This paper studies irregularity-type invariants of special C-pairs, or "geometric orbifolds" in the sense of Campana. Under mild assumptions on the singularities, we show that the augmented irregularity of a C-pair (X,D) is bounded by its dimension. This generalizes earlier results of Campana, and strengthens known results even in the classic case where X is a projective manifold and D = 0. The proof builds on new extension results for adapted forms, analysis of foliations on Albanese varieties, and constructions of Bogomolov sheaves using strict wedge subspaces of adapted forms.
Background. The modern educational paradigm is characterized by the active implementation of distance learning technologies and inclusive education principles. In this context, ensuring effective learning for students with special educational needs, particularly those with sensory impairments, in an inclusive online environment is particularly relevant. The specifics of their motivation for learning and level of psychological well-being, as well as the interrelationships between these factors, remain insufficiently studied. This is critical for developing adequate pedagogical strategies. Studying these aspects in the context of foreign language learning, which requires a high degree of engagement and cognitive effort, will help identify key determinants of success and adaptation in students with diverse learning needs.
Purpose. The purpose of this study was to identify and compare the characteristics of motivational profiles and levels of psychological well-being in students with typical development, hearing impairments, and visual impairments, studying foreign languages in an inclusive online environment.
Materials and methods. The study involved 60 students from the inclusive online school MySchool, divided into three equal groups of 20 students each: students with typical development, students with hearing impairments, and students with visual impairments. Academic motivation was assessed using the Academic Motivation Scale (Deci & Ryan, 1985, adapted by E.L. Dubovitskaya), which includes subscales of intrinsic motivation, extrinsic motivation (identification, introjection, external regulation), and amotivation. Psychological well-being was measured using K. Ryff's Psychological Well-Being Scales, which encompass six aspects: autonomy, competence, personal growth, positive relationships with others, purpose in life, and self-acceptance. Statistical data processing was performed using comparative and correlational analysis.
Results. The study results demonstrate statistically significant differences in motivational profiles and levels of psychological well-being between the study groups. Students with typical development are characterized by a predominance of intrinsic motivation for learning and high scores on all psychological well-being scales. Students with hearing impairments are characterized by maladaptive motivation and moderately low well-being, although for them, almost all types of motivation are positively correlated with well-being. Students with visual impairments have the lowest levels of psychological well-being, and, importantly, no significant correlations were found between motivation and well-being, which may indicate the prevalence of other, non-motivational factors influencing their mental state.
Conclusion. The identified differences highlight the need for a differentiated approach to organizing the educational process and providing psychological and pedagogical support. The findings highlight the importance of developing and implementing adapted pedagogical strategies aimed at increasing intrinsic motivation, fostering a sense of competence and autonomy, and improving the overall psychological well-being of students with sensory impairments in the context of distance learning foreign languages. This includes the use of multimodal teaching methods, personalised learning pathways and enhanced psychosocial support.
EDN: PKENFQ
AbstractThis article seeks to examine aspect and coercion at the predicate level and within the three syntactic layers of nucleus, core, and clause in Kurdish. Utilizing Role and Reference Grammar as the framework, the study identifies lexical aspects with inherent aspectual features at predicate level. Predicates are categorized into five types: activity, accomplishment, achievement, semelfactive, and state, based on their lexical characteristics. The other layers mainly host derivative aspects and aspectual operators. In the Kurdish language, the nucleus layer hosts three imperfective operators and one perfect operator, each of which modifies the aspectual features of the five mentioned event types. At this level, each predicate with its own lexical aspect undergoes aspect shifting due to its combination with one of these operators. All kinds of aspect shifting are triggered due to the semantic dimensions of the aspectual operators at the nucleus level. Also, the findings show that at the core level, predicates may undergo coercion when combined with adverbial items or internal arguments that have special referential characteristics; the derivative predicates (such as active accomplishments) appear at this level. This study shows that the temporal operator at the clause level also has a significant impact on the eventual structure of predicates, and the verbs at the clause level affected by the time operator may undergo coercion. All kinds of aspect shifting at this level are aimed at harmonizing the eventual structure of the verbs with the semantic dimensions of the time operator.Keywords: Kurdish, Aspect, Coercion, Role and Reference Grammar, Time Introduction Lexical Aspect (Aktionsart) and aspectual coercion are two interrelated dimensions within the realm of the semantics of verbs. While lexical aspects pertain to the inherent aspectual properties of verbs as abstract lexical items, aspectual coercion refers to the modification of the aspectual features of predicates when they are combined with other linguistic operators in a syntactic environment (Smith 1997; De Swart 1998; Michaelis, 2004; Cortés-Rodriguez, 2014). To clarify, aspect denotes the intrinsic aspectual characteristics of a verb, independent of its syntactic context, whereas coercion, also known as aspect shifting, denotes the alteration and adaptation of a predicate’s aspectual features due to its syntactic amalgamation with other sentence constituents.Based on three fundamental features—dynamicity, duration, and telicity—lexical aspectual classes can be categorized into five groups (Smith 1997):Static: “He has a car.” {-dynamic, ±durative, -telic}Activity: “He swims.” {+dynamic, +durative, -telic}Accomplishment: “He built a house.” {+dynamic, +durative, +telic}Achievement: “He won the game.” {+dynamic, -durative, +telic}Semelfactive: “He coughed.” {+dynamic, -durative, -telic}However, it should be noted that this basic classification may be subject to modifications in different theoretical approaches. For instance, within the Role and Reference Grammar framework (Van Valin & LaPolla 1997; Van Valin, Robert. 2005; Pavey 2010.), there are six types: state (“love”), activity (“dance”), achievement (“pop”), accomplishment (“melt”), semelfactive (“cough”), and active accomplishment (“X ate the fish”), each with their corresponding causative forms. In this same framework, Cortés-Rodríguez (2014) views the active accomplishment as a derived aspectual construction. Furthermore, various theories have been proposed regarding aspectual classes and features, such as those by Verkuyl (1972, 2005), Moens and Steedman (1988), and Croft (2012), to name a few. Despite these differing perspectives, this study employs the classification of Cortés-Rodríguez (2014) to examine the relationship between aspectual classes and coercion.In the present study, we examine aspect and aspectual coercion within Kurdish, utilizing the framework of Role and Reference Grammar. Initially, we delineate the aspectual classes in Kurdish as per this theoretical approach. Subsequently, we explore aspectual coercion in the language by elucidating the interplay between various predicate types and operators across different sentential layers, ranging from predicates to the nucleus, core, and clause. While numerous studies have investigated aspectual classes and type shifting in Kurdish (Veisi Hasar 2015, 2017; Najafi far et al., 2016; Tabei et al., 2020), research within this specific framework remains unexplored. Furthermore, the scope and influence of operators (in different layers) on the final aspectual construction and interpretation of a sentence in Kurdish has yet to be addressed. Materials and Methods In Role and Reference Grammar, the predicate is the most fundamental element of a sentence and is situated within the nucleus layer. This predicate, when combined with its arguments, forms the core layer. The core represents the central part of the clause, serving as both its semantic and syntactic foundation. Additionally, the periphery includes adjunct elements. It is the integration of the core and the periphery that constitutes the complete structure of a clause (Van Valin, Robert. 1993; Van Valin & LaPolla 1997; Van Valin, Robert. 2005; Cortés-Rodriguez 2014). Core periphery ArgumentNucleus clause Figure 1- The structure of a clause The structure outlined above is predicated solely on the argument structure; however, various sentence operators must also be integrated within this overarching framework. These operators, while not intrinsic to the argument structure, are incorporated into the clause to impart additional semantic and syntactic information. The amalgamation of these operators with the clause’s layered architecture engenders the semantic and syntactic blueprint of the clause (Van Valin and LaPolla 1997: 40-52; Pavey 2010: 76). They are organized into three layers within the sentence:Nucleus layer: Aspect operators, negation, and directionals.Core layer: Event quantification, deontic modality, internal negation, and directionals.Clause layer: Status operators, external negation, epistemic modality, tense, evidentiality, and illocutionary force.This hierarchical arrangement is predicated on the degree to which these operators influence the sentence’s ultimate form and interpretation. A figure illustrates the syntactic elements and operators’ interactions in the sentence ‘The boy did not go to the marker.’ Figure 2- The operators of a clause in KurdishBased on this mode, Cortés-Rodriguez (2014) presents a new model about aspect and coercion in this framework. He initially identifies three aspectual levels: (lexical) Aktionsart, (grammatical) aspect, and aspectuality. The first level pertains to the predicate level, where various event types are inherent to the predicates themselves. The second level, the nucleus layer, involves the application of grammatical aspectual operators—such as the progressive, perfective, and perfect—which modify the predicates. The third level, known as the core layer, is where derived event types (e.g., active accomplishment) emerge. In this layer, the interaction of certain predicates with directional adverbs or specific arguments results in these derived event types. Lastly, the fourth level is the clause layer, which encompasses tense and force. This layered approach demonstrates that different operators are applied at various levels to the verbal structures, thereby generating new aspectual modifications. Discussion of Results and ConclusionsFirstly, the analysis reveals that in Kurdish, within the domain of Aktionsart, five distinct event types are identified, each accompanied by a causative variant. Verbs such as haɫ-parin (dancing, activity), gajštǝn (arriving, achievement), koxin (coughing, semelfactive), tuwānawa (melting, accomplishment), and rǝq-le-bun (hating, state) serve as exemplars for these categories. These predicates embody the event classifications within the Aktionsart domain. However, at the secondary level—the nucleus layer—we scrutinize the operators that interact with these diverse aspectual classes to modify their event structures. The evidence suggests that within this layer, a minimum of three imperfective operators (-da; xarik + Ezafe linker; xarik + bu (to be)) and a single perfect operator (-uwa) are utilized to modify the aspectual characteristics of the predicates. The subsequent examples elucidate this point, employing solely an activity verb:ħasan la ħawša pjāsa-j kǝrd.Hasan in yard walk-3SG doHasan walked in the yard.ħasan la ħawša pjāsa-j da-kǝrd.Hasan in yard walk-3SG Imp-doHasan was walking in the yard.ħasan xarik-i pjāsa kǝrdǝn bu la ħawša ka karim hāt.Hasan xarik-Ez walk do be.pst.3SG in yard that Karim come.pst.3SGHasan was walking in the yard that Karim came in.ħasan xarik bu la ħawša pjāsa bǝ-kā ka bārān bāri.Hasan xarik be-pst.3SG in yard walk SBJV-do that rain rain-pst.3SGHasan was about to walk in the yard that it started to rain.ħasan la ħawša pjāsa-j kǝrd-uwa.Hasan in yard walk-3SG do-perf.Hasan has walked in the yard.These four operators modify the aspectual characteristics of predicates. The study demonstrates that the first and second imperfective operators (da; xarik + Ezafe linker) when applied to durative verbs such as activities and accomplishments, highlight the middle phases of these events. However, the third imperfective operator (xarik + bu), when used with these verbs, focalizes the preparatory phases of the predicates. Additionally, the data indicates that punctual achievement verbs, when associated with these operators, bring attention solely to their preparatory phase. Moreover, the first and second imperfective operators transform a semelfactive predicate into an iterative process, whereas the third one may change it into an achievement predicate emphasizing the preparatory phase. The findings also reveal that these operators are not compatible with static predicates unless the predicates are subjected to coercion. Finally, the research argues that the perfect operator, when combined with telic predicates, highlights their ending points, but when paired with non-telic predicates, it emphasizes their stopping points.The findings indicate that within the core layer, certain linguistic elements, including specific arguments (such as a definite internal argument) and particular adjuncts (like directional adverbs), can trigger coercion. Primarily, these elements convert activity predicates into active accomplishments. The subsequent examples illustrate this transformation:Ɂaw gorāni-jak-i wǝt.He song-DEF-3SG sayHe sang a song.Hasan baraw māl pjāsa-j kǝrd.Hasan to house walk-3SG doHasan walks towards the house.Finally, the results demonstrate that the tense operator within the clause layer significantly influences the aspectual properties of predicates and can also initiate coercion. While the past tense is aspectually neutral and exerts no influence, the present tense functions similarly to an imperfective operator. It highlights the intermediate stages of durative predicates, such as activities and accomplishments, and emphasizes the preparatory phase of achievements. Additionally, it transforms semelfactive predicates into iterative processes. To pjāsa-t kǝrd.You walk-2SG doYou walkedTo pjāsa da-kaj.You walk imp-doYou (are) walk (-ing).The diagram below illustrates the aspectual layers of Kurdish as delineated by the Role and Reference Grammar framework. kharik, kharik-i, kharik bun, perfect (-uwa)Directional adverbs, specific argumentsTenseFive event types Predicate Nucleus Core ClauseFigure 3- Aspectual layers in Kurdish
Sanjaya Paudel, Cristiano G. Sabiu, Suk-Jin Yoon
et al.
Understanding the quenching mechanisms in dwarf galaxies is crucial for constraining models of galaxy formation and evolution. In this vein, isolated dwarf galaxies offer valuable insight by helping disentangle the relative roles of internal and environmental processes in shutting down star formation. Here we report the discovery of a quiescent early-type dwarf galaxy (dE), SDSS J011754.86+095819.0 (hereafter dE01+09), located in a nearly isolated environment at a projected distance of approximately one megaparsec from its most likely host group, the NGC 524 group. dE01+09 has M_r = -15.72 and g-r = 0.67 mag and its light profile is well described by a Sérsic function with an index n = 1.1, consistent with typical dEs. Using optical spectroscopy from the DESI survey, we derive its simple stellar population properties, finding an intermediate luminosity-weighted age of 8.3$\pm$1.4 Gyr and a subsolar metallicity of -1.19$\pm$0.21 dex -- characteristics comparable to those of classical quiescent dEs. We propose that NGC 524 may represent an extreme example of group dynamics, in which a member galaxy, dE01+09, is ejected from its host group and subsequently evolves as an isolated system in the field.
Working hours, including the number and the arrangement thereof – such as shift work, night work, and quick returns – are classic topics in research on work environment and health. The struggle for working time reduction and the eight-hour work day is also one of the oldest fights of the labor movement, dating back to the 19th century (1). International Workers’ Day, celebrated annually on 1 May, has its origin in the Haymarket Affair, a rally in support of a strike for the eight-hour work day at the Haymarket Square in Chicago, USA, on 4 May 1886. At the rally, a riot broke out and a bomb exploded, killing several workers and police officers. In the aftermath, the State of Illinois prosecuted labor movement activists. Although the person who throw the bomb was never identified and the circumstances of the attack remained unclear, four labor movement activists, including August Spies, the editor of the German-American newspaper Arbeiter-Zeitung, were executed by hanging on 11 November 1887. A fifth activist died by suicide in prison (2). When the International Labour Organization (ILO) was established as an agency of the newly created League of Nations (the predecessor of today’s United Nations) after World War I in 1919, one of its main aims was the regulation and reduction of working time (1). The demand for the 8-hour work day and 48-hour work week was even included in the peace treaty of Versailles (Part XIII, Section II, Article 427) that was signed on 28 June 1919 following World War I (3, 4). Although working hours have been greatly reduced in many high-income countries since the 19th century, particularly in Europe, the discussion about working hours remains topical, as can be seen by the recent debate about a 4-day working week (5, 6). In South-East and East Asian countries, such as Japan, South Korea, and Taiwan, where working hours >48 hours per week are still widely prevalent, health concerns of such long working hours are an important topic of discussion (7, 8). Notably, the Japanese language has coined two terms: karōshi for death due to overwork (usually of cardiovascular causes) and karōjisatsu for death by suicide due to overwork (9). At the Scandinavian Journal of Work, Environment & Health, we regularly receive papers from researchers in Asia examining the health effects of long working hours (10–12). This issue includes a paper from a German research group on the association between night shift work and risk of cardiovascular disease (13). I use this opportunity to reflect briefly in this editorial on research on working hours and cardiovascular health. In the May issue (number 4) of the Journal, as part of our 50-year anniversary special publication series (14, 15), there will be a much more detailed account on what we have learned so far on working hours and health. Long working hours and cardiovascular disease In 2015, Kivimäki et al (16) published a seminal paper on long working hours and cardiovascular disease for the Individual Participant Data Meta-Analysis of Working Population (IPD-Work) Consortium that showed an association of long working hours with an increased risk of both ischemic heart disease and stroke (16). The association was stronger for stroke than ischemic heart disease (pooled relative risks 1.33 versus 1.13). Furthermore, for stroke, but not ischemic heart disease, the analyses suggested an exposure–response pattern. Thus, the longer the working hours, the greater the risk of stroke. From 2017 to 2021, the World Health Organization (WHO) and ILO conducted a project on the WHO/ILO Joint Estimates of the Work-Related Burden of Disease and Injury (17, 18) that included systematic