Individual Performance Research Articles

Enhancing accessibility and discoverability of digital archive images through automated image recognition tool

This research paper presents a comprehensive evaluation of the effectiveness of Imagga and Google cloud vision application programming interface (API) as image recognition tools for generating metadata in digital archive images. The assessment encompasses a diverse range of archive images, including those without text, images with text, and both color and black-and-white images. Through the use of evaluation metrics such as cosine similarity, word overlap similarity, recall, precision, and F1 score, the performance of these tools is quantitatively measured. The findings highlight the strong individual performance of both Imagga and Google cloud vision API, with the combined metadata outputs achieving significantly higher scores across all metrics. This emphasizes the potential benefits of employing a combined approach, leveraging the strengths of multiple tools to enhance the reliability and robustness of the metadata extraction process. The findings contribute to the advancement of metadata management in digital archives and underscore the importance of utilizing multiple tools for improved performance in image metadata generation.

An Attempt for a New Growth Model Based on Inter-class Mobility Probability

After Kuznets' pioneering study in 1955, the relationship between growth and income distribution attracted the attention of researchers. Approaches used to explain the relationship between growth and income distribution can be summarized as wealth and redistribution, international trade, technological development, macroeconomic volatility and political economy. In this study, firstly, the theoretical background and literature regarding these approaches are mentioned. Later, based on Akerlof and Yellen's theories on the fair wage-productivity relationship, a new model was tried to be developed that links economic growth with inter class mobility probability. The model is based on the hypothesis that in a hypothetical society of two-class without government, there will be an increase in the productivity of individuals belonging to the lower class as the probability of moving up the class increases. As the probability of individuals belonging to the lower class moving up increases, the probability of individuals belonging to the upper class falling down the class also increases. For this reason, the increase in the transition between classes will lead to an increase in the efforts of individuals belonging to the upper class. An increase in the effort of both classes will result in higher output and therefore higher growth. For this reason, as the income distribution becomes more fair, the growth rate will also increase, but if the income is distributed completely equally, the performance of individuals will decrease because there is no possibility of moving to upper class. Therefore, income inequality up to a certain level motivates individuals, while income inequality above the optimal level demotivates individuals. In other words, the relationship between income inequality and growth is non-linear. Finally, the game theory version of the model is introduced in the study.

Boston Criteria v2.0 for Cerebral Amyloid Angiopathy Without Hemorrhage: An MRI-Neuropathologic Validation Study.

Updated criteria for the clinical-MRI diagnosis of cerebral amyloid angiopathy (CAA) have recently been proposed. However, their performance in individuals without symptomatic intracerebral hemorrhage (ICH) presentations is less defined. We aimed to assess the diagnostic performance of the Boston criteria version 2.0 for CAA diagnosis in a cohort of individuals ranging from cognitively normal to dementia in the community and memory clinic settings. Fifty-four participants from the Mayo Clinic Study of Aging or Alzheimer's Disease Research Center were included if they had an antemortem MRI with gradient-recall echo sequences and a brain autopsy with CAA evaluation. Performance of the Boston criteria v2.0 was compared with v1.5 using histopathologically verified CAA as the reference standard. The median age at MRI was 75 years (interquartile range 65-80) with 28/54 participants having histopathologically verified CAA (i.e., moderate-to-severe CAA in at least 1 lobar region). The sensitivity and specificity of the Boston criteria v2.0 were 28.6% (95% CI 13.2%-48.7%) and 65.3% (95% CI 44.3%-82.8%) for probable CAA diagnosis (area under the receiver operating characteristic curve [AUC] 0.47) and 75.0% (55.1-89.3) and 38.5% (20.2-59.4) for any CAA diagnosis (possible + probable; AUC 0.57), respectively. The v2.0 Boston criteria were not superior in performance compared with the prior v1.5 criteria for either CAA diagnostic category. The Boston criteria v2.0 have low accuracy in patients who are asymptomatic or only have cognitive symptoms. Additional biomarkers need to be explored to optimize CAA diagnosis in this population.

