The concept of value co-creation (VCC) is central to service-dominant logic (SDL) and forms its second axiom, namely that “Value is cocreated by multiple actors, always including the beneficiary” (Vargo & Lusch, 2016, p.8). In parallel with the evolution of VCC in SDL, the term “value co-destruction” (VCD) has also emerged within the services and marketing literature (Echeverri & Skålén, 2011; Plé & Cáceres, 2010). Value co-destruction is pitched as a reverse concept to VCC—another side of the same coin (Plé, 2017)—capturing how interactions, practices, and resource integrations between actors might have negative impacts on value formation. Research on VCD has both expanded and fragmented (Echeverri & Skålén, 2021), but the concept has not been subject to the same scrutiny as VCC. In this article, we question the logic underpinning VCD conceptualization and problematize its use. We articulate three specific problems: first, the need to view VCC as a normative statement; second, a logical flaw in how VCD captures negative outcomes; and third, an issue with the “co” in co-destruction. We offer two solutions for researchers in this area: first, given that VCC is representative of a metatheory, we present mid-range theories as providing opportunities for exploring the role of valence in interactive service experiences; second, we identify literature that presents a continuum of contrasting negative and positive value outcomes.
Introduction Many depressed patients do not achieve remission with available treatments. Anhedonia is a common residual symptom associated with treatment resistance as well as low function and quality of life. There are currently no specific and effective treatments for anhedonia. Some trials have shown that dopamine agonist pramipexole is efficacious for treating depression, but more data is needed before it could become ready for clinical prime time. Given its mechanism of action, pramipexole might be a useful treatment for a depression subtype characterised by significant anhedonia and lack of motivation—symptoms associated with dopaminergic hypofunction. We recently showed, in an open-label pilot study, that add-on pramipexole is a feasible treatment for depression with significant anhedonia, and that pramipexole increases reward-related activity in the ventral striatum. We will now confirm or refute these preliminary results in a randomised controlled trial (RCT) and an open-label follow-up study. Methods and analysis Eighty patients with major depression (bipolar or unipolar) or dysthymia and significant anhedonia according to the Snaith Hamilton Pleasure Scale (SHAPS) are randomised to either add-on pramipexole or placebo for 9 weeks. Change in anhedonia symptoms per the SHAPS is the primary outcome, and secondary outcomes include change in core depressive symptoms, apathy, sleep problems, life quality, anxiety and side effects. Accelerometers are used to assess treatment-associated changes in physical activity and sleep patterns. Blood and brain biomarkers are investigated as treatment predictors and to establish target engagement. After the RCT phase, patients continue with open-label treatment in a 6-month follow-up study aiming to assess long-term efficacy and tolerability of pramipexole. Ethics and dissemination The study has been approved by the Swedish Ethical Review Authority and the Swedish Medical Products Agency. The study is externally monitored according to Good Clinical Practice guidelines. Results will be disseminated via conference presentations and peer-reviewed publications. Trial registration number NCT05355337 and NCT05825235 .
Objective Cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for insomnia, but half of the patients do not reach remission. This study aimed to explore subjective remission by investigating the characteristics of patients who reported lingering sleep problems after CBT-I. Methods Secondary analyses of a randomized controlled trial of group CBT-I in 72 primary care patients with insomnia disorder. Sociodemographic characteristics and outcomes (insomnia severity, sleep variables, hypnotics use, fatigue, depressive symptoms, and dysfunctional beliefs/attitudes), including baseline data and symptom change, were investigated in relation to patients' posttreatment response to the yes-or-no question “Would you say that you have sleep problems?” Results A total of 56.9% of patients reported sleep problems after CBT-I. At baseline, they had worse depressive symptoms (14.9 (SD 7.5) vs. 10.2 (SD 5.9), p = 0.006) and more awakenings (2.6 (SD 1.5) vs. 1.8 (SD 1.3), p = 0.034) than those in subjective remission from sleep problems. Patients in the non-remission and remission groups showed similar improvements in sleep, fatigue, and depressive symptoms, but patients in the non-remission group had improved less in insomnia severity, dysfunctional beliefs/attitudes about sleep, and hypnotic use. In patients with more pronounced depressive symptoms before CBT-I, change in depressive symptoms during treatment partially explained subjective remission from sleep problems. Discussion More severe depressive symptoms prior to CBT-I and less improvements in depressive symptoms during treatment predicted remaining subjective sleep problems after treatment. These findings highlight the importance of assessing depressive symptoms in primary care patients with insomnia, as patients with pronounced depressive symptoms may need tailored treatment.
