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Telehealth offers an exciting opportunity for observation medicine. It offers the same high quality patient care, but the patient is remote from the provider. Telehealth can be utilized in many ways such as centralizing patient care to a single provider and/or combining inter-hospital observation units. This larger tele-observation unit could allow for separate observation billing creating increased revenue for physician services. Creation of tele-observation requires a diverse group of stakeholders from information technology, observation medicine, telemedicine, and nursing to create a streamlined process for patient care and technical details. Due to the Covid-19 pandemic reimbursement is unchanged when using telemedicine for observation care but expect changes as the public health emergency ends. Telemedicine and tele-observation will use will likely expand and therefore should be incorporated into residency and continuing medical education training.
Claims relating to foods’ nutrition content and potential health benefits have been shown to influence consumer preferences and purchases regardless of the nutritional quality of the product(1). In Australia, permitted claims include nutrition content claims, which refer to the presence or absence of a nutrient, and health claims, which refer to health benefits of foods or nutrients in a product. Health claims include general level health claims, which refer to normal processes and functions, and high level health claims, which refer to a disease or biomarker of a disease. Products that display a health claim must meet the Nutrient Profiling Scoring Criterion (NPSC), however this is not required for products to make a nutrition content claim. The aim of this study was to examine the use of nutrition content and health claims made on Australian ready meal products and assess the proportion of products displaying claims that meet the NPSC. Analysis of the ready meal category in the 2023 FoodSwitch database, a repository of Australian food packaging images and label data for over 28,000 foods developed by The George Institute for Global Health, was conducted(2,3). Foods in the ready meal category were identified and data from the nutrition information panel was collated to calculate whether they met the NPSC. Nutrition content and health claims were extracted from product images and categorised according to claim type (nutrition or health claim) and claimed nutrient or attribute. The proportion of products meeting the NPSC was then calculated overall and by claim type (nutrition content vs health claims). Data were available for 777 ready meal products. Of these, 682 (87.8%) met the NPSC. In total, 2051 nutrition content or health claims were identified across the ready meal products, with 1909 (93.1%) of these categorised as nutrition content claims. The remaining 142 claims identified were general level health claims, with no high level health claims identified. Almost all (n = 1857, 97.3%) nutrition content claims and all general level health claims were made on products which met the NPSC. The most common claims related to protein, energy and fibre content. The use of claims was prevalent across the ready meal food category in Australia, with claims relating to nutrient content being most common. While most claims were made on products that met the NPSC, there is a need for further research to ensure the NPSC appropriately distinguishes between healthy and less healthy food products. This will ensure consumers are equipped to make informed decisions when purchasing food products.
The Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) Cross-Trial Statistics Group gathered lessons learned from statisticians responsible for the design and analysis of the 11 ACTIV therapeutic master protocols to inform contemporary trial design as well as preparation for a future pandemic. The ACTIV master protocols were designed to rapidly assess what treatments might save lives, keep people out of the hospital, and help them feel better faster. Study teams initially worked without knowledge of the natural history of disease and thus without key information for design decisions. Moreover, the science of platform trial design was in its infancy. Here, we discuss the statistical design choices made and the adaptations forced by the changing pandemic context. Lessons around critical aspects of trial design are summarized, and recommendations are made for the organization of master protocols in the future.
The scanning electron microscope (SEM) proves to be ideally suited for studying the configuration, texture, and fabric of clay samples. Growth mechanics of crystalline units — interpenetration and interlocking of crystallites, crystal habits, twinning, helical growth, and topotaxis — also are uniquely revealed by the SEM.
Authigenic kaolins make up the bulk of the examples because their larger crystallite size, better crystallinity, and open texture make them more suited to examination by the SEM than most other clay mineral types.
Inflammation is implicated in chronic diseases including cancer and CVD, which are major causes of mortality. Diet can influence inflammation status. We therefore examined whether the inflammatory potential of a person’s diet is associated with mortality.
Design:
The inflammatory potential of the usual diet was assessed by calculating Dietary Inflammatory Index (DII) scores from repeated FFQ data (collected in 1992, 1994 and 1996), placing each participant’s diet on a continuum from anti- to pro-inflammatory. DII scores were analysed as a continuous variable and as categories by creating quartile groups. Death registry data were used to ascertain all-cause mortality and separately mortality from CVD, cancers and other causes between 1992 and 2022. Cox proportional hazard regression analysis was used to calculate adjusted hazard ratios (HR) with 95 % CI, comparing higher and lowest quartile groups, or HR change per one DII unit increase.
Setting:
Nambour, Australia.
Participants:
A community-based sample of 1440 adults aged 25–75 years.
