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Double Measures:Conceptual Tensions and the Treatment of Evidence in Alcohol Policy
Get PDFThis paper argues that the lack of a shared evidence base in the policy debate around alcohol control, and the failure to acknowledge this fact, creates a tendency to dismiss key bodies of evidence as irrelevant, to the detriment of public health approaches. Using examples from three policy processes, it shows that proponents of opposed positions deploy rival conceptualizations of “problem alcohol use” as the object of policy intervention. Using analytic tools from the philosophy of science, it argues that these conceptualizations correspond to distinct bodies of evidence, which are treated as incompatible. Finally, it points to institutional mechanisms through which the problem can be mitigated
Influence of microstructure on the mechanical behavior of open-porous materials under large strains
Get PDFOpen-porous materials are characterized by a complex morphology consisting of an interconnected solid network and voids. The mechanical performance of these materials is strongly governed by their underlying microstructure. This study presents a computational framework to investigate the structure–property relationships in open-porous materials by explicitly modeling the effects of pore-size distribution (PSD), solid fraction, and pore wall geometry. Microstructures with tunable PSDs are generated using Laguerre-Voronoi tessellation based on random closed packing of polydisperse spheres, allowing precise control over pore morphology. A finite element framework with the elastoplastic material model is used to study the macroscopic behavior under compressive loading. The model response is validated against experimental data from aerogel and foam materials. The study reveals that while the solid fraction alone governs the bulk elastic modulus and plastic collapse stress through well-established scaling laws, the PSD critically affects the post-yield behavior, including the plateau and densification regimes under large strains. This study highlights the importance of PSD beyond classical density-based models and provides a predictive design strategy to tailor open-porous materials to application-specific mechanical requirements
Soft Condensation
Get PDFWhen moist air meets a cold surface, it creates a breath figure characterized by numerous small droplets. The central question is how the vapor flux is distributed between the growth of condensed drops and the nucleation of new ones. Here, we investigate the nucleation, growth, and coalescence of droplets on soft substrates consisting of cross-linked polymer networks. The number of droplets initially remains constant, until drops start to coarsen according to a universal law; both phenomena are explained via the formation of a saturated boundary layer. We quantitatively unveil an algebraic sensitivity of the number of droplets on substrate elasticity, which is unexpected since nucleation occurs at a scale where the polymer network resembles a melt. Breath figures thus offer a macroscopic probe of the molecular characteristics of the polymer surface, and suggest a surprisingly low-energy pathway for nucleation.</p
Female levator ani muscle damage assessment in supine and upright position
Get PDFThere is damage in the pelvic floor only visible in upright imaging. This damage have not been yet studied. The aim of this research is to assess the difference in levator ani muscle (LAM) damage in supine and upright position by means of MRI scans. Sixty-four patients with minimum stage 2 prolapse of the anterior vaginal wall or uterus, without previous pelvic organ prolapse (POP) surgery were scanned in a MR scanner in supine and upright position. Damage to the pubococcygeus muscle (PCM) and the iliococcygeal muscle (ICM) was scored as none, minor or major. For PCM, a previously established protocol was used. For ICM, a protocol for damage assessment was established and validated in this study, by determining the interclass correlation coefficient (ICC). The new ICM assessment protocol was established with ICC values of 0.68 (0.57–0.77) for supine and 0.81 (0.74–0.86) for upright assessment. 6.3% major ICM damage was found in supine vs. 51.6% in upright position with a significant difference of p < 0.001 for the sign-test. There was an underestimation of ICM damage in 59% of the cases in supine position. PCM damage scoring was not feasible on upright MRI’s and therefore only assessed on supine scans. In our POP population we found 53.1% of the women with major damage to either the PCM or ICM and 32.8% with major damage in both, leading to a total of 85.9% of women with major damage to at least one structure. There is a significant difference in LAM damage assessment between supine and upright position. Supine imaging leads to a severe underestimation of ICM damage while for the PCM supine damage assessment remains superior.</p
The State of the Art of eHealth Self-Management Interventions for People With Chronic Obstructive Pulmonary Disease:Scoping Review
Get PDFBackground: Chronic obstructive pulmonary disease (COPD) is a common chronic incurable disease. Treatment of COPD often focuses on symptom management and progression prevention using pharmacological and nonpharmacological therapies (eg, medication, inhaler use, and smoking cessation). Self-management is an important aspect of managing COPD. Self-management interventions are increasingly delivered through eHealth, which may help people with COPD engage in self-management. However, little is known about the actual content of these eHealth interventions. Objective: This literature review aimed to investigate the state-of-the-art eHealth self-management technologies for COPD. More specifically, we aimed to investigate the functionality, modality, technology readiness level, underlying theories of the technology, the positive health dimensions addressed, the target population characteristics (ie, the intended population, the included population, and the actual population), the self-management processes, and behavior change techniques. Methods: A scoping review was performed to answer the proposed research questions. The databases PubMed, Scopus, PsycINFO (via EBSCO), and Wiley were searched for relevant articles. We identified articles published between January 1, 2012, and June 1, 2022, that described eHealth self-management interventions for COPD. Identified articles were screened for eligibility using the web-based software Rayyan.ai. Eligible articles were identified, assessed, and categorized by the reviewers, either directly or through a combination of methods, using Atlas.ti version 9.1.7.0. Thereafter, data were charted