Research on gender-fair language aims to identify language inclusive to a multitude of individuals, for example, increasing the visibility of women by using paired pronouns (he/she) instead of generic masculine forms (he). However, binary presentations like he/she might come with unwanted side effects and evoke what we label as normative gender bias. A normative gender bias is defined as when words lead to stronger associations with individuals with normative gender expressions than with individuals with non-normative gender expressions, thus contributing to making non-normative individuals invisible. In three experiments, we compared the extent to which the paired pronoun he/she (Swedish and English), the neo-pronouns hen (Swedish), ze (English), and the generic pronoun singular they (English) evoked a normative gender bias. Swedish- (N = 219 and 268) and English- (N = 837, from the UK) speaking participants read about individuals referred to with the paired pronoun he/she or with hen, ze, or they. In Experiment 1 (Swedish), there was no main effect of condition on a normative bias, but in Experiment 2 (Swedish), the paired pronouns he/she evoked normative gender bias while hen did not. In Experiment 3 (English), both ze and singular they evoked normative gender bias, although normative associations were lower in these conditions compared to he/she. Furthermore, the normative bias was lower among participants who had knowledge about the use of ze as a nonbinary pronoun. Finally, neither ze nor they evoked a normative gender bias when their use was explicitly stated to be nonbinary. A potential explanation for why singular they did not generally result in less normative associations, despite almost all participants knowing about it, may include its more common use as a generic pronoun. Taken together, our results suggest that neo-pronouns, but not paired pronouns, have the potential to evoke less normative associations, but that they must be both (1) actively created new words and (2) well-known to language users as nonbinary pronouns.
Valid measurements are needed to investigate the impact of parental bonding on child health development from a life-course perspective. The aim was to develop and validate a psychometric rating scale, the Parent-to-Infant Bonding Scale (PIBS) to measure bonding in both mothers and fathers. Internal consistency and construct validity were analysed using data from Swedish parents from both clinical ( N = 182), and community ( N = 122) population samples. Overall, good internal consistency, convergent validity (against the Postpartum Bonding Questionnaire, analysed in the clinical sample), and discriminant validity (against the mental health constructs depressive symptoms and anxiety) appeared. The results indicate good psychometric measurement properties of the PIBS for both mothers and fathers in community and clinical populations. Similarities in PIBS measurement properties between the groups suggest its usefulness for comparisons between mothers and fathers, and for investigating unique and interactive impacts of maternal and paternal bonding on child outcomes using community and clinical cohorts.
Rock pools are eroded depressions in bedrock providing temporary aquatic habitats with varying morphometric and chemical conditions. Tardigrades have adapted to many habitats with varying and extreme abiotic conditions, including desiccation, but their occurrence in rock pools have rarely been investigated. This study investigated the occurrence of tardigrades and the morphometric and chemical conditions in rock pools by the Baltic Sea in southeast Sweden. Samples of benthic material were collected from rock pools at three sites near the town Karlshamn together with measurements of pool size, pH, temperature, salinity, and dissolved oxygen of the water. Tardigrades occurred in about one fifth of the rock pools and included five eutardigrade genera. Also rotifers and nematodes were observed in the samples. The morphometric and chemical variables varied both within and among the three sites but with few differences between rock pools with or without tardigrades. However, rock pools with tardigrades tended to be overall shallower than pools without tardigrades, indicating that more desiccating-prone rock pools may be more favourable habitats for tardigrades. The study shows that tardigrades are part of the micro-invertebrate fauna in rock pools and this habitat deserves more investigations into the occurrence of this animal group.
Smart healthcare is altering the delivery of healthcare by combining the benefits of IoT, mobile, and cloud computing. Cloud computing has tremendously helped the health industry connect healthcare facilities, caregivers, and patients for information sharing. The main drivers for implementing effective healthcare systems are low latency and faster response times. Thus, quick responses among healthcare organizations are important in general, but in an emergency, significant latency at different stakeholders might result in disastrous situations. Thus, cutting-edge approaches like edge computing and artificial intelligence (AI) can deal with such problems. A packet cannot be sent from one location to another unless the “quality of service” (QoS) specifications are met. The term QoS refers to how well a service works for users. QoS parameters like throughput, bandwidth, transmission delay, availability, jitter, latency, and packet loss are crucial in this regard. Our focus is on the individual devices present at different levels of the smart healthcare infrastructure and the QoS requirements of the healthcare system as a whole. The contribution of this paper is five-fold: first, a novel pre-SLR method for comprehensive keyword research on subject-related themes for mining pertinent research papers for quality SLR; second, SLR on QoS improvement in smart healthcare apps; third a review of several QoS techniques used in current smart healthcare apps; fourth, the examination of the most important QoS measures in contemporary smart healthcare apps; fifth, offering solutions to the problems encountered in delivering QoS in smart healthcare IoT applications to improve healthcare services.
