We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
“Improper linear models” (see Dawes, Am. Psychol. 34:571–582, 1979), such as equal weighting, have garnered interest as alternatives to standard regression models. We analyze the general circumstances under which these models perform well by recasting a class of “improper” linear models as “proper” statistical models with a single predictor. We derive the upper bound on the mean squared error of this estimator and demonstrate that it has less variance than ordinary least squares estimates. We examine common choices of the weighting vector used in the literature, e.g., single variable heuristics and equal weighting, and illustrate their performance in various test cases.
FoodRx is a 12-month healthy food prescription incentive program for people with type 2 diabetes (T2DM) and experiences of household food insecurity. In this study, we aimed to explore potential users’ prospective acceptability (acceptability prior to program use) of the design and delivery of the FoodRx incentive and identify factors influencing prospective acceptability.
Design:
We used a qualitative descriptive approach and purposive sampling to recruit individuals who were interested or uninterested in using the FoodRx incentive. Semi-structured interviews were guided by the theoretical framework of acceptability, and corresponding interview transcripts were analysed using differential qualitative analysis guided by the socioecological model.
Setting:
Individuals living in Alberta, Canada.
Participants:
In total, fifteen adults with T2DM and experiences of household food insecurity.
Results:
People who were interested in using the FoodRx incentive (n 10) perceived it to be more acceptable than those who were uninterested (n 5). We identified four themes that captured factors that influenced users’ prospective acceptability: (i) participants’ confidence, views and beliefs of FoodRx design and delivery and its future use (intrapersonal), (ii) the shopping routines and roles of individuals in participants’ social networks (interpersonal), (iii) access to and experience with food retail outlets (community), and (iv) income and food access support to cope with the cost of living (policy).
Conclusion:
Future healthy food prescription programs should consider how factors at all levels of the socioecological model influence program acceptability and use these data to inform program design and delivery.
Inequalities in terms of who participates in politics yield policy outcomes that fail to reflect the interests of the broader public. Because these processes fail to engage the full citizenry in political decision-making processes, they are also markers of an anemic civic culture. Advocates of participatory budgeting (PB) – a process implemented at the subnational level in thousands of cities in the United States and beyond that invites residents to participate directly in the process of allocating public resources for local projects – argue that it can alleviate these inequalities. They argue that features of the PB process make it ripe for engaging new participants in the political process and weaving a more inclusive social fabric. We examine the correlates of interest in participating in PB using a survey of Cook County residents. We also consider the extent to which the policy priorities of those who are interested in participating diverge from those who are less interested. Although we find evidence that the process is particularly appealing to younger respondents and those who identify as Latine or Black (as opposed to White), we also find that interest is higher among those with higher socioeconomic status and those who perceive conditions in their neighborhood to already be good. Our evidence also suggests that inequalities in who is interested in participating may not radically affect policy outcomes. However, those who decline to participate cannot reap the broader social and political benefits advocates hope the PB process can foster.
Background: Blood cultures are a fundamental tool in the diagnosis of infections, but they can lead to clinical confusion and waste resources when they yield false results. To optimize blood-culture orders at our institution, we developed an evidence-based clinical guideline (Fig. 1) to be used by frontline providers on nonneutropenic hospitalized adult inpatients. We retrospectively reviewed charts of patients with positive blood cultures to evaluate whether frontline providers and infectious diseases (ID) attending physicians were able to consistently interpret the guidelines to determine whether blood cultures were drawn appropriately. Methods: In total, 95 nonneutropenic adults with an initial positive blood culture collected while on an inpatient unit were identified through a query of the electronic medical record from January 2021 through June 2022. Patients with polymicrobial bacteremia and bacteremia due to Enterococcus, Streptococcus, and gram-positive rods were excluded. Moreover, 4 medical resident physicians reviewed all patients and 2 ID attending physicians reviewed one-quarter of cases; all were blinded to the culture results. Blood cultures were determined to be either appropriately or inappropriately performed based on our institution’s guideline. The free-marginal multirater κ statistics with 95% CIs were calculated to evaluate interrater agreement. Results: Baseline patient demographics are shown in Table 1. Immune compromise without neutropenia was noted in 21 of 95 patients. Most patients were at high risk for bacteremia (72%) per our institutional guideline, most of whom were septic (67.7%). Low risk for bacteremia was found in only 12.3% of reviews. Medical resident physicians, ID attending physicians, and all reviewers combined agreed on whether blood cultures were drawn appropriately or inappropriately (84.2%, 92%, and 86.4% agreement rates, respectively). The free-marginal κ statistic was highest for ID attending physicians (0.84; 95% CI, 0.62–0.78), followed by attending physicians and resident physicians combined (0.73; 95% CI, 0.56–0.90), and resident physicians alone (0.68; 95% CI, 0.58–0.78). In the 21 patients with immune compromise, the agreement rates on blood culture appropriateness remained high among all reviewers, resident physicians, and ID attending physicians were 86.6%, 90.5%, and 95%, respectively. Conclusions: In our retrospective study of nonneutropenic hospitalized adult inpatients, frontline providers and ID attending physicians interpreted blood-culture guidelines consistently, largely agreeing on which patients had cultures drawn appropriately. Agreement among ID attending physicians was excellent and remained substantial among medical resident physicians. Guidelines on the appropriate use of blood cultures are vital to limiting unnecessarily collected cultures, which can lead to extended length of stay and increase cost across hospital systems. Further analyses on the clinical impact of this guideline are ongoing.
