluated the effects of a POLD initiative on various types of crime. Methods The POLD initiative was conducted in the state of Minnesota (USA). We compared 26 intervention jurisdictions to 26 matched comparisons. Outcomes were six crime measures (e.g., driving under the influence, violent, nonviolent). Predictors were levels of participation and implementation of POLD. We fit a separate Poisson regression model for each crime outcome and each predictor. Results In all models, we found little difference in crime rates between intervention and comparison jurisdictions. No effect on crime was observed for either participation or implementation levels of POLD. However, we found implementation levels were relatively low across jurisdictions. Conclusion This study adds to a very limited literature addressing the effects of POLD on public health harms such as crime. The particular POLD initiative did not appear to affect crime rates. We found POLD implementation levels showed considerable room for improvement and could help to explain some of the lack of effects of POLD on crime. More research is needed in additional localities and to assess whether specific aspects of implementation could help to strengthen POLD efforts.

Examinations of search interactions, experiences and communication in collaborative search

PurposeThis study aims to explore the characteristics of collaborative information searching by comparing the differences in search experience and interaction between collaborative search mode and individual search mode and by analyzing the communication content and patterns during collaborative searches.Design/methodology/approachA user experiment was conducted using the Conference and Labs of the Evaluation Forum (CLEF)-Social Book Search platform, recruiting 16 individual and 18 collaborative participants. Each of the participants was required to complete two types of book search tasks in a lab setting. Interactions with the system were logged, and participants' experiences were captured through pre/post-search questionnaires. Additionally, the communication among collaborative participants was recorded and coded.FindingsThis study identified characteristics of collaborative information searching in three aspects. (1) Search experience: collaborative searchers showed a higher appreciation for the system’s functionality and aesthetics and were more engaged than individual searchers, despite experiencing slightly more mental strain. (2) Search strategies: in focus tasks, collaborative searchers made more decisions than individual searchers, indicating a need for book sorting. In open tasks, collaborative searchers take longer before making decisions, likely due to a higher level of interest and participation. (3) Communication content and pattern: collaborative searchers mainly discussed understanding and judgment of books and task plan. Searchers with same cognitive style talked more about search operations than those with different cognitive styles, while less about book judgment. Three communication patterns were identified: understanding-judgment, judgment-dominant and balanced. Judgment-dominant participants generally reported higher satisfaction with their search results than those in the other two patterns.Originality/valueThis study enhances understanding of collaborative search by comparing it with individual search and analyzing communication content, potentially inspiring collaborative search system and experiment design. Additionally, the coding table for communication between collaborative searchers offers valuable insights for future research.

Abdominal wall muscle ultrasound assessment and level of experience in Pilates - an exploratory study

The core refers to a group of muscles that allow optimal force transfer along the body’s kinetic chain and is critical for movement. The goal of this quasi-experimental study was to investigate the relationship between the experience level of Pilates participants and abdominal wall thickness. For this, we compared the thickness of four abdominal muscles—transversus abdominis (TrA), internal oblique (IO), external oblique (EO), and rectus abdominis (RA)—as measured before and after 8 weeks of Pilates training in three conditions, namely, relaxation, abdominal hollowing, and plank exercise. Eighteen participants were distributed into three groups with different levels of Pilates practice—experienced (EG; n=6), inexperienced (IG; n=7), and control (CG; n=5) groups. The RA showed a tendency to increase post-intervention in the EG (all conditions: p=0,002, p=0,006, and p=0,002, respectively for relaxation condition, abdominal hollowing and standing plank). Additionally, significant differences were found in relaxation (p=0.003, d=−0.744) and plank (p=0.009, d=−0.630) conditions in the IG. Significant differences were also registered in the EO muscle in the IG (all conditions: p=0.046, p=0.013, and p=0.008, respectively; d=0.464, d=−0.596, and d=−0.637, respectively). IO muscle thickness tended to increase in the CG in all conditions (p=0.044, p=0.006, and p&lt;0.001, respectively) and the EG in relaxation and plank conditions (p=0.009 and p=0.007, respectively). Within groups, the effects of Pilates practice were more significant post-intervention, with the exceptions being under the contraction condition in the deepest muscles (IO: p=0.109, d=0.083; TrA: p=0.194, d=0.062). Our hypothesis was partially confirmed because 8 weeks of Pilates practice have improved significantly the thickness of the RA and EO muscles in the IG.

Developing a Wearable Sensor-Based Digital Biomarker of Opioid Dependence.