reviews on the association of long working hours and risk of ischemic heart disease (19) and stroke (20). Results were similar to those reported by the IPD-Work Consortium in 2015. Long working hours, defined as ≥55 hours per week, were associated with a small increased risk of ischemic heart disease (pooled risk ratio 1.17) (19) and a larger increased risk of stroke (pooled risk ratio 1.35) (20). Based on these risk estimates and estimates on the country-specific prevalence of long working hours, the WHO and ILO estimated that, in 2016, globally 745 194 deaths were attributable to long working hours, with the largest burden in South-East Asia (17, 18, 21). A summary of the WHO/ILO joint estimates project has been published as a discussion paper in our Journal (22), together with an editorial (23). Obviously, the estimate of approximately 750 000 annual deaths due to long working hours is based on several assumptions, including that the epidemiological studies` estimates indicate a causal association between long working hours and cardiovascular outcomes and that data on the worldwide prevalence of long working hours are valid. Kivimäki and colleagues (24) expressed concerns about the interpretation that there is sufficient evidence for harmfulness of long working hours with regard to ischemic heart disease. Among other things, the authors were concerned about residual confounding (eg, by health-related behaviors, although it is debated whether they are mainly confounders, for which one should control, or mediators, for which one should not control (25)). They also presented analyses of data that suggested that socioeconomic position might be an important effect modifier and that the harmful effect of long working hours on risk of ischemic heart disease may be limited to workers of low socioeconomic position. As socioeconomic position is linked to the type of work the workers are doing, the possible effect modification by socioeconomic position could also mean that other, unmeasured working conditions may modify the association between long working hours and health. In other words, in addition to the length of the working hours, what happens during these working hours might also be important. In Denmark, Hannerz and colleagues (26, 27) attempted to replicate the analyses on long working hours and ischemic heart disease and stroke using large-scale register data. With regard to ischemic heart disease, they did not find an increased risk with long working hours [rate ratio (RR) 1.07, 95% confidence interval (CI) 0.94–1.21 for >48 versus 32–40 hours] (26). When stratified by socioeconomic position, long working hours were not associated with an increased risk of ischemic heart disease among workers of high, medium and unknown socioeconomic position, but there was an increased risk among workers of low socioeconomic position that worked long hours (RR 1.27, 95% CI 1.05–1.53). Although the interaction `long working hours × socioeconomic position` was not statistically significant, this increased risk among workers of low socioeconomic position is in agreement with the analyses by Kivimäki et al (24). With regard to stroke, Hannerz et al (27) did not find an increased risk for all types of stroke combined among those with long working hours, however, they reported an association between long working hours and increased risk of hemorrhagic stroke. This result was recently replicated in an analysis of the French CONSTANCES study (28) where exposure to long working hours during the past ten years was, in the adjusted model, associated with an increased risk of hemorrhagic stroke but not ischemic stroke. One can summarize that during the past ten years, several large-scale studies and meta-analyses on long working hours and cardiovascular outcomes have been published. Whereas the WHO has concluded that there is sufficient evidence for harmfulness for the association between long working hours and ischemic heart disease and stroke (19–21), other studies point to possible effect modification by socioeconomic position (24, 26) with regard to ischemic heart disease and the need to distinguish between ischemic and hemorrhagic stroke (27, 28). Shift work, night shift work and cardiovascular disease In 2018, Torquati et al (29) published a systematic review and meta-analysis that showed an increased risk of cardiovascular disease among shift workers. For those working shifts for five years, each additional five-year period of shift work was associated with a 7% increased risk of cardiovascular disease. Night shift work has been of particular interest for cancer research (30) but might also be relevant with regard to cardiovascular diseases. In their recent review and meta-analysis, Su et al (31) reported that night shift work was associated with an increased risk of cardiovascular mortality (pooled estimate 1.15, 95% CI 1.03–1.29). However, only four studies were included in this review. In 2022, a Swedish research group published two papers on night shift work from a large sample of healthcare workers in Stockholm, one on cerebrovascular disease and the other on ischemic heart disease. Bigert et al (32) reported that frequent night shifts and frequent consecutive night shifts were associated with an increased risk of cerebrovascular disease, including stroke. Kader et al (33) reported that permanent night shifts and frequent night shifts were associated with an increased risk of ischemic heart disease. In Denmark, Vestergaard et al (34)examined the association between night shift work and ischemic heart disease in a large-cohort of healthcare workers with day-to-day payroll information. The results were less clear than those of Kader et al (33): male, but not female, healthcare workers with night work had an increased risk of ischemic heart disease compared to day-time workers. The paper by Jankowiak et al (13) in the current issue of the Journal examined night shift work and risk of cardiovascular disease in a population-based cohort in the city of Mainz and Mainz-Bingen in Germany (13). The hazard ratios for low, middle, and high night shift work were 1.19, 1.32, and 1.14, respectively, compared to no night shift work, in the most-adjusted model. An important strength of the study is the comprehensive clinical examination of the participants, both at baseline and follow-up. An important limitation is the very low number of cases in the exposure groups during the five-year follow-up. Unsurprisingly, the CI of all estimates were wide and included unity and, thus, were far away from being statistically significant. The uncertainty of the estimates do not allow firm conclusions on the results. However, the estimates from this study can be included in meta-analyses, which then may provide us with more insight on the role of night shift work on risk of cardiovascular disease. Important challenges for future research on working time and cardiovascular disease will include better use of electronic working time registration systems that will allow a more precise measurement of exposure to long working hours and the frequency and type of shift work and night shift work (35, 36). It will also be important to conceptually clarify whether health behaviors that are hazardous to cardiovascular health – such as certain dietary patterns, lack of leisure time physical activity, or smoking – are confounders or mediators, or both, for the association between working time and cardiovascular disease. This clarification is key to correctly handling data on these health behaviors in the statistical models. Finally, examining the relations of the different working time arrangements with the contents of work conducted during these arrangements might be fruitful for a better understanding of the contribution of work to cardiovascular disease. Conflict of interest statement Reiner Rugulies was involved in both the IPD-Work Consortium and the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury project. References 1. International Labour Organization (ILO). International Labour Standards on Working time [Website]. 2024. Available from: https://www.ilo.org/global/standards/subjects-covered-by-international-labour-standards/working-time/lang--en/index.htm. (Accessed: 26 Februar 2024). 2. Chicago Historical Society and the Trustees of Northwestern University. The dramas of Haymarket [Website]. 2000. Available from: https://www.chicagohistoryresources.org/dramas/. (Accessed: 26 February 2024). 3. Yale Law School. The Avalon Project: Documents in Law, History and Diplomay. The Versailles Treaty June 28, 1919: Part XIII [Website]. 2008. Available from: https://avalon.law.yale.edu/imt/partxiii.asp. (Accessed: 2 March 2024). 4. International Labour Office. Official Bulletin, Volume I, April 1919 - August 1920. Chapter VI: Part XIII of the Treaty of Peace of Versailles. Geneva ILO; 1923. Available from: https://www.ilo.org/wcmsp5/groups/public/---dgreports/---jur/documents/genericdocument/wcms_441862.pdf. (Accessed: 2 March 2024). 5. Ashton JR. The public health case for the four-day working week. J R Soc Med. 2019;112(2):81-82. https://doi.org/10.1177/0141076819826782 6. Spencer DA. A four-day working week: its role in a politics of work. Polit Q. 2022;93(3):401-407. https://doi.org/10.1111/1467-923X.13173 7. Tsai M-C, Nitta M, Kim S-W, Wang W. Working overtime in East Asia: convergence or divergence? J Contemp Asia. 2016;46(4):700-722. https://doi.org/10.1080/00472336.2016.1144778 8. Cheng Y, Park J, Kim Y, Kawakami N. The recognition of occupational diseases attributed to heavy workloads: experiences in Japan, Korea, and Taiwan. Int Arch Occup Environ Health. 2012;85(7):791-799. https://doi.org/10.1007/s00420-011-0722-8 9. Hiyama T, Yoshihara M. New occupational threats to Japanese physicians: karoshi (death due to overwork) and karojisatsu (suicide due to overwork). Occup Environ Med. 2008;65(6):428-429. https://doi.org/10.1136/oem.2007.037473 10. Huang Y, Xiang Y, Zhou W, Li G, Zhao C, Zhang D, et al. Long working hours and all-cause mortality in China: A 26-year follow-up study. Scand J Work Environ Health. 2023;49(8):539-548. https://doi.org/10.5271/sjweh.4115 11. Lee DW, Choi J, Kim HR, Myong JP, Kang MY. Differential impact of working hours on unmet medical needs by income level: a longitudinal study of Korean workers. Scand J Work Environ Health. 