Linking grandiose and vulnerable narcissism to managerial work performance, through the lens of core personality traits and social desirability

While grandiose narcissism is well-studied, vulnerable narcissism remains largely unexplored in the workplace context. Our study aimed to compare grandiose and vulnerable narcissism among managers and people from the general population. Within the managerial sample, our objective was to examine how these traits diverge concerning core personality traits and socially desirable responses. Furthermore, we endeavored to explore their associations with individual managerial performance, encompassing task performance, contextual performance, and counterproductive work behavior (CWB). Involving a pool of managerial participants (N = 344), we found that compared to the general population, managers exhibited higher levels of grandiose narcissism and lower levels of vulnerable narcissism. While both narcissistic variants had a minimal correlation (r = .02) with each other, they differentially predicted work performance. Notably, grandiose narcissism did not significantly predict any work performance dimension, whereas vulnerable narcissism, along with neuroticism, predicted higher CWB and lower task performance. Conscientiousness emerged as the strongest predictor of task performance. This study suggests that organizations might not benefit from managers with vulnerable narcissism. Understanding these distinct narcissistic variants offers insights into their impacts on managerial performance in work settings.

Macintosh-style videolaryngoscope use for tracheal intubation in elective surgical patients revisited: a sub-analysis of the 2022 Cochrane review data

The Cochrane systematic review and meta-analysis published in 2022 that compared videolaryngoscopy (VL) with direct laryngoscopy (DL) for facilitating tracheal intubation in adults found that all three types of VL device (Macintosh-style, hyper-angulated and channeled) reduced the risk of failed intubation and increased the likelihood of first-pass success. We report the findings of a subgroup re-analysis of the 2022 Cochrane meta-analysis data focusing on the Macintosh-style VL group. This was undertaken to establish whether sufficient evidence exists to guide airway managers in making purchasing decisions for their local institutions based upon individual device-specific performance. This re-analysis confirmed the superiority of Macintosh-style VL over Macintosh DL in elective surgical patients, with similar efficacy demonstrated between the Macintosh-style VL devices examined. Thus, when selecting which VL device(s) to purchase for their hospital, airway managers decisions are likely to remain focused upon issues such as financial costs, portability, cleaning schedules and previous device experience.

Vancomycin: An analysis and evaluation of eight population pharmacokinetic models for clinical application in general adult population.

Based on the recent guidelines for vancomycin therapeutic drug monitoring (TDM), the area under the curve to minimum inhibitory concentration ratio was to be employed combined with the usage of population pharmacokinetic (popPK) model for dosing adaptation. Yet, deploying these models in a clinical setting requires an external evaluation of their performance. This study aimed to evaluate existing vancomycin popPK models from the literature for the use in TDM within the general patient population in a clinical setting. The models under external evaluation were chosen based on a review of literature covering vancomycin popPK models developed in general adult populations. Patients' data were collected from Charles-Le Moyne Hospital (CLMH). The external evaluation was performed with NONMEM® (v7.5). Additional analyses such as evaluating the impact of number of samples on external evaluation, Bayesian forecasting, and a priori dosing regimen simulations were performed on the best performing model. Eight popPK models were evaluated with an independent dataset that included 40 patients and 252 samples. The model developed by Goti and colleagues demonstrated superior performance in diagnostic plots and population predictive performance, with bias and inaccuracy values of 0.251% and 22.7%, respectively, and for individual predictive performance, bias and inaccuracy were -4.90% and 12.1%, respectively. When limiting the independent dataset to one or two samples per patient, the Goti model exhibited inadequate predictive performance for inaccuracy, with values exceeding 30%. Moreover, the Goti model is suitable for Bayesian forecasting with at least two samples as prior for the prediction of the next trough concentration. Furthermore, the vancomycin dosing regimen that would maximize therapeutic targets of area under the curve to minimum inhibitory concentration ratio (AUC24/MIC) and trough concentrations (Ctrough) for the Goti model was 20 mg/kg/dose twice daily. Considering the superior predictive performance and potential for Bayesian forecasting in the Goti model, future research aims to test its applicability in clinical settings at CLMH, both in a priori and a posteriori scenario.

Practice is the best of all instructors-Effects of enactment encoding and episodic future thinking on prospective memory performance in high-functioning adults with autism spectrum disorder.

