Medical-legal partnerships connect legal advocates to healthcare providers and settings. Maintaining effectiveness of medical-legal partnerships and consistently identifying opportunities for innovation and adaptation takes intentionality and effort. In this paper, we discuss ways in which our use of data and quality improvement methods have facilitated advocacy at both patient (client) and population levels as we collectively pursue better, more equitable outcomes.

Background: Early postoperative and acute prosthetic joint infection (PJI) may be managed with debridement, antibiotics, and implant retention (DAIR). Among patients with nonstaphylococcal PJI, an initial 4–6-week course of intravenous or highly bioavailable oral antibiotics is recommended in the Infectious Diseases Society of America (IDSA) guidelines, with disagreement among committee members on the need for subsequent chronic oral antimicrobial suppression (CAS). We aimed to characterize patients with nonstaphylococcal PJI who received CAS and to compare them to those who did not receive CAS. Methods: This retrospective cohort study included patients admitted to Veterans’ Affairs (VA) hospitals from 2003 to 2017 who had a PJI caused by nonstaphylococcal bacteria, underwent DAIR, and received 4–6 weeks of antimicrobial treatment. PJI was defined by Musculoskeletal Infection Society (MSIS) 2011 criteria. CAS was defined as at least 6 months of oral antibiotics following initial treatment of the PJI. Patients were followed for 5 years after debridement. We used χ2 tests and t tests were used to compare patients who received CAS with those who did not receive CAS. Results: Overall, 561 patients had a nonstaphylococcal PJI treated with DAIR, and 80.6% of patients received CAS. The most common organisms causing PJI were streptococci. We detected no significant differences between patients who received CAS and those who did not receive CAS, except that modified Acute Physiology and Chronic Health Evaluation (mAPACHE) scores were higher among patients who did not receive CAS (Table 1). Conclusion: Patients not on CAS were more severely ill (by mAPACHE) than those on CAS. Otherwise, the 2 groups were not different. This finding was contrary to our hypothesis that patients with multiple comorbidities or higher mAPACHE scores would be more likely to get CAS. A future analysis will be conducted to assess treatment failure in both groups. We hope to find a specific cohort who may benefit from CAS and hope to deimplement CAS in others who may not benefit from it.

Funding: No

Disclosures: None

Table 1.

Recently there have been a number of developments in cognitive behaviour therapy (CBT) that have led to cultural adaptations of specific interventions and a greater awareness of how in general CBT might be adapted for Black and Minority Ethnic (BME) service users. These developments, however, involve change at the level of the individual therapist and particular treatment approach, but involve very few considerations of what needs to happen at the levels of teams or services in order to best meet the mental health needs of British South Asian and other BME populations. This paper summarizes the way that services need to understand how minority populations use services and how to involve those populations in developing services in order to ensure their needs are best met.

Experiences of racism can be a cumulative risk factor for developing mental health problems. Cognitive Behaviour Therapists working with Black and Minority Ethnic (BME) service users should be confident in their ability to establish the necessary rapport to ask about these experiences and be able to incorporate this information into longitudinal formulations and as part of maintenance cycles. This paper sets out guidelines as to how to do this as part of a wider engagement process.

Cognitive behaviour therapy (CBT) has become the first line of treatment for a wide range of mental health problems across many countries. The flexibility of CBT, and a strong evidence base and good track record of training and dissemination, has lent itself to scaling up of this therapy, and projects such as the Improving Access to Psychological Therapies (IAPT) programme in England have shown that large-scale projects to roll out CBT at a national level are possible (Clark, 2011).