The U.S. Department of Agriculture–Agricultural Research Service (USDA-ARS) has been a leader in weed science research covering topics ranging from the development and use of integrated weed management (IWM) tactics to basic mechanistic studies, including biotic resistance of desirable plant communities and herbicide resistance. ARS weed scientists have worked in agricultural and natural ecosystems, including agronomic and horticultural crops, pastures, forests, wild lands, aquatic habitats, wetlands, and riparian areas. Through strong partnerships with academia, state agencies, private industry, and numerous federal programs, ARS weed scientists have made contributions to discoveries in the newest fields of robotics and genetics, as well as the traditional and fundamental subjects of weed–crop competition and physiology and integration of weed control tactics and practices. Weed science at ARS is often overshadowed by other research topics; thus, few are aware of the long history of ARS weed science and its important contributions. This review is the result of a symposium held at the Weed Science Society of America’s 62nd Annual Meeting in 2022 that included 10 separate presentations in a virtual Weed Science Webinar Series. The overarching themes of management tactics (IWM, biological control, and automation), basic mechanisms (competition, invasive plant genetics, and herbicide resistance), and ecosystem impacts (invasive plant spread, climate change, conservation, and restoration) represent core ARS weed science research that is dynamic and efficacious and has been a significant component of the agency’s national and international efforts. This review highlights current studies and future directions that exemplify the science and collaborative relationships both within and outside ARS. Given the constraints of weeds and invasive plants on all aspects of food, feed, and fiber systems, there is an acknowledged need to face new challenges, including agriculture and natural resources sustainability, economic resilience and reliability, and societal health and well-being.
This study explored programme recipients’ and deliverers’ experiences and perceived outcomes of accessing or facilitating a grocery gift card (GGC) programme from I Can for Kids (iCAN), a community-based programme that provides GGC to low-income families with children.
Design:
This qualitative descriptive study used Freedman et al’s framework of nutritious food access to guide data generation and analysis. Semi-structured interviews were conducted between August and November 2020. Data were analysed using directed content analysis with a deductive–inductive approach.
Participants:
Fifty-four participants were purposively recruited, including thirty-seven programme recipients who accessed iCAN’s GGC programme and seventeen programme deliverers who facilitated it.
Setting:
Calgary, Alberta, Canada.
Results:
Three themes were generated from the data. First, iCAN’s GGC programme promoted a sense of autonomy and dignity among programme recipients as they appreciated receiving financial support, the flexibility and convenience of using GGC, and the freedom to select foods they desired. Recipients perceived these benefits improved their social and emotional well-being. Second, recipients reported that the use of GGC improved their households’ dietary patterns and food skills. Third, both participant groups identified programmatic strengths and limitations.
Conclusion:
Programme recipients reported that iCAN’s GGC programme provided them with dignified access to nutritious food and improved their households’ finances, dietary patterns, and social and emotional well-being. Increasing the number of GGC provided to households on each occasion, establishing clear and consistent criteria for distributing GGC to recipients, and increasing potential donors’ awareness of iCAN’s GGC programme may augment the amount of support iCAN could provide to households.