Results:
During follow-up, 488 participants died, including 188 from CVD, 151 from cancer and 170 from other causes. Participants in the most pro-inflammatory diet group were at increased risk of all-cause mortality (HRQ4 v. Q1 = 1·55; 95 % CI 1·19, 2·03; P < 0·001) and other-cause mortality (HRQ4 v. Q1 = 1·69; 95 % CI 1·12, 2·54; P 0·01). A one-unit increase in DII score was associated with a 36 % increased risk of CVD among those younger than 55 years of age (HR for a one-unit increase in DII score 1·36, 95 % CI 1·04, 1·78). The risk of cancer mortality was also increased for those with a more pro-inflammatory diet in age ≤ 55 years (HR for a one-unit increase in DII score 1·20, 95 % CI 1·02, 1·40) and age 56–65 years (HR for a one-unit increase in DII score 1·11, 95 % CI 1·00, 1·23).
Conclusions:
A pro-inflammatory diet increases the risk of all-cause mortality. Our results support the promotion of anti-inflammatory diets to help promote longevity.
OBJECTIVES/GOALS: Community-based residency programs often lack formal training in research scholarship required by ACGME. To address this need, UCSF’s CTSI collaborated with residency leaders to implement a self-paced online curriculum for residents called Training in Practice Based Research (TIPR). We describe characteristics of the initial trainee cohort. METHODS/STUDY POPULATION: In the 2022-23 academic year, TIPR was offered to 10 UCSF-affiliated family medicine residency programs across Northern California and the Central Valley, and 8 chose to participate. An additional community-based psychiatry residency independently contacted our team and was also granted permission to participate. We conducted baseline surveys with participants to understand their prior research experience and motivation to join TIPR. Descriptive data for demographics of trainees and their prior research experience were collected using Qualtrics. Thematic analyses were conducted on qualitative responses. RESULTS/ANTICIPATED RESULTS: Of 32 participants, 29 completed the survey (91%). Learners identified as 40% non-Hispanic White, 28% Asian, 16% Hispanic, 9% non-Hispanic Black, and 15% non-Hispanic other. 28% were motivated to participate in the program because it was a residency requirement, 31% wanted to improve their scholarly skills and confidence, 16% were interested in career development, and 6% were interested in networking. 19% reported no research experience. Participants are currently working on scholarly projects designed during the first year of TIPR. In 2023-2024, with the addition of two new family medicine residency programs, an additional 40 residents have enrolled in TIPR. In April 2024, we will present data on projects completed, and demographics of the full cohort. DISCUSSION/SIGNIFICANCE: With CTSI support, TIPR has reached a large cohort of ethnically diverse physician trainees in community-based settings. Future evaluation will focus on whether TIPR increases the quantity and quality of practice-based research within residency training programs served by this program.
This study investigated replicating six generations of glasshouse-based flowering date selection in wild radish (Raphanus raphanistrum L.) using an adaptation of the population model SOMER (Spatial Orientated Modelling of Evolutionary Resistance). This individual-based model was chosen because it could be altered to contain varying numbers of genes, along with varying levels of environmental influence on the phenotype (namely the heritability). Accurate replication of six generations of genetic change that had occurred in a previous glasshouse-based selection was achieved, without intermediate adjustments. This study found that multiple copies of just two genes were required to reproduce the polygenic flowering time adaptations demonstrated in that previous research. The model included major effect type M1 genes, with linkage and crossing over, and minor effect type M2 genes undergoing independent assortment. Within the model, transmissibility (heritability of each gene type) was parameterized at 0.60 for the M1 genes and 0.45 for the M2 genes. The serviceable parameterization of the genetics of flowering in R. raphanistrum within a population model means that simulated examinations of the effects of external weed control on flowering time adaptations are now more feasible. An accurate and simplified Mendelian-based model replicating the adaptive shifts of flowering time that is controlled by a complex array of genes is useful in predicting life-cycle adaptations to evade weed control measures such as harvest weed seed control, which apply intense adaptive selections on traits that affect seed retention at harvest, including flowering time.
To explore the usefulness of the Lowenstein-Acevedo Scales for Semantic Interference and Learning (LASSI-L) [Crocco et al, 2013], a novel memory-based cognitive stress test capitalizing on semantic interference, in Huntington’s Disease (HD).
Participants and Methods:
12 healthy adults (HA) and 14 individuals with manifest HD were administered the LASSI-L as part of an annual research visit with the UCSD Huntington’s Disease Clinical Research Center (HDCRC.) Participants in each group were well matched with regard to age and education. Individuals with manifest HD had an average MoCA score of 26, total functional capacity score of 10, and total motor score of 21 suggesting that they were in the early stages of HD. The LASSI-L examines different types of semantic interference that occur in the learning/encoding process. There are free and cued recall trials for two lists of semantically related words with certain trials specific to different aspects of semantic interference including proactive, retroactive, and failure to recover from proactive interference. T-tests for all recall trials and number of intrusions for each trial were conducted between HA and those with HD to examine whether HD renders one more prone to semantic interference in both encoding and retrieval memory processes.