This article attempts to address the challenge that preschool teachers face, when integrating a specific content area, science, with play. The study builds on the theoretical framework of Play-Responsive Early Childhood Education and Care (PRECEC), in which teaching, and play are understood as a mutual activity. In this mutual activity, teachers and children signal their participation by shifting between as if (fantasy and fictional worlds) and as is (acquiring knowledge of the world as it is) (Pramling et al., 2019). The empirical data consists of video-observations of a preschool teacher and 1-4-year-old children who participate in activities that incorporate play and scientific content. The video-observations were analysed through studying how and why shifts between as is and as if were made by the preschool teacher. The results show that the preschool teacher made the play shift between as if and as is through different types of actions (voice change and bodily expression). Further, shifts seemed to be made with two aims in sight: science learning and socialisation. In conclusion, the preschool teacher (as a more knowledgeable adult) has an important role in creating a responsive environment and in introducing science content, which does not arise by itself. Implications for preschool teachers and preschool practice are discussed.
Molecularly imprinted polymers (MIPs) and the imprinting technique provide polymeric material with recognition elements similar to natural antibodies. The template of choice (i.e., the antigen) can be almost any type of smaller or larger molecule, protein, or even tissue. There are various formats of MIPs developed for different medical purposes, such as targeting, imaging, assay diagnostics, and biomarker detection. Biologically applied MIPs are widely used and currently developed for medical applications, and targeting the antigen with MIPs can also help in personalized medicine. The synthetic recognition sites of the MIPs can be tailor-made to function as analytics, diagnostics, and drug delivery systems. This review will cover the promising clinical applications of different MIP systems recently developed for disease diagnosis and treatment.
Background Plasma soluble urokinase-type Plasminogen Activator Receptor (suPAR) predicts disease aggressiveness in renal cell carcinoma (ccRCC), but its prognostic accuracy has not been investigated. To investigate the prognostic accuracy of preoperative plasma suPAR in patients who received curative treatment for initially localized ccRCC. Methods We retrospectively analyzed plasma samples stored in the Danish National Biobank between 2010 and 2015 from 235 patients with ccRCC at any stage. Relationships with outcome analyzed using univariate and multiple logistic Cox regression analysis. Results There were 235 patients with ccRCC. The median follow-up period was 7.7 years. In univariate analysis suPAR ≥ 6 ng/mL was significantly associated with overall survival (OS) and recurrence-free survival (RFS). Patients with elevated suPAR were more likely to recur, with a Hazard Ratio (HR) of 2.3 for RFS. In multiple logistic regression, suPAR ≥ 6 ng/mL remained a negative predictor of OS and RFS. Limitations include retrospective study design, wide confidence intervals, and tumor subtype heterogeneity bias. Conclusions ccRCC patients with high plasma suPAR concentrations are at an elevated risk of disease recurrence and see lower OS. suPAR is a promising surveillance tool to more precisely follow up with ccRCC patients and detect future recurrences. Patient Summary In this study, we showed that new type of liquid marker in blood plasma, called suPAR, is associated to a higher risk of kidney cancer recurrence when elevated above 6ng/mL. We also showed suPAR to independently be able to predict patients overall and recurrence free survival in patient with any stage of kidney cancer.
Background Vascular adverse events after collagenase injection for Dupuytren disease are absent in large trials and systematic reviews. The aim of this study is to present a case series of delayed vascular complications after collagenase treatment. Methods A prospective evaluation of 1181 consecutively treated patients at one orthopedic department identified three patients reporting symptoms of possible vascular complication. Baseline demographics and description of symptoms were collected, with a physical examination documenting extension deficit and neurovascular status. All patients completed the Cold Intolerance Symptom Severity (CISS) scale (range 4-100, lower is better) and underwent Doppler sonography examination of the digital arteries. Results All patients were treated in the small finger and two had an isolated proximal interphalangeal joint contracture. All patients had a delayed presentation of a few months, with episodes of white discoloration of the treated finger relieved within 30 min and associated with variable pain, paresthesia, stiffness and weakness. Two of the patients reported cold exposure as an episode trigger and had a pathological CISS score (40 and 36, respectively). Doppler sonography identified a nonpatent ulnar digital artery in one patient. Conclusions Delayed vascular complication after collagenase treatment is rare, but surgeons and patients should be aware of the risk, especially when treating the small finger.