In political science research these days, the R 2 is out of fashion. A chorus of our best methodologists sounds notes of caution, at varying degrees of pitch. Berry and Feldman (1985, 15) remark in their popular regression monograph: “A researcher should be careful to recognize the limitations of R 2 as a measure of goodness of fit.” In their more general statistics text, Hanushek and Jackson (1977, 59) claim that “one must be extremely cautious in interpreting the R 2 value for an estimation and particularly in comparing R 2 values for models that have been estimated with different data sets.” Perhaps the most pointed attack comes from Achen (1982, 61), who argues that the R 2 “measures nothing of serious importance.” His contention is that it should be abandoned, and the standard error of the regression (SEE) substituted as a goodness-of-fit measure. Developing these lines of inquiry further, King (1986) provides the latest set of criticisms. Accordingly, “In most practical political science situations, it makes little sense to use [the R 2]” (King 1986, 669). And, concerning the “proportion of variance explained” definition more particularly, “it is not clear how this interpretation adds meaning to political analyses.” (King 1986, 678).

An assemblage of killer whales that has been sighted in waters off the west coast of the British Isles and Ireland has previously been shown to be isolated from other North Atlantic killer whale communities based on association patterns. By applying a Bayesian formulation of the Jolly–Seber mark-recapture model to the photo-identification data compiled from opportunistic photographic encounters with this population of killer whales, we show that such sparse and opportunistically-collected data can still be valuable in estimating population dynamics of small, wide-ranging groups. Good quality photo-identification data was collected from 32 encounters over 19 years. Despite a cumulative total of 77 identifications from these encounters, just ten individuals were identified and the remaining 67 identifications were re-sights of these ten animals. There was no detected recruitment through births during the study and, as a result, the population appears to be in a slight decline. The demography of the population was highly skewed towards older individuals and had an unusually high ratio of adult males, and we suggest that demographic stochasticity due to a small population size may be further impacting the population growth rate. We recommend that this population be managed as a separate conservation unit from neighbouring killer whale populations.

This pilot study evaluated the addition of 1 to 6 sessions of cognitive–behavioural therapy (CBT) for patients of a mental health acute assessment and treatment team. A pre-post design for 12 months of consecutive referrals used the Health of the Nation Outcome Scale (HONOS), Depression, Anxiety, Stress Scales (DASS), and patient satisfaction. Forty-two patients who attended CBT were compared with 19 patients who were referred but did not attend therapy due to refusal, referral to another service, or loss to follow-up. With a mean of 3.2 sessions, HONOS scores improved by a mean of 1.02 SD in patients who attended CBT and 0.72 SD in nonattenders. DASS results showed a mean reduction of 0.55 SD in symptoms of depression, anxiety and stress in those who attended. Patients' overall satisfaction averaged 4.7/5. Results showed brief CBT was feasible in this setting, with high patient satisfaction and some evidence of improved patient outcomes compared with usual care.

We report a range-wide status assessment of a key Neotropical ecosystem architect, the white-lipped peccary Tayassu pecari, categorized as Near Threatened on the IUCN Red List, using published information and unpublished data from 41 scientists in 15 range countries. We estimate that the white-lipped peccary has been extirpated in 21% of its historical range over the last 100 years, with reduced abundance and a low to medium probability of long-term survival in another 48% of its current range. We found major range declines in Argentina, Paraguay, southern Brazil, Colombia, Venezuela, north-east Brazil, Mexico and Costa Rica. This species is particularly at risk in more xeric ecosystems, especially the caatinga, cerrado and pampas. Hunting and habitat destruction are the most severe threats, although there are also unexplained sudden die-offs suggestive of disease. We evaluate our results in light of this species’ important interspecific interactions and its role as an ecosystem architect. One of our recommendations is that conservation efforts should focus on landscape conservation of large, continuous and ecologically intact areas containing a mosaic of different habitat types.

Political science, unlike economics, does not have a long tradition of forecasting models. However, this is changing. Currently, there is considerable interest in election forecasting. The basis for the interest is a flurry of related publications on House, Senate and presidential elections. A common goal for these studies is the development of a model, inevitably based on aggregate time-series data, which predicts election returns. The resulting models, some of which are quite accurate, can differ a good deal in specification and estimation. Also, they vary in complexity, making them more or less accessible to the engaged voter.