2022;48(2):109-117. https://doi.org/10.5271/sjweh.3999 12. Lee W, Kang SK, Choi WJ. Effect of long work hours and shift work on high-sensitivity C-reactive protein levels among Korean workers. Scand J Work Environ Health. 2021;47(3):200-207. https://doi.org/10.5271/sjweh.3933 13. Jankowiak S, Rossnagel K, Bauer J, Schulz A, Liebers F, Latza U, et al. Night shift work and cardiovascular diseases among employees in Germany: five-year follow-up of the Gutenberg Health Study. Scand J Work Environ Health. 2024;50(3):142–151. https://doi.org/10.5271/sjweh.4139 14. Rugulies R, Burdorf A. The achievements and challenges of occupational health research: Looking back and ahead. Scand J Work Environ Health. 2024;50(1):1-2. https://doi.org/10.5271/sjweh.4136 15. Burdorf A, Rugulies R. Fifty years of research in the Scandinavian Journal of Work, Environment & Health. Scand J Work Environ Health. 2024;50(1):3-10. https://doi.org/10.5271/sjweh.4135 16. Kivimäki M, Jokela M, Nyberg ST, Singh-Manoux A, Fransson EI, Alfredsson L, et al. Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603,838 individuals. Lancet. 2015;386(10005):1739-1746. https://doi.org/10.1016/S0140-6736(15)60295-1 17. World Health Organization and International Labour Organization (WHO/ILO). Joint estimates of the work-related burden of disease and injury, 2000-2016: global monitoring report. Geneva: WHO/ILO; 2021. Available from: https://apps.who.int/iris/rest/bitstreams/1370920/retrieve. (Accessed: 25 March 2022). 18. World Health Organization and International Labour Organization (WHO/ILO). Joint estimates of the work-related burden of disease and injury, 2000-2016: technical report with data sources and methods. Geneva: WHO/ILO; 2021. Available from: https://apps.who.int/iris/rest/bitstreams/1370904/retrieve. (Accessed: 25 March 2022). 19. Li J, Pega F, Ujita Y, Brisson C, Clays E, Descatha A, et al. The effect of exposure to long working hours on ischaemic heart disease: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury. Environ Int. 2020;142:105739. https://doi.org/10.1016/j.envint.2020.105739 20. Descatha A, Sembajwe G, Pega F, Ujita Y, Baer M, Boccuni F, et al. The effect of exposure to long working hours on stroke: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury. Environ Int. 2020;142:105746. https://doi.org/10.1016/j.envint.2020.105746 21. Pega F, Náfrádi B, Momen NC, Ujita Y, Streicher KN, Prüss-Üstün AM, et al. Global, regional, and national burdens of ischemic heart disease and stroke attributable to exposure to long working hours for 194 countries, 2000-2016: A systematic analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury. Environ Int. 2021;154:106595. https://doi.org/10.1016/j.envint.2021.106595 22. Pega F, Hamzaoui H, Nafradi B, Momen NC. Global, regional and national burden of disease attributable to 19 selected occupational risk factors for 183 countries, 2000-2016: A systematic analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury. Scand J Work Environ Health. 2022;48(2):158-168. https://doi.org/10.5271/sjweh.4001 23. Coggon D. Estimating population burdens of occupational disease. Scand J Work Environ Health. 2022;48(2):83-85. https://doi.org/10.5271/sjweh.4007 24. Kivimäki M, Virtanen M, Nyberg ST, Batty GD. The WHO/ILO report on long working hours and ischaemic heart disease - Conclusions are not supported by the evidence. Environ Int. 2020;144:106048. https://doi.org/10.1016/j.envint.2020.106048 25. Li J, Rugulies R, Morgan RL, Woodruff T, Siegrist J, WHO/ILO Working Group of Individual Experts on Long Working Hours on Ischaemic Heart Disease. Systematic review and meta-analysis on exposure to long working hours and risk of ischaemic heart disease - Conclusions are supported by the evidence. Environ Int. 2020;144:106118. https://doi.org/10.1016/j.envint.2020.106118 26. Hannerz H, Larsen AD, Garde AH. Long weekly working hours and ischaemic heart disease: a follow-up study among 145 861 randomly selected workers in Denmark. BMJ Open. 2018;8(6):e019807. https://doi.org/10.1136/bmjopen-2017-019807 27. Hannerz H, Albertsen K, Burr H, Nielsen ML, Garde AH, Larsen AD, et al. Long working hours and stroke among employees in the general workforce of Denmark. Scand J Public Health. 2018;46(3):368-374. https://doi.org/10.1177/1403494817748264 28. Fadel M, Sembajwe G, Li J, Leclerc A, Pico F, Schnitzler A, et al. Association between prolonged exposure to long working hours and stroke subtypes in the CONSTANCES cohort. Occup Environ Med. 2023;80(4):196-201. https://doi.org/10.1136/oemed-2022-108656 29. Torquati L, Mielke GI, Brown WJ, Kolbe-Alexander T. Shift work and the risk of cardiovascular disease. A systematic review and meta-analysis including dose-response relationship. Scand J Work Environ Health. 2018;44(3):229-238. https://doi.org/10.5271/sjweh.3700 30. IARC Working Group on the Identification of Carcinogenic Hazards to Humans. Night shift work. Lyon, France: IARC; 2020. Available from: https://publications.iarc.fr/_publications/media/download/6397/c965a667eda3a390d9797cbcde59765fef9dcb7a.pdf. (Accessed: 29 February 2024). 31. Su F, Huang D, Wang H, Yang Z. Associations of shift work and night work with risk of all-cause, cardiovascular and cancer mortality: a meta-analysis of cohort studies. Sleep Med. 2021;86:90-98. https://doi.org/10.1016/j.sleep.2021.08.017 32. Bigert C, Kader M, Andersson T, Selander J, Bodin T, Gustavsson P, et al. Night and shift work and incidence of cerebrovascular disease - a prospective cohort study of healthcare employees in Stockholm. Scand J Work Environ Health. 2022;48(1):31-40. https://doi.org/10.5271/sjweh.3986 33. Kader M, Selander J, Andersson T, Albin M, Bodin T, Harma M, et al. Night and shift work characteristics and incident ischemic heart disease and atrial fibrillation among healthcare employees - a prospective cohort study. Scand J Work Environ Health. 2022;48(7):520-529. https://doi.org/10.5271/sjweh.4045 34. Vestergaard JM, Dalboge A, Bonde JPE, Garde AH, Hansen J, Hansen AM, et al. Night shift work characteristics and risk of incident coronary heart disease among health care workers: national cohort study. Int J Epidemiol. 2023;52(6):1853-1861. https://doi.org/10.1093/ije/dyad126 35. Larsen AD, Nielsen HB, Kirschheiner-Rasmussen J, Hansen J, Hansen ÅM, Kolstad HA, et al. Night and evening shifts and risk of calling in sick within the next two days - a case-crossover study design based on day-to-day payroll data. Scand J Work Environ Health. 2023;49(2):117-125.https://doi.org/10.5271/sjweh.4074 36. Vestergaard JM, Haug JND, Dalbøge A, Bonde JPE, Garde AH, Hansen J, et al. Validity of self-reported night shift work among women with and without breast cancer. Scand J Work Environ Health. 2024;50(3):152–157. https://doi.org/10.5271/sjweh.4142
WANG Fuyi, YU Shuang, DONG Xinyu, CHEN Biyi,, LI Ying,, ZHAO Qiancheng, SANG Xue
Globally, obesity has become the fifth leading risk factor for death, and discoverying prebiotics with preventive and therapeutic effects on obesity is a hot topic in current research. Marine polysaccharides, a special class of bioactive substances from marine organisms, have novel structural features and unique bioactivities due to the unique environment of the ocean. Marine polysaccharides have an excellent potential to treat obesity by regulating glucose and lipid metabolism, inflammatory factor levels, and the gut microbiota. This article reviews the types of marine polysaccharides, the effects of their structures and compositions on their antiobesity activity, and the underlying mechanisms of action. With the aim of providing a basis for the development of antiobesity drugs using marine polysaccharides, the article focuses on discussing the signaling pathways by which marine polysaccharides inhibit obesity through the gut microbiota, and gives an outlook on the application of marine polysaccharides for obesity inhibition.
Taysa M. Mendonça, Lucas C. Céleri, Mauro Paternostro
et al.
The return of the information from the environment to the system is a phenomenon can be related to existence of non-Markovian mechanisms in the environment and such transformation of resources can be useful for quantum information applications. Thus, understanding the details of the system-environment information dynamics, i.e., the transference of quantum resources is of key importance to design noise-resilient quantum technologies. In this work, we show how a quantum resource propagates from the main system to an environment, using as model a single qubit coupled to two linear chains of qubits, and also the information dynamics among the environment qubits. In this way, we characterize the propagation of information leaving the main qubit and going through the environment. Finally, we connect the conditions for the emergence of this dynamics to the existence of quantum Darwinism.
The aim of this article is to examine the production of socio-ecological knowledge relating to the landscape within the framework of thought-action adopting the ‘inhabitant’s point of view’ (Ingold, 2016). To do this, it draws on the results of a research project aimed at creating an inhabited landscape cooperative (in French, Coopérative habitante de paysage or CHP) within the area of the Estuaire grouping of municipalities in the region of Haute Gironde. The scheme is designed to support local initiatives resulting in socio-spatial innovation in outlying areas. The study is based on a narrative approach. The research uses a range of tools aimed at collectively generating situated knowledge. One of these tools is the landscape narrative. It provides insight into local culture via the actions, relationships and emotions of the inhabitants. The aim is to offer a reflexive perspective of an inhabited environment composed of interactions between humans and non-humans. The results show how landscape knowledge can shed light on the ‘black box’ of the landscape project. This makes it possible to identify what makes landscape knowledge special compared to other types of situated knowledge and, by the same token, to better define the profiles of the inhabitants and the scope of their participation in territorial action.
