The goal of this research is to explore the transformational power of a new consumption and production practice, the practice of blogging, to understand its impact on consumers' identity ...transformations beyond their self-concept as consumers and on the blogosphere as an organizational field. Through an exploratory study of over 12,000 blog posts from five fashion bloggers, complemented by in-depth interviews, we trace the transformation of consumer bloggers. We identify and describe three identity phases, the individual consumer, collective blogger and blogger identity phase, and two important turning points. Our findings show that through a continuous process of identity negotiation, adaptation, and re-interpretation with multiple stakeholders, these bloggers transform into human brands. In turn, these individual transformation processes reciprocally influence the emergence of blogging as a professional practice and of the blogosphere as a new organizational field. These findings contribute to a theoretical understanding of consumer transformation processes in a new field, where consumers can leave their role as consumers through continuously engaging in identity negotiation, adaptation and re-interpretation, creating alternative points of reference and validation in a new field that in turn continues to influence their brand identity. Furthermore, our findings contribute to an understanding of human brands from a brand-as-process perspective, and have implications for brands wishing to collaborate with these influential actors.
•Traces the processes of bloggers' transformation from consumer to human brand•Identifies three identity phases and two turning points•Bloggers negotiate and re-interpret their (brand) identities in a stakeholder network.•The blogosphere emerges as a new organizational field.•Relationship with brands changes from displaying consumption to collaboration.
This article examines the emotional labour of digital influencers to extend our understanding of the processes of transmutation of workers’ emotional systems. According to Arlie Hochschild, ...transmutation occurs when workers’ emotional systems are engineered into commercial and organizational settings for economic profit. To date much work has been carried out within formal organizational settings on ‘surface acting’, which often leads to self-abuse, burnout and depersonalization, and ‘deep acting’, which is associated with feelings of personal freedom. We use a multi-sited ethnography of digital influencers’ emotional work practices to show how so-called ‘person-brands’ labour on the self through dialectical process between emancipating one’s person-brand and exploiting oneself. We suggest a new mode of emotional labour in which transmutation happens in practices where influencers display their private actions to the public and where they transfer commercial agendas into their private realm and exploit their selves. Consequently, digital influencers work under the condition that they must self-exploit to succeed, and we demonstrate how they do this in seven distinct work practices. While we suggest self-exploitation to be a condition of digital influencers’ work, we question whether this is a boundary condition in the transformation to become more powerful person-brands where work becomes more individualized and subjectified.
To measure the incidence of intraoperative hypotension (IOH) during surgery in ambulatory surgery centers (ASCs) and describe associated characteristics of patients and procedures.
Retrospective ...analysis.
20 ASCs.
16,750 patients having non-emergent, non-cardiac surgery; ASA physical status 2 through 4.
None.
We assessed incidence of IOH using the definition from the Centers for Medicare & Medicaid Services (CMS) Merit-based Incentive Payment System (MIPS)—mean arterial pressure (MAP) < 65 mmHg for at least 15 cumulative minutes—and three secondary definitions: minutes of MAP <65 mmHg, area under MAP of 65 mmHg, and time-weighted average MAP <65 mmHg.
30.9% of ASC cases had a MAP <65 mmHg for at least 15 min. The incidence of IOH varied significantly, and was higher among younger adults (age 18–39; 36.2%), females (35.2%), and patients with ASA physical status 2 (32.8%). IOH increased with increasing surgery length, even when time-weighted, and was higher among low complexity (30.6%) than moderate complexity (28.8%) procedures, and highest among high complexity procedures (44.1%).
There was substantial occurrence of IOH in ASCs, similar to that described in academic hospital settings in previous literature. We hypothesize that this may reflect clinician preference not to intervene in perceived healthy patients or assumptions about ability to tolerate lower blood pressures on behalf of these patients. Future research will determine whether IOH in ACSs is associated with adverse outcomes to the same extent as described in more complex hospital-based surgeries.
•Intraoperative hypotension (IOH) is associated with organ damage.•Interoperative hypotension occurred in 30.9% of cases in ambulatory surgery centers.•Intraoperative hypotension was more common in patients considered lower risk.•Clinicians may tolerate lower pressures in cases deemed low risk for complications.