Prospective memory (PM) is the ability to remember to carry out intended actions in the future. The present study investigated the effects of episodic future thinking (EFT) and enactment encoding (EE) on PM performance in autistic adults (ASD). A total of 72 autistic individuals and 70 controls matched for age, gender, and cognitive abilities completed a computerized version of the Dresden breakfast Task, which required participants to prepare breakfast following a set of rules and time restrictions. A two (group: ASD vs. controls) by three (encoding condition: EFT vs. EE vs. standard) between-subjects design was applied. Participants were either instructed to engage in EFT or EE to prepare to the different tasks prior to performing the Dresden breakfast or received standard instructions. Analyses of variance were conducted. Autism-spectrum-disorders (ASD) participants did not differ from control participants in their PM performance, regardless of which strategy they used. Compared to the standard condition, EE but not EFT improved time-based PM performance in all participants. This is the first study to find spared time-based PM performance in autistic individuals. The results confirm earlier results of beneficial effects of EE on PM performance. Findings are discussed with regards to the methodology used, sample composition as well as autistic characteristics.

Vitamin D, Cognition, and Alzheimer’s Disease: Observational and Two-Sample Mendelian Randomization Studies

Background: Observational studies have found that vitamin D supplementation is associated with improved cognition. Further, recent Mendelian randomization (MR) studies have shown that higher vitamin D levels, 25(OH)D, may protect against Alzheimer’s disease. Thus, it is possible that 25(OH)D may protect against Alzheimer’s disease by improving cognition. Objective: We assessed this hypothesis, by examining the relationship between 25(OH)D levels and seven cognitive measurements. Methods: To mitigate bias from confounding, we performed two-sample MR analyses. We used instruments from three publications: Manousaki et al. (2020), Sutherland et al. (2022), and the Emerging Risk Factors Collaboration/EPIC-CVD/Vitamin D Studies Collaboration (2021). Results: Our observational studies suggested a protective association between 25(OH)D levels and cognitive measures. An increase in the natural log of 25(OH)D by 1 SD was associated with a higher PACC score (BetaPACCscore = 0.06, 95% CI = (0.04–0.08); p = 1.8×10 - 10). However, in the MR analyses, the estimated effect of 25(OH)D on cognitive measures was null. Specifically, per 1 SD increase in genetically estimated natural log of 25(OH)D, the PACC scores remained unchanged in the overall population, (BetaPACCscore = –0.01, 95% CI (–0.06 to 0.03); p = 0.53), and amongst individuals aged over 60 (BetaPACCscore = 0.03, 95% CI (–0.028 to 0.08); p = 0.35). Conclusions: In conclusion, our MR study found no clear evidence to support a protective role of increased 25(OH)D concentrations on cognitive performance in European ancestry individuals. However, our study cannot entirely dismiss the potential beneficial effect on PACC for individuals over the age of 60.

Examining the association between balance self-efficacy and virtual balance performance in individuals with stroke: a cross-sectional study

ABSTRACT Background Balance self-efficacy is a strong predictor of fall risk after stroke and is related to performance on balance and walking tests. The use of telerehabilitation for delivering stroke rehabilitation has increased in recent years and there is a need to adapt common clinical assessments to be administered in virtual formats, but the association between balance self-efficacy and virtually administered clinical tests of balance performance has yet to be established. This study examined the association between the Activities-specific Balance Confidence (ABC) Scale and virtually administered Timed Up and Go (TUG), Tandem Stand, and Functional Reach tests (FRT) in individuals with stroke. Methods This was a secondary analysis of baseline data from two telerehabilitation trials with individuals with stroke. All assessments were administered by trained physical therapists through videoconferencing software. Multivariate regression analyses were used to examine the associations between the ABC scale and TUG test, Tandem Stand test, and FRT, adjusted for age and number of comorbidities. Results Data from 51 participants (n = 11 female, median age = 64 [IQR: 18] years, 9.3 ± 4.6 months poststroke) were analyzed. The ABC scores were associated with TUG (R2 = 0.56, F(3,47) = 20.26, p < 0.01), but not Tandem Stand (R2 = 0.18, F(5,45) = 1.93, p = 0.11) or FRT (R2 = 0.14, F(3,47) = 2.55, p = 0.07) tests. Conclusion We observed associations between the ABC scores and virtual TUG, but not with Tandem Stand or FRT, which may be attributed to the context-specificity of balance self-efficacy. As virtual administration of outcomes assessments becomes part of common practice in stroke rehabilitation, our study supports the use of virtually administered TUG in stroke.