Various product and sum relationships are established using special functions, specifically involving Special functions. These relationships are derived from formulas inspired by the finite sum that incorporates the Hurwitz-Lerch zeta function.
The inverse problem of special geometry (Seiberg-Witten geometry of 4d N=2 SCFT) asks for a recursive construction of all such geometries in rank $r$ by assembling together known lower-rank ``strata''. This leads to a program to understand/construct/classify all special geometries which looks surprising effective. After reviewing some advanced topics in special geometry, in this long note we define the inverse problem and introduce the basic tools of the trade. The program is essentially completed in rank 2, and we pave the way to proceed to higher ranks. A central role is played by various notions of geometric rigidity: in addition to the obvious one (triviality of the conformal manifold), Falting-Saito-Peters rigidity and Deligne-Simpson rigidity also enter in the story.
Sogand Asadolahi Shad, Vahid Tavakoli, Hossain Rahimpour-Bonab
AbstractPaleohighs play an important role in increasing the quality and sedimentological characteristics of the reservoirs. The Upper Dalan Formation with Late Permian age in the center of the Persian Gulf Basin is known as a giant gas reservoir. In this paper, 60 meters of the Upper Dalan Formation have been studied in two fields in the center of the Persian Gulf Basin. Petrographic studies of the two fields led to the identification of seven microfacies in field A and six microfacies in field B in the form of four facies belts in the carbonated ramp environment. In order to evaluate the heterogeneity of the reservoir, the determination of rock types was performed by using four standard methods. Examination of the average porosity and permeability shows that the dissolution in field B is more severe than in field A. Study of diagenetic processes, the type of dolomites formed and the average porosity and permeability in the samples of the two fields indicate that the location of field B on the Qatar arc leads to the formation of dolomicrites, increased dissolution and finally higher reservoir quality in microfacies groups in this field in comparison with field A.Keywords: Upper Dalan Formation, Qatar Arc, Permian–Triassic boundary, Microfacies, Heterogeneity IntroductionDue to the presence of great hydrocarbon resources and fields in the south and southwest of Iran, the study and investigation of fields and formations in these areas was an important and a significant topic for many researches in recent decades. The Dalan Formation of the Middle–Late Permian age forms the main gas and condensate reservoirs in numerous hydrocarbon fields in the south and southwest of Iran (Alsharhan and Nairn 1994; Ehrenberg et al. 2007; Tavakoli 2015). The Upper Dalan Formation of the Late Permian age has one of the largest gas reservoirs in the world and it is placed on the Faragan Formation of the Early Permian and continues to the Kangan Formation of the Early Triassic. This formation is mainly composed of carbonate-evaporite sequences that developed on a homoclinal carbonate ramp continuously with significant changes in heterogeneity and reservoir quality towards the Late Permian Paleotethys Ocean (Fallah-Bagtash et al. 2020; Ghasemi et al. 2022). Extensive studies have been conducted concerning the investigation and analysis of sedimentological evolution, texture (petrographic analysis), analysis of facies groups, sedimentary environments and sub-environments, diagenetic processes and investigation of heterogeneities in it. The most common pores identified in the formation are interparticle, moldic and connected vuggy types. The main diagenetic processes affecting the upper Dalan Formation in these studies are dolomitization and dissolution which increase the reservoir quality and the formation of anhydrite and calcite cements as well as compaction that reduce the reservoir quality (Amel et al. 2015; Fallah-Bagtash et al. 2020; Ghasemi et al. 2022). There have been limited case studies on paleohighs in the world. For example, concerning the effect of paleohighs on gas reservoirs, we can refer to the research conducted on the Middle Permian Maoko Limestone, which is a main natural gas production reservoir in the southern Sichuan basin of China. The results of these studies state that the presence of ancient elevations causes special changes in hydrocarbon reservoirs. These changes may increase reservoir quality, change the diagenetic processes, and subsequently increase dissolution which makes favorable conditions for the accumulation of hydrocarbon materials in reservoirs. Despite such importance, the influence of the Qatar-Arc on the sedimentological and petrophysical characteristics of the Dalan Formation has not been studied. Therefore, the main goal of this paper is to investigate the effects of the presence of the Qatar-Arc on the reservoir quality (porosity and permeability), diagenetic processes, facies properties, and sedimentological evolution of a part (30 meters in each field) of the Upper Dalan Formation below the Permian–Triassic boundary. This study compares the effects of the presence of the arc in the upper part of the Dalan Formation in two fields A and B in the central part of the Persian Gulf basin. Materials & MethodsData studied in this research was obtained from two exploration wells in two different fields. The data includes information obtained from the study of 30 meters of cores in each field. In X1 well (Field A) and X2 well (Field B), the studied data are related to the amount of porosity, permeability, investigation of facies and sedimentary characteristics. In each meter, four thin sections and a total of 123 thin sections in X1 well and 121 thin sections in t X2 well have been studied and analyzed. The number of plugs taken in X1 well is 93 for porosity and 92 for permeability. In X2 well, 103 plugs have been prepared for porosity and 96 plugs for permeability. The study of thin sections has been done by a polarizing microscope. To accurately determine the lithology of limestone from dolomite, one-third of each thin section was stained with Alizarin Red-S solution according to the common method of Dickson (1965). Boyle's law has been used to determine the porosity and Darcy's law has been used to determine the permeability of core plugs. Blue epoxy impregnation has been used to determine the types of pores (Choquette and Pray 1970). The classification of microfacies analyzed in both fields is based on Dunham classification (Dunham 1962) and the division related to facies belts based on Flugel (2010). To determine the rock types, four common methods, Winland (Winland-Plot; Schmalz and Rahme 1950; Kolodzie 1980; Pitman 1992; Amaefule et al. 1993; Rezaee et al. 2006; Purcell 2013), Lorenz (SML-Plot; Lorenz 1905), Reservoir quality index (RQI-FZI Method; Amaefule et al. 1993) and Lucia's Method (1995) have been used. Discussion of Results & ConclusionsFacies analysis led to the identification of seven microfacies in field A and six microfacies in field B belonging to four sub-environments deposited in a carbonate ramp. Micriticization, bioturbation, cementation, dolomization, neomorphism, dissolution, compaction (chemical) and fracturing are observed in the studied succession. These diagenetic processes affected the deposits of the Upper Dalan Formation during different stages of marine, meteoric and burial diagenesis. The study of the reservoir quality in the upper Dalan in both fields indicates that the reservoir quality is higher in the B field compared to field A. Detection and evaluation of heterogeneity were performed to increase the quality and accuracy of studying reservoirs. Four common methods of determining rock types and evaluating heterogeneity have been used. In the Winland method, plotting the porosity and permeability data related to two fields separately has led to the identification of six rock types in field A and seven rock types in field B. In the A field, most samples have small pore-throats and in field B, a large number of samples have a medium, and particularly large pore-throats (pore-throats between 5 to 15 and 15 to 60 microns). In the hydraulic flow unit method, six rock types have been determined after performing calculations in both fields. The results show that the reservoir quality is higher in the samples of B field compared to field A. In the method, Lucia, based on the standard ranges in both fields A and B, five rock types were determined from the final results. In field A, the amount of non-reservoir samples is more than in field B, the changes in the diagrams are almost uniform, and the samples are distributed in three classes 1 (grain support), 2 (grain support-packstone), and 3 (mud support) of Lucia. In field B, most of the samples are concentrated in classes 1 and 2 of the Lucia classification, respectively. In the Lorenz method, four rock types have been determined in both fields. Distribution patterns are almost the same in both fields. Rock type 1 with the highest reservoir quality has the lowest amount of abundance.The most abundant sedimentary sub-environments in field A are leeward shoal and lagoon while in field B, tidal facies and lagoon are more abundant. In field B, the low depth and high evaporation have caused intolerable conditions for living organisms. Also, the bioturbation process has not been observed near the Permian–Triassic boundary (PTB) of field B. Isopachous cements were not formed in field B because these sediments have not spent a long time in the marine environment and the water depth has decreased rapidly. The abundant dissolution of grains in B field and the lack of observation of this phenomenon in field A is other evidence of the influence of atmospheric diagenesis on the sediments near the boundary in field B. The dolomites formed in B field are fine-grained compared to field A, which indicates the formation in a marine diagenetic environment with a short time for formation. The seepage-reflux dolomitization model has been widely accepted for these fine-grained (dolomicrite) and anhedral dolomites (Tucker 1994; Amel et al. 2015; Fallah-Bagtash et al. 2020; Enayati-Bidgoli and Navidtalab 2020). The model states that dolomites have been formed in an early diagenetic stage in shallow water depth. It can be seen that the presence of the Qatar-Arc and the decrease in water depth have led to strong effects of the evaporation process in field B. It also caused increasing dolomite and anhydrite formation in the lower part of the PTB. An increase in dissolution in the upper part of the boundary is another effect of the Arc. The formation of fine-crystalline dolomites, increased dissolution (moldic and vuggy), formation of anhydrite nodules, and better reservoir quality in field B compared to field A are the results of the presence of the Qatar-Arc in the field B.
