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Increase bleeding control knowledge and self-efficacy among middle school students and determine efficacy of health care student-led Stop the Bleed (STB) training.
Methods
An interprofessional group of health care students led STB trainings at 6 Texas middle schools. Trainings included a presentation plus hands-on skills training and were evaluated using pre- and post-training surveys focused on bleeding control knowledge, self-efficacy, and willingness to assist in emergencies. Paired pre- and post-training survey responses were compared using McNemar’s test for knowledge-based questions and paired t tests for Likert scale responses.
Results
Health care students (N = 103) trained 805 middle school students, aged 10-16 years, of which 447 (55.5%) completed pre- and post-surveys. There was significant improvement in all 7 knowledge-based questions from pre- to post-training. There were significant improvements in comfort using tourniquets (median [interquartile range]: 3 [2-4] vs. 4 [3-5]; P < 0.0001), confidence applying direct pressure (3 [2-4] vs. 4 [3-5]; P < 0.0001), and likeliness to assist someone bleeding (4 [3-5] vs. 4 [4-5]; P = 0.0096). Eighty-four percent of students found this training “useful.”
Conclusions
While previous studies have demonstrated STB training efficacy, this is among the first to provide evidence that health care student-led STB training significantly increased bleeding control knowledge and self-efficacy among middle school students.
This study analyzes empirically and graphically the effects of the relative market price level on the premiums and discounts received associated with alfalfa hay quality. Findings indicate that at times when alfalfa prices are elevated relative to the average, there is no significant impact on the average premiums and discounts received. Conversely, at times when alfalfa prices are depressed relative to the average, there are statistically significant variations in the premiums and discounts across quality grades compared with a market characterized by average prices. Understanding these dynamics can aid producers in optimizing production decisions and assist consumers in managing input costs.
Antipseudomonal antibiotics are commonly prescribed for diabetic foot infections (DFI) at our institution despite a low local prevalence of Pseudomonas aeruginosa. A multidisciplinary team implemented a DFI electronic health record (EHR)-embedded treatment algorithm and order set.
Methods
This multi-center, quasi-experimental study evaluated adults on antibiotics admitted for DFI to vascular surgery or medical units pre- and post-implementation of an EHR-embedded treatment algorithm and order set. Exclusion criteria: duplicate patients, concomitant infection, transfer from an outside hospital. Primary endpoint: antipseudomonal use among included patients (DOT/1000 DFI days present). Secondary outcomes: empiric antipseudomonal use, length of stay, 30-day readmission, mortality, amputation, and Clostridioides difficile infection. Patient demographics, diagnostics, treatments, and outcomes were evaluated.
Results
Two hundred ten patients were included with 70 patients included in each group. The post-algorithm group had lower antipseudomonal DOT/1000 DFI days present compared to the pre-intervention group (360 vs 503, P < 0.001). The post-order set group had the lowest antipseudomonal use (347 vs 503, P < 0.001). Empiric antipseudomonal use decreased from 85.7% pre-intervention to 72% post-algorithm and 68.5% post-order set. Collectively, 30-day mortality was < 5%. Amputation during and within 30 days of hospitalization was similar in the pre-intervention (48.6%), post-algorithm (30%), and post-order set (41.4%) groups. Methicillin-susceptible Staphylococcus aureus and Streptococcus spp. were most frequently isolated. Wound cultures were not collected in 24.3%, 22.9%, and 40% of the pre-intervention, post-algorithm, and post-order set group.
Conclusions
EHR-embedded clinical decision-making tools reduce antipseudomonal use for DFI treatment without increasing 30-day mortality or amputation.
Medical debt is the largest form of consumer debt in collections, with $88 billion recorded on credit reports, affecting roughly one in five US households. Medical debt pushes millions into financial distress and is exacerbated by harsh collection practices to garnish wages, seize assets, place liens on homes, and reduce creditworthiness. Concerned federal and state policymakers have pursued policies to protect consumers from medical debt.
Most federal medical debt policies are forms of public law – namely administrative requirements imposed by government on health care and consumer finance entities. Nevertheless, significant gaps in the federal public law of medical debt persist, leaving an important role for states, particularly in the creation of private enforcement actions for violations of state consumer protections against medical debt. States have created both public law and private law protections, prescribing standards for financial assistance, applying to a broader range of providers, barring certain collection actions, and empowering individuals to seek private remedies for violations.
Is medical debt better addressed at the federal or state level and using the tools public law or private law? The answer is all the above: Stronger national, public-law standards to guard against medical debt are critical, but federal policy should retain a vital role for what states do well – policy innovation and greater enforcement through private remedies. Preserving a meaningful role for states and private law in consumer protection policy enhances separation of powers and serves as a check against regulatory failure by federal public law solutions and the gutting of federal administrative and statutory authority.