A Study on Employee Relationship Management

Recent studies highlight the importance of employee relationship management in the context of strategic human resources management, outlining the role of organizational context. Accordingly, the paper presents an employee performance appraisal conceptual framework including the role of contextual factors, where strategic human resources management plays a key role. Moreover, the model includes two sets of procedural and representative basic performance criteria, as well as a new category of profile performance criteria as the foundation for developing flexible, customized and meaningful employee performance appraisal systems and processes aimed at improving individual and organizational overall performance. Keywords—Conceptual model, organizational context, employee relationship performance criteria.

#2756 Metabolomic prediction of end stage renal disease in large national biobanks

Abstract Background and Aims Identifying at-risk individuals likely to progress to end-stage renal disease as early as possible is important to effectively concentrate preventative interventions. Existing predictive tools, like the kidney failure risk score, are effective for individuals who already have moderate to severe kidney disease. Here we examine whether comprehensive metabolomics can improve performance in individuals with mildly impaired kidney function. Method Using an NMR metabolomics platform we measured &amp;gt;200 biomarkers including creatinine, albumin, lipids, fatty acids, amino acids, glycolysis metabolites and inflammation markers in blood samples from all 500,000 participants of the UK Biobank, who have &amp;gt;10 years of linked prospective follow-up data. We used machine learning to develop a score to predict kidney disease progression based on biomarkers, age and sex. We compared its performance to eGFR in a held out set of individuals in UK Biobank, and replicated in 200,000 participants of the Estonian Biobank. Results Among individuals with prevalent diabetes, hypertension or eGFR &amp;lt; 90 the biomarker score performs as well as or better than eGFR for all individuals. In particular it outperforms among individuals with only moderate (eGFR 60-75) or mild (eGFR 75-90) impairment of kidney function with an AUC increase from 0.63 to 0.72 and 0.48 to 0.70, respectively (Figure). This improvement is driven by contributions from numerous biomarkers, including lipids and inflammation markers. Furthermore, because these biomarkers capture diverse metabolic risk, the biomarker score also strongly predicts major adverse cardiovascular outcomes. Conclusion This large dataset allows detailed investigation of the value of metabolomics in identifying future risk of severe kidney disease early. In particular these biomarkers can highlight individuals who do not already have very low eGFR.

#1098 Utilizing a novel individual patient performance score for mortality prediction in hemodialysis patients

Abstract Background and Aims Chronic kidney disease (CKD) management has advanced significantly over recent years, yet mortality rates among hemodialysis (HD) patients remain high. This study aims to assess the impact of changes in an individualized patient performance score (IPPS) on survival in a large cohort of HD patients. Method This multicentre, observational, prospective cohort study included HD patients across 19 countries, starting from January 1st, 2022. We followed these patients for one year, categorizing them based on their survival status at year's end. We calculated the mean IPPS monthly, from June to December 2021, and divided the patients into tertiles based on their December 2021 scores. Subsequently, we formed five groups based on their IPPS dynamics over six months. We used Kaplan-Meier and Cox regression analyses to evaluate survival, presenting the results as hazard ratios (HR) and 95% confidence intervals (95% CI). A p-value below 0.05 was considered statistically significant. The IPPS, ranging from 0 to 100, was calculated based on eight key performance areas, with higher scores indicating better medical performance: Vascular Access (20 points): type of vascular access, episodes of thrombosis and infection); HD adequacy (20 points): eKt/V, blood flow and treatment time; Anemia (20 points): hemoglobin concentration, transferrin saturation, ferritin; Arterial hypertension (10 points): mean arterial pressure; Mineral Bone disease (15 points): iPTH, plasmatic phosphorus and calcium; Fluid status (5 points): percentage of interdialytic fluid gain; Nutrition (5 points): plasmatic albumin and phosphorus and Others (5 points): influenzae vaccination, transplantation status and hospitalization events. The final score is obtained by the weighted sum of positive clinical factors, subtracted from the weighted sum of negative clinical factors and is reported as a number ranging from 0 to 100, with a higher score representing a better medical performance. Results The study included 10 458 HD patients. In the survival analysis, a significant increase in mortality odds was observed in patients with a stable IPPS of 72 or lower, compared to those with a score consistently above 86. Patients transitioning from the lowest to the highest tertile in six months had a mortality HR similar to those consistently in the highest tertile. On the other hand, patients showing a decrease in IPPS score from the highest to the lowest tertile in the same period had a mortality HR similar to the intermediate group (Table 1). Conclusion A lower total IPPS score (&amp;lt;72) was associated with a threefold increase in mortality risk compared to scores above 86. An increase in IPPS from the lowest to the highest tertile correlated with a significant reduction in mortality, equating to the survival rates of patients consistently scoring high. These findings underscore the potential of IPPS as a valuable tool for guiding clinical interventions in the HD population to enhance patient survival.