The interaction of city and village is a spatial-spatial and geographical phenomenon, and thus recognizing, discovering and discovering the rules governing it in the context of human-environment interactions is a geographic issue that has a special theoretical and practical significance. Also, considering the role of these relations in the process of development and development of urban and rural centers, in addition to the importance of studying the types of these relationships, the recognition of its socio-cultural, socio-cultural and spatial effects on urban and rural development in the context of sustainable development of rural and urban areas It is very important. This study is to investigate the interrelationship between Jiroft city and surrounding villages through descriptive-analytical method. The method of collecting information based on library and field studies is complete including questionnaire, observation and interview. To do this, out of 1288 villages in the city, we selected 47 randomly selected items and 384 questionnaires were filled in among the villagers. The data were analyzed using Kruskal Wallis & Anova tests (T-test ANOVA) and Pearson & Wilcoxon correlation tests and Wendel Kandal test. . The results of the research show that Jiroft as a middle town and a major pole of agriculture in the south of the country, as well as in terms of aggregation of facilities, capital and manpower in the region, is dominant in the region and its superiority in the area has a two-way relationship with its surrounding villages. On the other hand, the villages under the sphere of influence, also by establishing economic and social-cultural processes, trade relations and investment in the manufacturing, market and urban housing sectors, have the dynamics of the economy and the growth of the city of Jiroft as well as the development in their village as "city dependence" Provided relative.
The competitive activity of racers on the highway makes high demands on the level of their physical fitness, since the competition can be held in the form of a multi-day race. The training of road racers is based on the development of physical qualities, among which the most important for them are different types of endurance. The development of these qualities is possible only with a purposeful impact on their physiological systems and, in particular, on the mechanisms of energy supply of muscle activity. The analysis of the literature showed that in most of the works devoted to the preparation of racers on the highway, there is no necessary scientific information characterizing the features of the energy supply of their muscular activity during preparation for multi-day races. This greatly limits the possibilities for differentiating the means and methods of developing different types of endurance in the process of training. The issues of application of methods for the development of endurance among racers on the highway, where the differentiation criterion would be different types of energy metabolism, are also insufficiently developed. The existing system of preparation of racers on the highway for competitions is characterized by insufficient consideration of the peculiarities of the mechanism of energy supply of muscular activity in the training process. Its main drawback is its general approach to training road riders. Coaches in their work with athletes are guided solely by their personal experience of preparing road riders for competitions.
David Hoffman, Ashley Stewart, Jennifer Breznay
et al.
Photo by Hush Naidoo Jade Photography on Unsplash
INTRODUCTION
In this collection of narratives, the authors describe their own experiences with and reflections on healthcare worker vaccine hesitancy. The narratives explore each author’s engagement with different communities experiencing vaccine hesitancy, touching on reasons for hesitancy, proposed solutions, and legal aspects. Author’s names appear above their narratives.
l. Johanna T. Crane
Vaccine hesitancy, defined as “a delay of acceptance or refusal of vaccination despite the availability of vaccination services,”[1] is a worldwide but locally shaped phenomenon that pre-dates the COVID-19 pandemic.[2] Contrary to some portrayals, vaccine hesitancy is not the same as the more absolute antivaccination stance, or what some call “anti-vax.” Many people who are hesitant are not ideologically opposed to vaccines. Hesitancy is also sometimes framed as anti-science, yet reluctance to vaccinate is often about managing risk, trustworthiness, and doubt in the context of uncertainty; it represents an effort to “talk back to science” about unaddressed needs and concerns.[3]
In the US, the newness of the vaccines, the unprecedented speed at which they were developed, and their remaining under emergency use authorization at first complicated public confidence. Political polarization and racial and social inequality shape vaccine acceptance and public distrust as well. While vaccine acceptance has increased in the months since the vaccines first became available, many eligible individuals have not yet been vaccinated, including a significant number of healthcare workers.[4]
Vaccine hesitancy among healthcare workers may seem surprising, especially given their frontline experience – I confess that it surprised me at first. But when I began interviewing health care workers for a study on COVID vaccine roll-out at community health centers, I learned to take a more complex view. Although the study was focused on patient vaccine access,[5] many of the frontline health care workers we spoke with also described hesitancy among some of their colleagues (and, in a few cases, themselves). From these conversations, I learned that these “healthcare heroes” are also regular people and members of communities. Their concerns about COVID vaccination often reflect the prevailing concerns advanced in their communities, such as worries about vaccine side effects and safety. Like other workers, some fear missing work and losing income, as not all healthcare employers offer paid time off for vaccination or recovery. (Importantly, reluctance to vaccinate is highest among healthcare workers in lower-paid positions with little job security, such as clerks, housekeepers, patient care assistants, and home health aides.)[6] For some healthcare workers of color, the protection offered by the vaccine sits in tension with both current and historical experiences of medical abuse and neglect. Some interviewees, fully vaccinated themselves, rejected the framework of “hesitancy” entirely, arguing that Black and Brown reluctance to be vaccinated first should be understood through the lens of “self-protection”.
Due to the nature of their work, healthcare workers have faced great social pressure to vaccinate and vaccinate first. This is understandable, given that vaccination against COVID-19 protects not only workers themselves but aligns with the ethical duty to prevent harm to patients by reducing the risk of transmission in healthcare settings. When the FDA approved COVID-19 vaccines under emergency use authorization in December 2020, many healthcare workers were extremely grateful to be designated “1a” – the first group prioritized to receive the shots.[7] For many bioethicists, prioritization of healthcare workers represented a recognition of the extreme risks that many front-line workers had endured since the onset of the pandemic, including critical shortages in PPE. But it is important to remember that for some workers, going first may have felt like serving as guinea pigs for new vaccines that had yet to be granted full FDA approval. For these individuals, the expectation that they would vaccinate first may have felt like an additional risk rather than a reward.
Healthcare workers who are hesitant to vaccinate may feel ashamed or be subject to shaming by others;[8] this may make it difficult to discuss their concerns in the workplace. Throughout the pandemic, healthcare workers have been lauded as “heroes”, and some healthcare employers have promoted vaccination among their workforce as a “heroic” action. This messaging implies that waiting to vaccinate is shameful or cowardly and is echoed in opinion pieces and op-eds describing unvaccinated people as “selfish” or “free riders.”[9]
By fostering the proper dialogue, we can respond respectfully to hesitancy among healthcare workers while still working towards the goal of increased vaccination. We in the bioethics and medical community should be willing to listen to our colleagues’ concerns with respect. Top-down approaches aimed at “correcting” hesitancy cannot address the more fundamental issues of trust that are often at stake. Instead, there must be dialogue over time. Conversations with a trusted healthcare provider have a crucial role.[10] Blaming and shaming rhetoric, whether explicit or implicit, gets us nowhere – in fact, it likely moves us backward by likely exacerbating any existing distrust or resentment that workers may hold toward their employers.[11] Lastly, the onus of trust must be with institutions, not individuals. There is a lot of talk about getting communities of color, and Black people, particularly, to "trust" healthcare institutions and the COVID vaccines. This racializes trust and puts the burden on harmed communities rather than on institutions acting in trustworthy ways.[12]
Dialogue, respect, and trustworthiness must guide us even in the new era of workplace mandates. Mandates make these strategies even more important as we look toward an uncertain future. As Heidi Larson, founder of the Vaccine Confidence Project, recently said, “We should not forget that we are making people's future history now. Are people going to remember that they were treated respectfully and engaged?”[13]
ll. Kara Simpson
Since the release of the vaccine for COVID-19 in late 2020, there have been robust discussions within the medical community, the media, and political arenas about vaccine hesitancy among healthcare workers. The public became aware that healthcare workers, the first group to become eligible for the vaccine, were not rushing to “take the shot.”
Many people’s opinions were aligned by race, ethnicity, socioeconomic status, and political affiliation. People of color were one of the first groups to be labeled vaccine hesitant as our experiences of distrust of the medical community and the politicization of the vaccine explained the low turnout.[14] It was not uncommon to hear, “this vaccine just came out; let’s wait and see if there are side effects.” Interestingly, many people in the healthcare community and in the public did not understand why healthcare workers of color remained hesitant.