Purpose Reablement is a multidisciplinary intervention aimed at promoting function and independence for people with functional decline. Detailed descriptions of various professions’ actions are needed for organization and evaluation of reablement services. This study describes physiotherapy practice in a reablement context in Swedish municipalities, focusing on the content and magnitude of interventions. Methods Physiotherapists (n=108) from 34 municipalities answered a web-based survey covering the target group, content and duration of their actions, and number of contacts initiated over a 3-week period. Data were analyzed with descriptive statistics and multiple logistic regression. Results Overall, 1005 cases were reported, with a mean age of 78.9 years (SD: 11.7); about 91% (n=912) were aged ≥65 and 61% (n=612) were women. About 70% were allocated to home care; 16% (n=160) of these had minor functional limitations (eg, needing safety alarms/help with domestic tasks), and 55% (n=550) had major functional limitations (eg, needing help with personal activities of daily living). The most reported actions were providing technical aids (60.8%, n=576), instructions/counseling (41.5%, n=393), walking/climbing stairs (27.6%, n=262), strength training (27.2%, n=258), and fall prevention (25.5%, n=242). Almost half of the cases included one action (n=494) and about 89% (n=890) targeted primary needs (body functions, walking indoors, self-care, or domestic life), mainly in clients with major functional limitations (odds ratio=2.96; 95% confidence interval: 1.95–4.49). About 50% (n=517) of the cases involved 1–2 contacts; about 55% (n=549) were completed within 3 weeks. Exercise was associated with ≥6 visits over ≥7 weeks. Supervision of home care staff was performed in 19.1% (n=181) of cases. Conclusion Reablement physiotherapy mostly comprises a few actions over a relatively short period. Whether this is a conscious strategy based on the purpose of home-based physiotherapy or clients’ needs and wishes, or conversely an expression of limited resources, remains to be investigated.
Weight stigma, defined as pervasive misconceptions and stereotypes associated with higher body weight, is both a social determinant of health and a human rights issue. It is imperative to consider how weight stigma may be impeding health promotion efforts on a global scale. The World Obesity Federation (WOF) convened a global working group of practitioners, researchers, policymakers, youth advocates, and individuals with lived experience of obesity to consider the ways that global obesity narratives may contribute to weight stigma. Specifically, the working group focused on how overall obesity narratives, food and physical activity narratives, and scientific and public‐facing language may contribute to weight stigma. The impact of weight stigma across the lifespan was also considered. Taking a global perspective, nine recommendations resulted from this work for global health research and health promotion efforts that can help to reduce harmful obesity narratives, both inside and outside health contexts.
Students experience the research-teaching nexus differently as they progress through their first three years of undergraduate study depending on the discipline. The question is if students, within the same discipline, experience the nexus differently depending on the profile of the institution where they study. The present study explored students’ experiences of the research-teaching nexus (RT-nexus) during their undergraduate studies at one research-intensive and one teaching-intensive university. A survey ( n = 340) was distributed among business students at two Swedish universities. One finding is that students from both universities reported on a progression in how they experience the nexus, and in learning outcomes. Students also rated what teachers do and what they themselves do higher, than what their peers do. The main gap between students from the two universities was that students from the research-intensive university generally perceived a stronger connection between teaching and research than did students from the teaching-intensive university. They also to a higher extent found that a close connection between research and teaching in their education would be important to them in their future work life, whereas students from the teaching-intensive university were more unsure.
This study investigates people’s associations between the exchange of sexual services for payment and different sexual activities. Sex work entails a range of activities, from in person services to online performances. To date, no study has asked about the activities individuals associate with the exchange of sexual services for payment. The relationship between the exchange of sexual services for payment and specific activities is an important area for inquiry, as there exists considerable variance in people’s views on sex work and associations are impacted by a range of attitudes. Using an original survey involving a substantial sample size of adults in the U.S. (n = 1,034), respondents are asked their level of association between the exchange of sexual services for payment and seven activities: pornographic photos, pornographic videos, webcamming, erotic dancing, erotic massages, oral sex, and sexual intercourse. The results reveal that respondents are more likely to associate the exchange of sexual services for payment with activities requiring in person and physical contact between sex workers and clients than non-physical activities. In addition, we find that conservatives are more likely to associate the exchange of sexual services for payment with non-physical activities than liberals. Moreover, we find that people who view the exchange of sexual services for payment as acceptable are more likely to recognize a broader range of activities as associated with such exchanges than are those who hold more negative attitudes. Views on acceptability are more important than are previous experiences of paying for sexual services. Our findings offer valuable insights for policymakers, researchers, and advocates seeking a comprehensive grasp of the complexities surrounding sex work in contemporary society.
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