Predicting Individual Work Performance Based on Work Engagement and Work Stress among Employees in Malaysia

Predicting Individual Work Performance Based on Work Engagement and Work Stress among Employees in Malaysia

Toward a better understanding of self‐regulation promoting interventions: When performance management and job crafting meet

AbstractOrganizations utilize self‐regulation promoting interventions to empower employees in managing challenges and resources autonomously. However, there is limited understanding of how these interventions impact employee task performance and innovative behavior, as well as which processes are critical for their effectiveness. Therefore, a field experiment was conducted to examine the effects of two self‐regulation promoting interventions—the Productivity Measurement and Enhancement Systems intervention (ProMES), a job crafting intervention, and their combination—on individual employee performance and innovation through selected process variables. We collected data before, during, and after the interventions over 16 weeks among 123 employees across three experimental and one control group. Consistent with predictions, participants of the ProMES intervention reported a higher level of perceived team climate, which consequently contributed to greater individual innovative behavior. Participants in the job crafting intervention exhibited an increase in job crafting behaviors, which consequently increased innovative behavior and task performance. Unexpectedly, the combined intervention yielded negative effects on both innovative behavior and task performance. The findings suggest that while self‐regulation promoting interventions increase favorable outcomes through different mechanisms their combination may impair relevant processes and, more generally, overwhelm employees.

#1604 LACE index as predictors of 30 day rehospitalisation among patients on maintenance hemodialysis, cohort study

Abstract Background and Aims Over 35% of patients on maintenance dialysis are readmitted to the hospital within 30 days of hospital discharge. Validated risk assessment tools such as the LACE index (Length of stay, Acuity of admission, Co-morbidities, and Emergency department visits) have been developed to identify patients at high risk of hospital readmission in non-dialysis patients but have not been tested in dialysis patients. Method Data was collected from electronic medical records of patients on maintenance hemodialysis in Diaverum outpatient clinics hospitalized during 2023. Data included Age, gender, duration of hospital stay, Charlson comorbidity index (CCS), urgent or planned, and cause of Hospitalization. Multivariable logistic regression models with 30-day readmission for the same reason as the dependent outcome were used to identify readmission risk factors and whether the LACE score validly predicts 30-day rehospitalization among our cohort. Results Among (4829) patients received dialysis in Diaverum Saudi Arabia during 2023. (1487) episodes of hospitalization were reported due to various reasons rate of hospitalization was 0.54 Episodes per patient-years at risk, and 372(25%) of hospitalized patients were re-hospitalized for the same reason within 30 days. The proportion of patients with 30 days of rehospitalization for the same reason was higher in patients with post-initial discharge LACE index ≥10 in comparison to patients with LACE index&amp;lt;10, 348(32.6%) &amp; 24(5.7) respectively P-VALUE&amp;lt;0.001. also significantly higher in patients ≥65years old than those younger 163(27.7%) &amp;209(23.3%) respectively P-VALUE&amp;lt;0.05, those in high risk group (defined as those with higher comorbidity index ≥6 and/or lower Individual Patient Performance Score&amp;lt;75) than those who are not in high risk group 215(35%) &amp; 157(17.9%) respectively P-VALUE&amp;lt;0.001. Multivariate logistic regression including covariates significantly associated with higher 30-day rehospitalization to avoid confounder effect with model including ( age, gender, dialysis duration, body mass index, comorbidity index, diabetes, vascular access, cause of hospitalization and inclusion in high-risk group ) showed significantly higher rehospitalization in patients with post-initial discharge LACE index ≥10 in comparison to patients with LACE index&amp;lt;10 ODDS RATIO (95%CI) 7.95(5.1-12.5) P-VALUE&amp;lt;0.001. independent of other covariates in the model Conclusion LACE index at discharge is an independent predictor of (30) days re-hospitalization in patients on maintenance Hemodialysis. Further analysis needed for a specific model for HD patients taking into consideration the unique characteristics of this cohort of patients.