Trust is a vital component of any viable relationship, especially in the clinical realm. To have successful health outcomes, it is essential for clinicians to build trusting relationships with their patients and peers. Many people of color are distrustful towards the medical institution due to the years of systemic racism and abuses that they have experienced, witnessed, or learned about. Healthcare workers of color are not excluded from the experiences of their communities outside of work. In fact, I assert that healthcare of color may have an additional burden of hesitation because of their lived experiences of distrust in receiving care and inequality within their professional environment. These dual traumas can work in tandem to strengthen hesitancy. I assert that building trusting clinical relationships will address hesitancy over time.
Currently, many healthcare workers are worried about vaccine mandates. For a group of people that have experienced intergenerational enslavement and marginalization, mandates feel coercive and serve as a reminder of how “lesser” bodies are considered unworthy of voice, fundamental human rights, independent decision making. To call the vaccine mandate paternalistic would be an understatement.
An unintended result of vaccine mandates will be the reinforcement of hesitancy and distrust of the medical institution as trust and coercion cannot coexist. This mandate will give more power to the conspiracy theories and harm those who already do not seek or receive adequate health care because of systemic inequalities. Furthermore, mandates can also dissuade people of color from becoming healthcare workers, and others may leave the field.
In essence, vaccine hesitancy is a symptom of a much larger problem: the distrust of the medical establishment. As bioethicists, our mission should be to support interventions that foster “trustworthiness” of the institutions rather than those that cause trauma. Several organizations have proposed mask mandates and weekly testing as a measure to protect the population at large and still respect the autonomy of the unvaccinated.[15]
lll. Jennifer Breznay
I work in a very large community teaching hospital in Brooklyn, and we were extremely hard hit by COVID in March 2020. I worked on inpatient medical units and witnessed a lot of suffering. And after nine months of fear and despair about COVID’s toll, I felt tremendous frustration in December when I heard that many healthcare workers would reject the vaccine. As the co-chair of the Bioethics Committee, I drafted a statement recommending vaccination for all employees. When the draft was revised and approved by the Bioethics Committee, I began to discuss it with employees, and I appreciated different perspectives I had not heard before. In the end, rather than releasing the statement, we directed our efforts at creating a dialogue.
I also volunteer at a not-for-profit which operates seven early childhood education centers in Northern Brooklyn. The Executive Director invited me to collaborate on strategies to encourage staff vaccination, and we decided to offer a Zoom conference to 20 members of the staff. I was extremely nervous about how the audience would perceive me, a white doctor whom they did not know. I felt awkward about coming to them with an agenda. And there was also the question of whether I was an appropriate messenger compared to a person of color.
Yet, I felt like I shouldn't back away from this. So, I chose to simply disclose my discomfort at the beginning of the Zoom. I said, “Thanks for having me. You know, as a white physician, I understand you might have concerns about trusting what I say. Four hundred years of inequity and abuse by the healthcare system can create a lot of mistrust, but I’m here to try to answer your questions.” Ultimately the Executive Director reported that the Zoom was successful in stimulating a lot of conversation among the staff about the vaccine. I think the critical piece is the intimate but open conversation, where you can elicit values.
lV. Ashley L. Stewart
In the rural areas of our state, healthcare institutions are inextricably tied to their communities. Rural hospitals hire from, serve, and function in the community where they are located. Successful implementation of a vaccine roll-out in such rural areas requires explicit recognition of the role and influence of the community. After identifying issues common to the area, rural institutions can address them. Even when rural institutions find that healthcare worker concerns seem to be unique or personal, they are often related to the larger concerns of the community.[16]
Community-based increased vaccine hesitancy may coincide with an underlying issue, such as lack of information rather than principled or experience-based resistance.[17] When the vaccines became available, rural vaccination coordinators encountered a wealth of misinformation that left many people initially undecided. Compounding this lack of information, workers expressed a sense of fear about the professional consequences of voicing concerns, especially in tight-knit communities. Many workers expressed concern about being judged merely for sharing their questions or decisions.[18] They also felt that saying or doing something to promote the value of vaccination might change their relationship with members of the community where they live and work.[19] As there was a fear of engaging in productive conversations, it was difficult for them to find valuable information, and the lack of information discouraged them from being vaccinated. Vaccine coordinators wanted to get information to the entire community based on the most current research and release unbiased, consistent, and timely information from sources all people in the community could trust, including from multiple sources at once. Communication must focus on answering many types of questions, which must often be done in private or anonymously.
Where poorly supported or incorrect information is widely available, sharing objective information is crucial to turning the tide of distrust. If the healthcare community dismisses concerns or assumes that answering questions based on misinformation is a waste of time, the community-based institutions will further the distrust. Some may feel that vaccine coordinators should not address misinformation directly, yet avoidance has been widely unsuccessful.[20] Being respectful and non-judgmental in answering questions posed by people who do not know what is true can be hard, but in rural communities, answering completely and honestly without judgment is a critical component of any effort to inform people. Telling people to get vaccinated “for the greater good” can sound the same as being told not to get a vaccine because it is “bad” if both sources of information fail to back up their claims. Ultimately rural institutions are respected because they are a resource to their communities, a priority we must preserve.
It is also critical to treat everyone respectfully regardless of vaccine status.[21] People may perceive mandates, divisive policies, or disrespectful treatment of people based on vaccination status as discriminatory or coercive, weakening the appeal of vaccination. Such practices may make people less trusting and more anchored to their position as they come to see vaccination proponents as untrustworthy or authoritarian. We must work to maintain respect for human autonomy. Using unethical means to achieve even a just end will not lead to a “greater good” but rather to the perception that people in positions of authority would achieve a result “by any means necessary.”
V. David N. Hoffman
The central moral quandary that arises whenever vaccine hesitancy among healthcare workers is discussed is whether workers who refuse to get vaccinated should or could be fired. We should clarify that we are applying a definition of mandate in the employment context for private employers, the violation of which results in loss of employment. Government-controlled provider organizations are just now weighing in on this topic and are generally pursuing strategies that impose periodic, usually weekly, testing requirements for those workers who decline to get vaccinated.
In the private sector, employers can require their employees to do a great many things as a condition of employment, and one of them is to get vaccinated against COVID -19. In the most prominent case to date, just such a mandate gave rise to a lawsuit in Texas involving Houston Methodist Hospital. In that case, 170 employees asserted that an employer should not be allowed to force them to get vaccinated. The judge held that, while no employer can force an employee to get vaccinated, no employer is obligated to continue the employment of any employee who declines to follow rules established by that employer, including the obligation to get vaccinated.[22]
In Texas, what the judge said is you are not being forced to get vaccinated, but your employer is allowed to set limits and conditions on employment, including vaccination. Employees do not have an obligation to get vaccinated, but they also have no right to their jobs. That is because of a widely misunderstood legal concept: “employment at will.” Employment at will sounds like a rule that employees can do what they want at work, but in fact, employment at will means only that you can quit your job whenever you want (we do not permit indentured servitude). At the same time, your employer can fire you at any time, for any reason or no reason, unless the reason is a pretext and involves one of the protected statuses (race, color, religion, sex, or national origin, and in some jurisdictions gender orientation, gender identity).
Generally, any employers, including hospitals, can decide that if someone is not willing to get a vaccination, or if they are not willing to complete sexual harassment training or participate in the hospital’s infection control program, that is the employee’s right, but it will mean that an employer can similarly decline to continue providing employment.
The evolution of this hesitancy discussion will be influenced by the narrower debate playing out in the court of public opinion, and the courts of law, over the enforceability of New York’s recently enacted vaccine mandate. Regardless of whether that mandate survives, with or without medical and religious exemptions, healthcare employers will be left with a profound ethical dilemma. At the end of all the litigation, if there is a religious exemption, employers will always be burdened with the responsibility to determine whether an individual employee has asserted a genuine and sincere religious objection to vaccination and whether the employer is able to provide an accommodation that is safe and effective in protecting the interests of co-workers and patients. The anticipated federal mandate, which reportedly will have a test/mask alternative, will only make this ethical task more challenging.