In recent years, virtue epistemology has been criticized for its individualism. Correspondingly, some attempts have been made to make it more social. However, there is some confusion about what it means for virtue epistemology to be individualistic, and how it should be socialized in the face of this. The current paper proposes a systematic answer to these questions. We distinguish elements of theories of virtue that might give rise to different forms of individualism: “subject individualism,” “faculty/trait individualism,” and “value individualism.” Then we show what specific challenges these elements might pose for virtue reliabilism and responsibilism. We focus on two challenges: the epistemic value of other-regarding intellectual virtues, and the problem of “epistemic outsourcing.” In both cases, we identify and evaluate possible strategies for socializing these elements of virtue epistemology.
Jubilees are good to think with, obviously. They provide a fitting opportunity to look back, to take stock, and to offer some thoughts about the future. As a scholar working on Byzantine history (and only slightly older than BMGS at that) I recognize that the state of the field has changed immensely in the last fifty years. First, there was a major expansion in departments and programmes dedicated to Byzantine studies, followed more recently by a contraction. And yet, even while Byzantine studies are offered in fewer academic institutions, there is an immense proliferation of academic research and publications on the Byzantine Empire – trend accelerating. Exact numbers may be hard to come by, but a quick search on WorldCat for books published in 2023 with the word ‘Byzantine’ in the title brought forth almost two hundred books – in English alone. If we add journal articles (there are over twenty major journals devoted solely to Byzantine studies), chapters in edited volumes, and, especially publications in languages other than English, we would probably reach the low thousands, all in one year. To survey, much less to read with care and absorb all this new knowledge, has become impossible. How handy would it be if someone else took over this task for us – processing research and synthesizing it in a clear, concise and readable volume. It is highly doubtful that such a book could be produced today, but there is a work that fulfilled these functions for a very long time, one of the most cited and recommended textbooks in Byzantine history, Georg Ostrogorsky's History of the Byzantine State.
Self-harm, self-poisoning or self-injury, irrespective of the motivation, is a central risk factor for suicide. Still, there is limited knowledge of self-harm among patients with substance use disorders (SUDs) who die by suicide.
Aims
We aimed to describe the prevalence of a history of self-harm and identify the factors associated with self-harm, comparing individuals who died by suicide with and without SUDs.
Method
We used data from the Norwegian Surveillance System for Suicide in Mental Health and Substance Use Services, which is based on a national linkage between the Norwegian Cause of Death Registry and the Norwegian Patient Registry, to identify individuals who died by suicide within 1 year after last contact with mental health or substance use services (n = 1140). A questionnaire was retrieved for 1041 (91.3%) of these individuals. We used least absolute shrinkage and selection operator (LASSO) regression to select variables and compared patients with and without SUDs. Conditional selective inference was used to improve 90% confidence intervals and p-values.
Results
The prevalence of self-harm was 55% in patients with SUDs and 52.6% in patients without SUDs. Suicidal ideation (odds ratio 2.98 (95% CI 1.74–5.10)) emerged as a factor shared with patients without SUDs, while personality disorders (odds ratio 1.96 (1.12–3.40)) and a history of violence (odds ratio 1.86 (1.20–2.87)) were unique factors for patients with SUDs.
Conclusions
A history of self-harm is prevalent in patients with SUDs who die by suicide and is associated with suicidal ideation, a history of violence and personality disorders in patients with SUDs.
The Brahman sage Gautama cursed Indra with emasculation, in some versions through the appearance of vulvas on his body, as a punishment for intercourse with Gautama's wife, Ahalyā; Ahalyā's punishment involved detraction from her visible or physical presence. I present an analysis of the version as told in Padmapurāṇa 1.54. The story, in addition to reflecting male suspicion of women and dread of feminisation, simultaneously functions as a cautionary tale about the dangers of succumbing to lust and reflects inter-varṇa tension: the weak-willed Indra, a divine kṣatriya, is humiliated by the continent Gautama, whose asceticism is the source of the devastating power that he unleashes against both Indra and Ahalyā. I also compare this myth to the Greek tales of Achilles, Herakles, and Teiresias's feminisations, and suggest that the association of heroic feminisation with sexuality (as seen in the stories in which Indra, Achilles, and Herakles are feminised) may be a shared inheritance from Proto-Indo-European times. However, the myths of Achilles and Herakles's feminisations, like that of Indra's, are shaped by their specific cultural context: the feminised Greek heroes’ penetration of women is confirmation of their continued masculinity, rather than the result of a reprehensible lack of self-control.