#2628 A haemodialysis patient-centred model of care with a multidisciplinary programme: what is its clinical and health efficiency impact?

Abstract Background and Aims Chronic kidney disease (CKD) constitutes a public health concern due to its notable morbidity &amp; mortality and associated costs. The Patient Care Coordination program (PCC) provides comprehensive and personalized care to haemodialysis (HD) patients. This study evaluated the cost-effectiveness of PCC compared to standard of care (SoC). Method The study included patients in 9 HD clinics (5 PCC, 4 SoC) in Catalonia, Spain, in 2020-2021. A comparative effectiveness evaluation was conducted to compare change in Individual Patient Performance Score (IPPS, score 0-100, evaluates parameters such as vascular access, adequacy of HD, anaemia, mineral bone disease, arterial hypertension, nutrition/hydration status) and number of hospitalisations of PCC patients vs SoC during the first year in the program. Instrumental variables (IV) regression analysis was performed to address potential confounding; number of interactions with program specialists was a valid IV to estimate degree of PCC use. An incremental cost-effectiveness analysis (iCEA) through microsimulation was performed using the effectiveness data from the previous step, population data from the renal patient registry of Catalonia, and the cost of hospitalisations obtained from the Public Health System. Results 127 patients in PCC and 363 patients in SoC were included. The degree of PCC use had a positive impact on IPPS variation during the first year of the program (p = 0.012). In the iCEA the PCC program resulted in a mean gain of 3.4 additional IPPS points, a reduction of 0.2 hospitalisations per patient, and reduced mean costs of €1,265 per patient in the first year compared to SoC, resulting to be a dominant alternative (Fig. 1). Conclusion The holistic and interdisciplinary approach to the patient has further highlighted the relevance of programme use and not only belonging to the programme in achieving clinical goals. The PCC program represents thus a dominant alternative, with greater effectiveness and total cost savings that could sum up to €5.5 million per year in the region due to reduced hospitalizations. This approach may be an alternative to address the challenges of CKD and optimise the allocation of healthcare resources.

Phenomenology and intersubjectivity in political economy: an anti-perfectionist perspective

Anti-perfectionism is a philosophical perspective combining the view of man as an imperfect and non-self-sufficient being with a scientific epistemology based on imperfect knowledge. From an epistemological perspective, it has roots in Socrates and, more recently, in the post-empiricism of Giambattista Vico, up to phenomenology. From an anthropological perspective, it is a philosophical tradition based on an awareness of the constitutive dependency of individual performance and fulfilment of man on his interaction with others. It is conceived in opposition to the individualism and perfect rationality of most social theories. The paper analyses both the philosophical and the epistemological premises of anti-perfectionism as well as its consequences in terms of economic methodology. It will specifically develop the momentary intersection of phenomenology and Austrian economics. The theory of knowledge and of sense-making of phenomenology will be discussed with particular attention to intersubjectivity, which expresses anti-perfectionism well. The interpretations of human knowledge and action of Scheler and Schütz are analysed and connected to some contemporary streams of Austrian economics.

Pozzolanic Reactivity of High-Alkali Supplementary Cementitious Materials and Its Impact on Mitigation of Alkali-Silica Reaction

The growing scarcity of conventional supplementary cementitious materials (SCMs) such as Class F, Class C fly ashes, and slag has necessitated exploring alternative SCMs previously considered suboptimal. In particular, high-alkali SCMs are often avoided because of the potential concern that their alkali content could release into the concrete pore solution, thus exacerbating the potential for alkali-silica reaction (ASR). However, preliminary research indicates that not all high-alkali SCMs are deleterious, and some can effectively suppress the ASR expansive reaction when used in sufficient dosage levels. This study evaluates the feasibility of using high-alkali SCMs, such as high-alkali natural pozzolans and reclaimed fly ashes, focusing on their pozzolanic reactivity and the correlation between the reactivity and their ASR mitigation performance. The pozzolanic reactivity of the SCMs was evaluated by the R3 test per ASTM C1897 and strength activity index test per ASTM C311. Thermogravimetric analysis was used to determine the calcium hydroxide consumption by the SCMs. ASR mitigation performance of SCMs was evaluated in accordance with American Association of State Highway and Transportation Officials (AASHTO) T380 miniature concrete prism test. Additionally, pore solution expression and analysis of paste specimens were conducted to determine the correlation between the total alkali and the released alkali levels into the pore solution. Based on the results of this study, all SCMs indicated high pozzolanic reactivity; however, individual performance varied by test method. Ultimately, the high-alkali SCMs, particularly natural pozzolans, did not appear to release any significant levels of alkalis into the pore solution readily and, therefore, show potential for ASR mitigation when used in sufficient dosage levels.