Repeated opioid exposure leads to a variety of physiologic adaptations that develop at different rates and may foreshadow risk of opioid-use disorder (OUD), including dependence and withdrawal. Digital pharmacovigilance strategies that use noninvasive sensors to identify physiologic adaptations to opioid use represent a novel strategy to facilitate safer opioid prescribing. This study aims to identify wearable sensor-derived features associated with opioid dependence by comparing opioid-naïve individuals to chronic opioid users with acute pain and developing a machine-learning model to distinguish between the 2 groups. Using a longitudinal observational study design, continuous physiologic data were collected on participants with acute pain receiving opioid analgesia. Monitoring continued throughout hospitalization and for up to 7 days posthospital discharge. Opioid administration data were obtained from electronic health record (EHR) and participant self-report. Participants were classified as belonging to 1 of 3 categories based on opioid use history: naïve, occasional, or chronic use. Thirty features were derived from sensor data, and an additional 9 features were derived from participant demographic and treatment characteristics. Physiologic feature behavior immediately postopioid use was compared among naïve and chronic participants, and subsequently features were used to generate machine learning models which were validated using cross-validation and holdout data. Forty-one participants with a combined total of 169 opioid administrations were ultimately included in the final analysis. Four interpretable decision tree-based machine learning models with 14 sensor-based and 5 clinical features were developed to predict class membership on the level of a given observation (dose) and on the participant level. Ranges for model metrics on the participant level were as follows: accuracy 70% to 90%, sensitivity 67% to 100%, and specificity 67% to 100%. Wearable sensor-derived digital biomarkers can be used to predict opioid use status (naïve versus chronic) and the differentiating features may be detecting opioid dependence. Future work should be aimed at further delineating the phenomenon identified in these models (including opioid dependence and/or withdrawal) and at identifying transition states where an individual changes from 1 profile to another with repetitive opioid exposure.

Incumbents’ marketing deterrence strategies and potential entrants’ time-to-entry: evidence from the US airline industry

Purpose The purpose of this study is to investigate how incumbent firms’ marketing deterrence strategies, price-cuts and quality improvement, influence potential entrants’ (PEs) entry timing into incumbents’ markets and examine the moderating role of incumbents’ market-level resources and capabilities (R&amp;Cs). Design/methodology/approach To test the hypotheses, an accelerated failure time model is applied to a rich data set of entry threats between 1997 and 2019 in the US airline industry. Findings The findings show that while quality improvements delay PEs’ entry, price-cuts expedite it. Furthermore, PEs are more likely to be deterred by price-cuts when incumbents possess high market-level R&amp;Cs. However, such R&amp;Cs do not moderate the link between incumbents’ quality improvement and PEs’ entry timing. Research limitations/implications Market entry in this research is conceptualized and defined as a large resource deployment into a market and operationalized as a binary variable. However, PEs might rather choose a minor resource deployment instead to establish a foothold in new markets. It would be fruitful for future research to examine various levels of participation in a new market and examine how the incumbents’ marketing deterrence strategies affect PEs’ entry timing. Doing so would provide us with a deeper understanding of the difference between actual/full market entry and micro/minor market entry. Practical implications This research examines the impact of incumbents’ marketing deterrence strategies in a contingency framework and highlights the crucial role of R&amp;Cs in implementing such deterrence strategies. Doing so provides actionable insights to managers who craft strategies to protect their markets against PEs. Originality/value Previous research illustrates that incumbent firms commonly respond to competitors’ entry threats by cutting prices and improving quality. While antecedents of these deterrence strategies have been extensively investigated, the consequences have yet to be empirically examined.

Stress in social and health care professionals working with people with intellectual disabilities: risk and protective factors

Objectives Those working in the field of intellectual disabilities are confronted with a multitude of stressors, which can give rise to considerable psychological difficulties. The objective of this study was to identify the key predictors of perceived and relational stress among professionals working in intellectual disability centers. Methods A cross-sectional design was employed, with 726 professionals participating (mean age = 43.35 years, SD = 11.19), predominantly women (78.6%). The variables assessed included perceived stress, relational stress, emotional balance, life satisfaction, social support, empathy, and counseling training. The analysis was conducted using structural equation modeling and qualitative-comparative analysis of fuzzy data (QCA). Results The study revealed that the stress levels of the study participants were moderate to low. The relationship between emotional balance and stress was mediated by life satisfaction. In both structural equation models, negative affect and life satisfaction were identified as primary predictors, significantly influencing perceived and relational stress. Additionally, QCA highlighted that empathy and social support, along with these factors, contribute to explaining stress levels. Conclusions Our findings highlight the necessity of implementing preventive strategies and support systems to mitigate stress among healthcare professionals who work with individuals with intellectual disabilities. These findings contribute to the existing body of knowledge regarding stress management in this specialized healthcare context.