This leads to the final point in this analysis, which is that while private employers, including hospitals, can deprive an individual of their employment if those individuals refuse to get vaccinated, just because an employer can do so does not mean it should do so.[23]
-
[1] MacDonald NE. Vaccine hesitancy: Definition, scope and determinants. Vaccine. 2015;33(34):4161-4164. doi:10.1016/j.vaccine.2015.04.036
[2] Larson HJ, de Figueiredo A, Xiahong Z, et al. The State of Vaccine Confidence 2016: Global Insights Through a 67-Country Survey. EBioMedicine. 2016;12:295-301. doi:10.1016/j.ebiom.2016.08.042
[3] Larson H. Stuck: How Vaccine Rumors Start - and Why They Don’t Go Away. Oxford University Press; 2020; Benjamin R. Informed Refusal: Toward a Justice-based Bioethics. Sci Technol Hum Values. 2016;41(6):967-990. doi:10.1177/0162243916656059
[4] Deepa Shivaram, In The Fight Against COVID, Health Workers Aren't Immune To Vaccine Misinformation
September 18, 2021. NPR Special Series: The Coronavirus. https://www.npr.org/2021/09/18/1037975289/unvaccinated-covid-19-vaccine-refuse-nurses-heath-care-workers
[5] Crane JT, Pacia D, Fabi R, Neuhaus C, and Berlinger N. Advancing Covid vaccination equity at Federally Qualified Health Centers: A rapid qualitative review. Accepted and awaiting publication at JGIM.
[6] Ashley Kirzinger. “KFF/The Washington Post Frontline Health Care Workers Survey - Vaccine Intentions.” KFF, 22 Apr. 2021, https://www.kff.org/report-section/kff-washington-post-frontline-health-care-workers-survey-vaccine-intentions/.
[7] Johanna Crane, Samuel Reis-Dennis and Megan Applewhite. “Prioritizing the ‘1a’: Ethically Allocating Scarce Covid Vaccines to Health Care Workers.” The Hastings Center, 21 Dec. 2020, https://www.thehastingscenter.org/prioritizing-the-1a-ethically-allocating-covid-vaccines-to-health-care-workers/.
[8] “'I'm Not an Anti-Vaxxer, but...' US Health Workers' Vaccine Hesitancy Raises Alarm.” The Guardian, Guardian News and Media, 10 Jan. 2021, https://www.theguardian.com/world/2021/jan/10/coronavirus-covid-19-vaccine-hesitancy-us-health-workers.
[9] Gerson M. If you are healthy and refuse to take the vaccine, you are a free-rider. Washington Post. April 15, 2021.
[10] Crane JT, Pacia D, Fabi R, Neuhaus C, and Berlinger N. Advancing Covid vaccination equity at Federally Qualified Health Centers: A rapid qualitative review. Accepted and awaiting publication at JGIM.
[11] Larson H. Stuck : How Vaccine Rumors Start - and Why They Don’t Go Away. Oxford University Press; 2020.
[12] Benjamin R. Race for Cures: Rethinking the Racial Logics of ‘Trust’ in Biomedicine. Sociology Compass. 2014;8(6):755-769. doi:10.1111/soc4.12167; Warren RC, Forrow L, David Augustin Hodge S, Truog RD. Trustworthiness before Trust — Covid-19 Vaccine Trials and the Black Community. N Engl J Med. Published online October 16, 2020. doi:10.1056/NEJMp2030033
[13] Offri D. Heidi Larson, Vaccine Anthropologist. New Yorker. Published online June 12, 2021. Accessed August 11, 2021. https://www.newyorker.com/science/annals-of-medicine/heidi-larson-vaccine-anthropologist
[14] Razai M S, Osama T, McKechnie D G J, Majeed A. Covid-19 Vaccine Hesitancy Among Ethnic Minority Groups. BMJ 2021; 372 :n513 doi:10.1136/bmj.n513
[15] Dasgupta, Sharoda, et al. “Differences in Rapid Increases in County-Level COVID-19 Incidence by Implementation of Statewide Closures and Mask Mandates — United States, June 1–September 30, 2020.” Annals of Epidemiology, vol. 57, Sept. 2021, pp. 46–53., https://doi.org/10.1016/j.annepidem.2021.02.006.
[16] Do, Tuong Vi C et al. “COVID-19 Vaccine Acceptance Among Rural Appalachian Healthcare Workers (Eastern Kentucky/West Virginia): A Cross-Sectional Study.” Cureus vol. 13,8 e16842. 2 Aug. 2021, doi:10.7759/cureus.16842;
Danabal, K.G.M., Magesh, S.S., Saravanan, S. et al. Attitude towards COVID 19 vaccines and vaccine hesitancy in urban and rural communities in Tamil Nadu, India – a community-based survey. BMC Health Serv Res 21, 994 (2021). https://doi.org/10.1186/s12913-021-07037-4
[17] Scott C. Ratzan MD, MPA, MA, Lawrence O. Gostin JD, Najmedin Meshkati PhD, CPE, Kenneth Rabin PhD & Ruth M. Parker MD (2020) COVID-19: An Urgent Call for Coordinated, Trusted Sources to Tell Everyone What They Need to Know and Do, Journal of Health Communication, 25:10, 747-749, DOI: 10.1080/10810730.2020.1894015
[18] Huang, Pien. “Some Health Care Workers Are Wary of Getting COVID-19 Vaccines.” NPR, NPR, 1 Dec. 2020, https://www.npr.org/sections/health-shots/2020/12/01/940158684/some-health-care-workers-are-wary-of-getting-covid-19-vaccines.
Portnoy, Jenna. “Several Hundred Virginia Health-Care Workers Have Been Suspended or Fired over Coronavirus Vaccine Mandates.” The Washington Post, WP Company, 4 Oct. 2021, https://www.washingtonpost.com/local/covid-vaccine-mandate-hospitals-virginia/2021/10/01/b7976d16-21ff-11ec-8200-5e3fd4c49f5e_story.html.
[19] Jennifer A. Lueck & Alaina Spiers (2020) Which Beliefs Predict Intention to Get Vaccinated against COVID-19? A Mixed-Methods Reasoned Action Approach Applied to Health Communication, Journal of Health Communication, 25:10, 790-798, DOI: 10.1080/10810730.2020.1865488
[20] Lockyer, Bridget, et al. “Understanding Covid-19 Misinformation and Vaccine Hesitancy in Context: Findings from a Qualitative Study Involving Citizens in Bradford, UK.” Health Expectations, vol. 24, no. 4, 4 May 2021, pp. 1158–1167., https://doi.org/10.1101/2020.12.22.20248259.
Scott C. Ratzan & Ruth M. Parker (2020) Vaccine Literacy—Helping Everyone Decide to Accept Vaccination, Journal of Health Communication, 25:10, 750-752, DOI: 10.1080/10810730.2021.1875083.
[21] Zimmerman, Anne. Columbia Academic Commons, 2020, Toward a Civilized Vaccination Discussion: Abandoning the False Assumption That Scientific Goals Are Shared by All, https://academiccommons.columbia.edu/doi/10.7916/d8-rzh0-1f73.
[22] Bridges, et al v. Houston Methodist Hospital et al, https://docs.justia.com/cases/federal/districtcourts/texas/txsdce/4:2021cv01774/1830373/18
[23] David N. Hoffman, “Vaccine Mandates for Health Care Workers Raise Several Ethical Dilemmas,” Hasting Center Bioethics Forum. August 2021. https://www.thehastingscenter.org/vaccine-mandates-for-health-care-workers-raise-several-ethical-dilemmas/
Introduction: The mental health of the health care professionals is more likely to be affected by the coronavirus disease-19 compared to the general population. Accordingly, the current study aimed to summarize the magnitudes and determinants of the psychological impact of coronavirus among health care professionals. Methods: The studies from Medline via PubMed, Science Direct, and Google Scholar were searched from 5 September to 19 October 2020. The review was conducted as per PRISMA-2009 (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Result: Initially, 6316 articles were searched from three databases (PubMed, Science Direct, and Google Scholar). Finally, 20 articles were filtered to be included in our review. Among different types of psychological impact, stress was reported that lies within the range from 5.2% to 100%, anxiety was reported from 11.1% to 100%, depression was from 10.6% to 58%, and insomnia was from 28.75% to 34%. Several factors were related to the negative psychological state of health care workers due to coronavirus disease-19 like educational level, occupation, gender, age, working environment, work experience, legal status, ethnicity, psychological comorbidity, social support, personal/family exposure, and feeling of health care providers. Conclusion: The most common psychological impacts among health care workers were anxiety and stress. Besides different sociodemographic factors that determine the psychological impacts, front-line health care workers and participants having psychological comorbidity have a high risk of negative psychological state impacts as compared to their counterparts. Therefore, special attention should tend to health care workers directly involved in the prevention and management of coronavirus disease-19 and having a different risk of mental health condition.
Kleber Carrapatoso, Jean Dolbeault, Frédéric Hérau
et al.
We study linear inhomogeneous kinetic equations with an external confining potential and a collision operator admitting several local conservation laws (local density, momentum and energy). We classify all special macroscopic modes (stationary solutions and time-periodic solutions). We also prove the convergence of all solutions of the evolution equation to such non-trivial modes, with a quantitative exponential rate. This is the first hypocoercivity result with multiple special macroscopic modes with constructive estimates depending on the geometry of the potential.