Many influential political science articles use close elections to study how important outcomes vary after a certain type of candidate wins, such as a Democrat or a Republican. This politician characteristic regression discontinuity (PCRD) design offers opportunities for inferential leverage but also the potential for confusion. In this article, we clarify what causal claims the PCRD licenses, offering a rigorous causal analysis that points to three principal lessons. First, PCRDs do nothing to isolate the effect of the politician characteristic of interest as apart from other politician characteristics. Second, selection processes (regarding both “who runs” and “which elections are close”) can generate and exacerbate such confounding, as noted in Marshall (2024). Third and more fortunately, this approach does make it possible to estimate the average effect of electing a leader of type “A” vs. “B” in the context of close elections, treating the units as districts, not leaders. We also suggest a set of tools that can aid in falsifying key assumptions, avoiding unwarranted claims, and surfacing mechanisms of interest. We illustrate these issues and tools through a reanalysis of an influential study about what happens when extremists win primaries (Hall 2015).
The purpose of this research was to understand perceptions and experiences of inclusion among underrepresented early-career biomedical researchers (postdoctoral fellows and early-career faculty) enrolled in the Building Up study. Because inclusion is vital to job satisfaction and engagement, our goal was to shed light on aspects of and barriers to inclusion within the academic workforce.
Methods:
We used qualitative interviews to assess workplace experiences of 25 underrepresented postdoctoral fellows and early-career faculty including: their daily work experiences; sense of the workplace culture within the institutions; experiences with microaggressions, racism, and discrimination; and whether the diversity, equity, and inclusion (DEI) policies and practices at their institution enhanced their experiences. Using qualitative methods, we identified themes that highlighted high-level characteristics of inclusion.
Results:
Four distinct themes were identified: (1) participants appreciated the flexibility, versatility, and sense of fulfillment of their positions which enhanced feelings of inclusion; (2) greater psychological safety led to a greater sense of belonging to a research community; (3) participants had varied experiences of inclusion in the presence of microaggressions, racism, and discrimination; and (4) access to opportunities and resources increased feelings of value within the workplace.
Discussion:
Our findings provide new insight into how inclusion is experienced within the institution among underrepresented early-career biomedical researchers. This research points to specific approaches that could be used to enhance experiences of inclusion and to address barriers. More research is needed to understand how to accomplish a balance between the two, so that perceptions of inclusion outweigh negative experiences.
Machine-learning (ML) methods have shown great potential for weather downscaling. These data-driven approaches provide a more efficient alternative for producing high-resolution weather datasets and forecasts compared to physics-based numerical simulations. Neural operators, which learn solution operators for a family of partial differential equations, have shown great success in scientific ML applications involving physics-driven datasets. Neural operators are grid-resolution-invariant and are often evaluated on higher grid resolutions than they are trained on, i.e., zero-shot super-resolution. Given their promising zero-shot super-resolution performance on dynamical systems emulation, we present a critical investigation of their zero-shot weather downscaling capabilities, which is when models are tasked with producing high-resolution outputs using higher upsampling factors than are seen during training. To this end, we create two realistic downscaling experiments with challenging upsampling factors (e.g., 8x and 15x) across data from different simulations: the European Centre for Medium-Range Weather Forecasts Reanalysis version 5 (ERA5) and the Wind Integration National Dataset Toolkit. While neural operator-based downscaling models perform better than interpolation and a simple convolutional baseline, we show the surprising performance of an approach that combines a powerful transformer-based model with parameter-free interpolation at zero-shot weather downscaling. We find that this Swin-Transformer-based approach mostly outperforms models with neural operator layers in terms of average error metrics, whereas an Enhanced Super-Resolution Generative Adversarial Network-based approach is better than most models in terms of capturing the physics of the ground truth data. We suggest their use in future work as strong baselines.
The American Law Institute’s first ever Restatement of Medical Malpractice law provides an opportunity to examine how generic private law doctrine shapes itself to the distinctive core features of medical care. Various Restatement provisions reflect tort law’s recognition of key features of medical care that justify regarding medical liability as a distinct branch of negligence law. Tort law does so, however, in a somewhat anachronistic manner that regards medical care encounters in a highly individualized fashion -- one that sees patient care encounters as primarily dyadic (simply between doctor and patient), rather than being embedded in complex institutional, professional, regulatory, and economic structures. To some extent, this simplification helps determine legal obligations and enforce patient protections. In other respects, however, tort law has not yet adequately reflected fundamental changes in health care finance and delivery over the past generation or two. The Medical Malpractice Restatement considers these changes and responds to some of them, but not to others. Because a Restatement is, at its core, a synthesis of existing doctrine rather than a law reform enterprise, it is limited in the extent to which it can aim to improve or modernize law. Embedded in the Restatement are a number of key passages that point in potentially constructive directions that future evolution of tort doctrine might take. Other points of doctrinal rigidity, however, might require more overt law reform efforts to overcome.