Results:
Individuals with HD recalled fewer words on average than HA across all recall trials except for the initial free recall of the first word list. HD individuals recalled significantly fewer (∼1.5) words during the initial (t=-2.8, p=.005, Cohen’s d=2.7) and secondary (t=-2.9, p=.003, Cohen’s d=2.6) cued recall trials from the words on the first list. Individuals with HD also recalled significantly fewer words on initial free recall (t=-2.9, p=.003, Cohen’s d=2.6) and cued recall trials of the second list, with the initial cued recall (t=-2.8, p=.005, Cohen’s d=3.1) sensitive to proactive semantic interference and the second cued recall (t=-3.3, p=.001, Cohen’s d=2.6) sensitive to failure to recover from proactive semantic interference. In addition, individuals with HD also recalled significantly fewer (∼2.2) words on delayed cued recall of the first list, a measure of retroactive semantic interference, than HA (t=-4.8, p<.001, Cohen’s d=2.4). Lastly, individuals with HD recalled fewer (∼4.1) words than HA on delayed free recall of both word lists (t=-3.5, p<.001, Cohen’s d=5.9). The groups did not differ significantly with regard to number of total intrusions per trial.
Conclusions:
Overall, our study supports the usefulness of the LASSI-L for neuropsychological assessment of HD in clinical and research settings. In comparison to a demographically similar group of HA, individuals with manifest HD showed significant differences in frontally mediated retrieval processes as well as semantic interference processes that affect efficient encoding of novel information.
This chapter guides the researcher through key elements of developing a research methodology for conducting research on and at global environmental negotiations and agreement-making sites. It addresses four important components: 1) Methodological: how to develop a research project; 2) Ethical: how to reflect on and comply with ethical standards; 3) Legal: how to protect, manage and store data and 4) Organizational: how to prepare research on-site. We address key cross-cutting issues relevant to all chapters of the book and the central question of how to decide whether you need to be on-site to answer your research question and advance the state of the art on global environmental agreement-making. The chapter includes three main takeaways: First, the ethical, legal, and organizational aspects of this kind of research are as important as the conceptual and methodological work that prepares scholars for data collection and participant observation on-site. Second, access, funding, and data protection need to be addressed early in the research process and should be reflected at different stages of the research process. Third, regardless of the research puzzle and methodology, conducting research on and at negotiations will always imply a high degree of reflexivity and preparedness.
This chapter brings central elements of the book to the fore, reflects the need for critical thinking, and problematizes the future of agreement-making and the study thereof. In doing so, it addresses critical questions that run through all chapters of the book: Why does it matter to “be there”? How do I navigate closeness and emotions? Is my data ever complete? What will “being there” mean in the future? Global environmental agreement-making is in constant flux, adapting to changing institutional circumstances, power relations, and new emerging environmental problems. Although the multilateral setting with its “old-fashioned” diplomatic practices and formalities creates the impression of stability, routine, and immutability, there is change and the possibility to do global environmental relations differently. We understand critical scholarship to have a vital role in illuminating enduring power relations and revealing potential openings for change and transformation to ensure agreement-making enables better collective stewardship of the Earth. This aspiration nourished the objective of this book to problematize how and why we conduct research at and on global environmental negotiations and to evaluate and expand the concepts and methods available to further this study. The chapter closes with a reflection on future research questions and themes.
In this chapter we explore how to identify and select concepts from the work of political theorists, using Pierre Boudieu, Michele Foucault, and Jacques Lacan as examples. Starting with Foucault’s notion of discourse, we explore how scholars of environmental politics have adapted this term to develop an analytical framework that enables them to address their research puzzle and sites of study. We then use our study of IPCC and IPBES to recount how the scholarship of Bourdieu and Foucault has informed our individual study and how adopting key concepts from these theorists has enabled us to understand and explain the power asymmetries observed during intergovernmental meetings. However, there may come a point when the concepts adopted and applied, and the analytical approach developed from these, no longer provide adequate explanations for the observations made, and this may signal the need for combining different approaches or developing new concepts, as explored through the weighted concept. At the same time, the chapter reflects on why as a research community we are attracted to particular theorists – often dead, white, French, men – and the limitations this choice has the potential to impose and reproduce on present observation and analysis of global environmental politics.
The introduction explores why there is so much scholarly interest in global environmental negotiations and how the conceptualization and study of these has changed over time. It unpacks how to study global environmental negotiations and related sites as agreement-making defined as the multiple actors, sites, and processes through which environmental agreements are made, and the new sets and arrangements of actors, sites, and processes that are created by any specific agreement, which have the potential to reinforce or reorient the global political order. This approach is offered as a way to organize, spatialize, situate, and connect diverse forms of scholarship into, around, and related to negotiation sites and their products. The introduction provides an overview of the book chapters, which provide the methodological building blocks for conducting this research. As such, the book is relevant for many other nonenvironmental issue areas where collective action is at the core, such as global health, nuclear nonproliferation, security, and trade.