A Conceptual Model of Individual Clinical Readiness.

Force readiness is a priority among senior leaders across all branches of the Department of Defense. Units that do not achieve readiness benchmarks are considered non-deployable until the unit achieves the requisite benchmarks. Because military units are made up of individuals, the unit cannot be ready if the individuals within the unit are not ready. For medical personnel, this refers to one's ability to competently provide patient care in a deployed setting or their individual clinical readiness (ICR). A review of the literature found no conceptual model of ICR. Other potential concepts, such as individual medical readiness, were identified but used inconsistently. Therefore, the purpose of this article is to define ICR and propose a conceptual model to inform future efforts to achieve ICR and facilitate future study of the concept. Model development occurred using a 3-step theoretical model synthesis process. The process included specification of key concepts, identification of related factors and relationships, and organizing them into an integrated network of ideas. ICR is the clinically oriented service members' (COSM) ability to meet the demands of the militarily relevant, assigned clinical mission. ICR leads to one's "individual clinical performance," a key concept distinct from ICR. To understand ICR, one must account for "individual characteristics," as well as one's "education," "training," and "exposure." ICR and individual clinical performance are influenced by the "quality of exposure" and the "patient care environment." One's "individual clinical performance" also reciprocally influences the patient care environment, as well as the "team's clinical performance." These factors (individual clinical performance, team clinical performance, and the patient care environment) influence "patient outcomes." In the proposed model, patient outcomes are an indirect result of ICR and its antecedents (personal characteristics, education, training, and exposure); one's individual clinical performance may not be consistent with their ICR. Patient outcomes are also influenced by the "patient environment" (external to the health care environment) and "patient characteristics"; these elements of the model do not influence ICR or individual clinical performance. Force readiness is a Department of Defense priority. In order for military units to be deployment ready, so too must their personnel be deployment ready. For COSMs, this includes one's ability to competently provide patient care in a deployed setting or their ICR. This article defines ICR, as well as identifies another key concept and other factors associated with ICR. The proposed model is a tool for military medical leaders to communicate with and influence non-medical military leaders in the Department of Defense. Future research is needed to further refine the proposed model, determine the strength of the proposed relationships, and identify interventions to improve ICR.

Fear of Missing Out Syndrome and its Impact on Sleep Quality in Medical Students: A Cross-Sectional Study

Abstract Objective Fear of missing out (FOMO) is a type of social anxiety defined as “intense concern that others may be experiencing rewarding experiences without one's presence,” which can lead to illness. Excessive smartphone use is often associated with FOMO. This study aimed to investigate FOMO among medical university students, as well as factors associated with sleep quality, anxiety, depression, and excessive smartphone use. Methods A cross-sectional observational study was conducted using electronic questionnaires and the following scales: FOMO scale/score, Pittsburgh Sleep Quality Index (PSQI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Smartphone Addiction Scale Short Version (SAS SV). Results Participants included 142 individuals (mean age 23.73 ± 4.98 years, 97 [68.3% female]). All participants were smartphone users. Fear of missing out was present (FOMO score 22.08 ± 6.71) along with poorer sleep quality (PSQI 7.26 ± 3.08) and excessive smartphone use (SAS SV 30.21 ± 10.20). Moderate/severe anxiety (BAI) was reported by 35.2% of participants, while 16.9% had moderate/severe depression (BDI). Positive correlations were found between PSQI and FOMO (p &lt; 0.05), as well as between SAS SV and FOMO (p &lt; 0.001), PSQI (p &lt; 0.001), BAI (p &lt; 0.001), and BDI (p &lt; 0.001). Discussion High levels of FOMO, poorer sleep quality, symptoms of depression, anxiety, and excessive smartphone use were found among medical students. Furthermore, a positive correlation was demonstrated between these factors, which can directly impact the physical and mental health, as well as the academic performance of these young individuals.