Levetiracetam (LEV) is an antiseizure medication (ASM) used as a second line after benzodiazepines for status epilepticus treatment. Current literature lacks direct head-to-head comparisons between different LEV loading dose strategies, leading to uncertainty about superior dosing methods and thus clinical practice variations.
Methods:
A retrospective cohort study was designed to compare efficacy and safety of low (<30 mg/kg) versus high (≥30 mg/kg) weight-based LEV loading doses in adults with benzodiazepine-refractory status epilepticus (BRSE). The primary outcome of this study was termination of BRSE. No requirement for additional ASM after LEV was a surrogate for BRSE termination. Secondary endpoints included endotracheal intubation, intensive care unit (ICU) admission, 30-day all-cause mortality and adverse drug reactions. Statistical analysis included discrete and inferential statistics, including logistic regression and win-ratio analysis, to control for potential confounding variables.
Results:
Of the 106 patients included in this study, 54 (51%) did not require additional ASM after LEV, thereby achieving seizure termination. There was a higher proportion of patients with seizure termination in the higher weight-based dosing group as compared to the lower weight-based group (66% vs 40%, respectively; aOR 3.07; 95% CI: 1.36–7.21). There were lower rates for endotracheal intubation, ICU admission and all-cause mortality in the higher dosing group. Adverse events were comparable between the both groups.
Conclusion:
LEV’s high weight-based loading dose strategy (≥30 mg/kg) is more effective in the termination of BRSE as compared to the lower weight-based loading dose strategy (<30 mg/kg).
We present a family of minimal modal logics (namely, modal logics based on minimal propositional logic) corresponding each to a different classical modal logic. The minimal modal logics are defined based on their classical counterparts in two distinct ways: (1) via embedding into fusions of classical modal logics through a natural extension of the Gödel–Johansson translation of minimal logic into modal logic S4; (2) via extension to modal logics of the multi- vs. single-succedent correspondence of sequent calculi for classical and minimal logic. We show that, despite being mutually independent, the two methods turn out to be equivalent for a wide class of modal systems. Moreover, we compare the resulting minimal version of K with the constructive modal logic CK studied in the literature, displaying tight relations among the two systems. Based on these relations, we also define a constructive correspondent for each minimal system, thus obtaining a family of constructive modal logics which includes CK as well as other constructive modal logics studied in the literature.
Bilinguals use languages strategically and make decisions differently depending on the language context. Here, we explored whether verbal feedback modulates language use and risk-taking in bilinguals engaged in a coin-drawing game that incentivises lying. In the game, participants announced bets in Chinese or English, and feedback on the outcome of the current bet was given in the same language. They selected Chinese over English after receiving positive feedback in Chinese, and no language difference was found when feedback was provided in English. They also tended to take more risks after receiving positive than negative feedback. Furthermore, participants were more likely to switch from one language to the other following negative feedback as compared to positive feedback, and when telling the truth, they were faster after negative than positive feedback. Thus, the language in which bilinguals receive feedback constrains language use, which may have implications for understanding interactions in multilingual communities.
In today’s insurance market, numerous cyber insurance products provide bundled coverage for losses resulting from different cyber events, including data breaches and ransomware attacks. Every category of incident has its own specific coverage limit and deductible. Although this gives prospective cyber insurance buyers more flexibility in customizing the coverage and better manages the risk exposures of sellers, it complicates the decision-making process in determining the optimal amount of risks to retain and transfer for both parties. This article aims to build an economic foundation for these incident-specific cyber insurance products with a focus on how incident-specific indemnities should be designed for achieving Pareto optimality for both the insurance seller and the buyer. Real data on cyber incidents are used to illustrate the feasibility of this approach. Several implementation improvement methods for practicality are also discussed.
Chapter 6 turns to metaethics and explains how the results in normative ethics might lead to a skeptical challenge. I start by revisiting Duhem and Quine and how they thought underdetermination should impact our view of science. I then explain why I understand the major challenge that moral underdetermination poses to be an epistemological, not a semantic, one. This leads me to sketch out the general lines of a skeptical argument to the effect that we should withhold belief in the explanatory claims of moral theories. I propose a standard form of the skeptical argument in science and show how it can be adapted to ethics.Finishing up, I address two possible objections. The first concerns the question of whether so-called theoretical virtues might tip the ballance between two deontically equivalent theories. The second questions whether withholding of belief is indeed the correct reaction to equally believable moral theories. Iargue that the skeptical argument in ethics is at least as plausible as, if not more plausible than, its counterpart in the philosophy of science.