Intraoperative hypotension is common and associated with organ injury and death, although randomized data showing a causal relationship remain sparse. A risk-adjusted measure of intraoperative ...hypotension may therefore contribute to quality improvement efforts.
The measure we developed defines hypotension as a mean arterial pressure <65 mm Hg sustained for at least 15 cumulative minutes. Comparisons are based on whether clinicians have more or fewer cases of hypotension than expected over 12 months, given their patient mix. The measure was developed and evaluated with data from 225,389 surgeries in 5 hospitals. We assessed discrimination and calibration of the risk adjustment model, then calculated the distribution of clinician-level measure scores, and finally estimated the signal-to-noise reliability and predictive validity of the measure.
The risk adjustment model showed acceptable calibration and discrimination (area under the curve was 0.72 and 0.73 in different validation samples). Clinician-level, risk-adjusted scores varied widely, and 36% of clinicians had significantly more cases of intraoperative hypotension than predicted. Clinician-level score distributions differed across hospitals, indicating substantial hospital-level variation. The mean signal-to-noise reliability estimate was 0.87 among all clinicians and 0.94 among clinicians with >30 cases during the 12-month measurement period. Kidney injury and in-hospital mortality were most common in patients whose anesthesia providers had worse scores. However, a sensitivity analysis in 1 hospital showed that score distributions differed markedly between anesthesiology fellows and attending anesthesiologists or certified registered nurse anesthetists; score distributions also varied as a function of the fraction of cases that were inpatients.
Intraoperative hypotension was common and was associated with acute kidney injury and in-hospital mortality. There were substantial variations in clinician-level scores, and the measure score distribution suggests that there may be opportunity to reduce hypotension which may improve patient safety and outcomes. However, sensitivity analyses suggest that some portion of the variation results from limitations of risk adjustment. Future versions of the measure should risk adjust for important patient and procedural factors including comorbidities and surgical complexity, although this will require more consistent structured data capture in anesthesia information management systems. Including structured data on additional risk factors may improve hypotension risk prediction which is integral to the measure's validity.
In August 2015, a soldier returned from field exercises in Texas, USA, with nonspecific febrile illness. Culture and sequencing of spirochetes from peripheral blood diagnosed Borrelia turicatae ...infection. The patient recovered after receiving doxycycline. No illness occurred in asymptomatic soldiers potentially exposed to the vector tick and prophylactically given treatment.
Over the past decades, early awareness and alert (EAA) activities and systems have gained importance and become a key early health technology assessment (HTA) tool. While a pioneer in HTA, Sweden had ...no national level EAA activities until 2010. We describe the evolution and current status of the Swedish EAA System.
This was a historical analysis based on the knowledge and experience of the authors supplemented by a targeted review of published and gray literature as well as documents relating to EAA activities in Sweden. Key milestones and a description of the current state of the Swedish EAA System is presented.
Initiatives to establish a system for the identification and assessment of emerging health technologies in Sweden date back to the 1980s. In the 1990s, the Swedish Agency for HTA and Assessment of Social Services (SBU) supported the development of EuroScan as one of its founder members. In the mid-2000s, an independent regional initiative, driven by the Stockholm County Drug and Therapeutics Committee, resulted in the establishment of a regional horizon scanning function. By 2009, this work had expanded to a collaboration between the four biggest counties in Sweden. The following year it was further expanded to the national level and since then the Swedish EAA System has been carrying out identification, filtration and prioritization of new medicines, early assessment of the prioritized medicines, and dissemination of information. In 2015, the EAA System was incorporated into the Swedish national process for managed introduction and follow-up of new medicines. Outputs from the EAA System are now used to select new medicines for inclusion in this process.
The Swedish EAA System started as a regional initiative and rapidly grew to become a national level activity. An important feature of the system today is its complete integration into the national process for managed introduction and follow-up of new medicines. The system will continue to evolve as a response both to the changing landscape of health innovations and to new policy initiatives at the regional, national and international level.
Intraoperative hypotension (IOH) is well-described in the academic setting but not in community practice. IOH is associated with risk of postoperative morbidity and mortality. This is the first ...report of IOH in the community setting using the IOH measure definition from the Centers for Medicare and Medicaid Services Merit-based Incentive Payment System program.