accordingly and presented with the purpose of giving an overview of currently available literature while highlighting existing gaps. Results: A total of 101 eligible articles were included. This review found that most eHealth technologies (91/101, 90.1%) enable patients to self-monitor their symptoms using (smart) measuring devices (39/91, 43%), smartphones (27/91, 30%), or tablets (25/91, 27%). The self-management process of “taking ownership of health needs” (94/101, 93.1%), the behavior change technique of “feedback and monitoring” (88/101, 87%), and the positive health dimension of “bodily functioning” (101/101, 100%) were most often addressed. The inclusion criteria of studies and the actual populations reached show that a subset of people with COPD participate in eHealth studies. Conclusions: The current body of literature related to eHealth interventions has a strong tendency toward managing the physical aspect of COPD self-management. The necessity to specify inclusion criteria to control variables, combined with the practical challenges of recruiting diverse participants, leads to people with COPD being included in eHealth studies that only represent a subgroup of the whole population. Therefore, future research should be aware of this unintentional blind spot, make efforts to reach the underrepresented population, and address multiple dimensions of the positive health paradigm.</p
Stochastic co-teaching for robust cardiac segmentation in ultrasound with noisy labels
Get PDFIn this work, we propose a label noise-robust segmentation framework for left ventricle blood pool segmentation in echocardiography. Based on the stochastic co-teaching approach, our method extends pixel-level filtering of label noise with additional image-level filtering to more effectively prevent noisy labels from backpropagating. We evaluate our framework on the EchoNet-Dynamic dataset, and simulate diverse noisy label scenarios, including over- and undersegmented (i.e., biased) labels. Our results demonstrate that the incorporation of image-based rejection enhances the Dice coefficient by 1.5% points and ejection fraction estimation by 2.3% points with respect to the pixel-based co-teaching framework under heavily biased label noise conditions, and thereby maintains the same performance as on clean data
The European University Initiative:an idea whose time has (finally) come (again)?
No full textIn 2017, after 70 years, an idea resurfaced in a political speech on the future of Europe: The European University. Within months, the idea made its way to the European Union (EU) higher education agenda and was adopted. The resulting European Universities Initiative (EUI) became the EU’s flagship project on higher education, a sector that falls under the subsidiarity principle. How did this old idea gain so much traction in such a short timeframe? This article investigates this puzzle using Kingdon’s Multiple Stream Theory that explains policy change through the coupling of problems, politics, and policy streams that open a window of opportunity for policy entrepreneurs. Based on a content analysis of policy documents supported by interviews with key actors, the study finds that a window of opportunity opened in 2017 due to focusing events in the problems and politics streams–Brexit and French President Macron’s speech at Sorbonne University–that enabled the European Commission to act as a policy entrepreneur and push the idea through the policy cycle. The article contributes to understanding EU-level policy change in higher education and explains how the European Commission plays an active role in an area where it has supporting competencies.</p
Healthy Embodiment:Philosophical Reflections on the Experience of Health
No full textThis book provides a philosophical analysis of the experience of health and investigates how this experience is shaped by recent developments in medicine and public health. It shows how phenomenological and Foucauldian approaches to health can be systematically integrated into a general account of healthy embodiment. Many medical practitioners argue for a shift from curative to preventative medicine. Technoscientific developments now enable us to track our health and provide more effective ways to live healthily. This book argues that these developments shape how we experience our health of and others, as well as the way in which we distinguish between health and illness. Its starting point is that health is not so much an object with well-defined boundaries that can be scrutinized scientifically but is better understood as an embodied experience. The author uses phenomenology and the work of Foucault to develop a theory of healthy embodiment. He argues that experiencing oneself as a healthy subject requires being made present as a healthy object by someone or something else. He explores how the experience of health results from the interaction between being a subject and being an object and potentially involves challenging medical norms. Healthy Embodiment will be of interest to researchers and graduate students working in phenomenology, science and technology studies, medical humanities, bioethics and sociology of medicine.</p
Sustainability transitions in infrastructure:understanding causal dynamics in the Dutch asphalt paving sector
Get PDFRecognizing that sustainability transitions are often impeded by complex social and institutional factors, this study aims to identify systemic barriers that hinder the scaling up of sustainable innovations in the Dutch asphalt paving sector and the causal dynamics that shape these barriers. Using a single-case study approach, we develop a causal loop diagram (CLD) based on data from 19 semi-structured interviews with key actors, selected through snowball sampling. Through this analysis, we identified three key clusters of systemic barriers: 1) project-centric loops, reflecting the dominant project-focused perspective in business models in the sector; 2) conservative mindset loops, linked to the risk-averse mindset in the sector; and 3) collective knowledge-building loops, which highlight gaps in information exchange, monitoring, and knowledge sharing. Our findings show that a lack of collective knowledge is a core barrier, manifesting in interconnected challenges such as misinformed policies and requirements. We propose practical interventions, including mandating environmental cost indicators, developing testing lanes, supporting independent testing organizations, and creating specialized innovation roles. This study provides actionable insights for public organizations, market parties, and third-sector actors to manage infrastructure projects in ways that promote alignment with long-term sustainability goals.</p