To describe the incidence of IOH in the community setting; assess variation in IOH by patient-, procedure-, and facility-level characteristics; and describe variation in risk-adjusted IOH across clinicians.
Design Cross-sectional descriptive analysis of retrospective data from anesthesia records in 2020 and 2021. Setting Forty-five facilities affiliated with two large anesthesia providers in the USA. Participants Patients aged 18 years or older having non-emergent, non-cardiac surgery under general, neuraxial, or regional anesthesia. Cases were excluded based on criteria for the IOH measure: baseline mean arterial pressure (MAP) below 65 mmHg prior to anesthesia induction; American Society of Anesthesiologists (ASA) physical status classification of I, V, or VI; monitored anesthesia care only; deliberate induced hypotension; obstetric non-operative procedures; liver or lung transplant; cataract surgery; non-invasive gastrointestinal cases. Main outcomes IOH, using four definitions. Primary definition: binary assessment of whether the case had MAP < 65 mmHg for 15 min or more. Secondary definitions: total number of minutes of MAP < 65 mmHg, total area under MAP of 65 mmHg, time-weighted average MAP < 65 mmHg.
Among 127,095 non-emergent, non-cardiac cases in community anesthesia settings, 29% had MAP < 65 mmHg for at least 15 min cumulatively, with an overall mean of 12.4 min < 65 mmHg. IOH was slightly more common in patients who were younger, female, and ASA II (versus III or IV); in procedures that were longer and had higher anesthesia base units; and in ambulatory surgery centers. Incidence of IOH varied widely across individual clinicians in both unadjusted and risk-adjusted analyses.
Intraoperative hypotension is common in community anesthesia practice, including among patients and settings typically considered "low risk." Variation in incidence across clinicians remains after risk-adjustment, suggesting that IOH is a modifiable risk worth pursuing in quality improvement initiatives.
In the eleven years since the Supreme Court handed down its Lawrence v. Texas1 ruling, state courts have not consistently adhered to the decision's implicit rejection of laws that regulate based on ...animus alone. Relying on the Court's explicit limitation of its decision to cases that do not involve minors, "persons who might be injured or coerced or who are situated in relationships where consent might not easily be refused, " public conduct, prostitution, government recognition of same-sex relationships, and practices not "common to a homosexual lifestyle"2—the so-called Lawrence exceptions—a number of states have continued to use archaic antisodomy laws to police conduct they see as morally reprehensible. This Comment examines the interpretation and application of the Lawrence exceptions by state courts, arguing that by maintaining discriminatory prosecution and punishment schemes for conduct deemed to fall within the exceptions, states run afoul of the core antidiscriminatory logic of Lawrence and of the Court's earlier ruling in Romer v. Evans.3 My analysis addresses not only whether laws that fall within the Lawrence exceptions discriminate on the basis of sexual orientation, but also whether they enable or invite discrimination along gender- and race-based lines. While some commentators have addressed Lawrence's exceptions for conduct involving minors,4 potentially coercive or injurious relationships,5 and, to a lesser extent, the exception for same-sex marriage,6 there is a lack of scholarship on how the Lawrence exceptions have affected so-called crime against nature laws—antisodomy laws which often survived in some form after 2003 because of the exceptions identified by the Court. This Comment addresses this gap, using crime against nature laws as an example to suggest that the Lawrence exceptions continue to enable and invite discrimination that contravenes the principles of Lawrence and Romer. Arguing that this trend cuts against the Court's intent in deciding Lawrence, I draw on an analogue from First Amendment jurisprudence to propose a framework with which courts can adhere to Lawrence's antidiscriminatory principles.
This study investigated the effect of institutions on the unemployment duration gap between non‐EU immigrants and native‐born in 12 European countries. Going further than the existing literature, our ...study encompassed unemployment duration, distinguishing between exits to inactivity, primary and secondary employment. Additionally, we have provided a stronger micro‐foundation to the comparative literature by introducing institutional measures for unemployment‐related benefits at the individual level rather than merely using aggregate proxies. Our analysis found no disincentive effects of benefits for immigrants. Furthermore, the employment prospects of immigrants were better when the demand for low‐skilled labour was high, and immigration policy was labour market‐oriented. In contrast, employment protection legislation did not affect the unemployment duration of immigrants.
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