OBJECTIVES/GOALS: Community Engagement Advisory Boards (CEAB) serve as a vital resource for engaging and partnering with communities in research. The purpose of this project is to describe the perspectives of members of a long-standing CEAB in providing input and promoting research that aligns with the needs, experiences, and concerns of the communities they represent METHODS/STUDY POPULATION: Three 90-minute focus groups were conducted with a subset of a CEAB(n=17)(M years spent with CEAB =7.3) affiliated with the Center for Clinical and Translational Science at the University of Illinois-Chicago. Members areas of expertise include perspectives from faith-based organizations, community organizing, public health and working with diverse populations. Transcribed audio recordings of the focus groups were coded using thematic analysis wherein two authors coded independently, followed by audited discussion and final consensus codes. Main themes were identified after reviewing final codes. RESULTS/ANTICIPATED RESULTS: CEAB members described the bi-directional nature of their role serving as a conduit between research institutions and their communities, identified strategies to promote research literacy in communities, called for researchers to take a proactive approach in forming and sustaining community partnerships, and helped identify opportunities to promote community engagement in more creative and feasible ways. Additionally, CEAB members identified perceived opportunities for the board as a whole to be more involved in Chicago communities to further their role as a liaison between the university and the community. DISCUSSION/SIGNIFICANCE: These findings may have implications for investigators to better address community priorities in research by understanding unique local realities as well as help other CTSA hubs’ to leverage their communities’ expertise.
OBJECTIVES/GOALS: CTSIs around the country rely on Community Engagement Advisory Boards (CEABs) to bridge research and communities. The history of this 22-year-old board offers insight on 1) how it was created and has been sustained over time 2) its evolution, and 3) members’views of their contributions to translational research at UIC. METHODS/STUDY POPULATION: As founding members began to step down from this long-standing board, we started to document its history and members’ narratives and perspectives of the work conducted at UIC since its inception. Using an Oral History methodology, we conducted three virtual focus groups with 13 short and long-term members (n=6, n=4, n=3) to learn about changes within CEAB and in members’ roles, and individual semi-structured interviews with three long-standing members to expand on the origin and evolution of CEAB. Focus group data was coded and analyzed. We also extracted data on key events from archived files including grant proposals and CEAB meeting notes. A steering committee of three CEAB members helped guide this process. RESULTS/ANTICIPATED RESULTS: The CEAB was founded at the UIC College of Nursing in 2001 under the Center for Research on Cardiovascular Respiratory Health, with a grant from the National Institutes of Nursing Research (NINR). It was established as college-wide advisory board of community experts to help engage underserved communities and to contribute to research beyond recruitment and retention. In 2009, upon receipt of a Clinical Translational Science award that established the Center for Clinical Translational Science (CCTS), the CEAB became a campus-wide board. Over 30 community organizations and many non-affiliated community members have contributed to translational research at UIC throughout the board’s history. DISCUSSION/SIGNIFICANCE: Over twenty years later, the CEAB continues to help bridge researchers and communities, and to raise awareness about community needs, the importance of cultural relevance, and the inclusion of underserved communities in research. Long-term members have played a key role in providing continuity over the years.
The coronavirus disease 2019 (COVID-19) pandemic highlighted the lack of agreement regarding the definition of aerosol-generating procedures and potential risk to healthcare personnel. We convened a group of Massachusetts healthcare epidemiologists to develop consensus through expert opinion in an area where broader guidance was lacking at the time.
The use of personal protective equipment (PPE) in prehospital emergency care has significantly increased since the onset of the coronavirus disease 2019 (COVID-19) pandemic. Several studies investigating the potential effects of PPE use by Emergency Medical Service providers on the quality of chest compressions during resuscitation have been inconclusive.
Study Objectives:
This study aimed to determine whether the use of PPE affects the quality of chest compressions or influences select physiological biomarkers that are associated with stress.
Methods:
This was a prospective randomized, quasi-experimental crossover study with 35 Emergency Medical Service providers who performed 20 minutes of chest compressions on a manikin. Two iterations were completed in a randomized order: (1) without PPE and (2) with PPE consisting of Tyvek, goggles, KN95 mask, and nitrile gloves. The rate and depth of chest compressions were measured. Salivary cortisol, lactate, end-tidal carbon dioxide (EtCO2), and body temperature were measured before and after each set of chest compressions.
Results:
There were no differences in the quality of chest compressions (rate and depth) between the two groups (P >.05). After performing chest compressions, the group with PPE did not have elevated levels of cortisol, lactate, or EtCO2 when compared to the group without PPE, but did have a higher body temperature (P <.001).
Conclusion:
The use of PPE during resuscitation did not lower the quality of chest compressions, nor did it lead to higher stress-associated biomarker levels, with the exception of body temperature.
The Recognition Heuristic (Gigerenzer & Goldstein, 1996; Goldstein & Gigerenzer, 2002) makes the counter-intuitive prediction that a decision maker utilizing less information may do as well as, or outperform, an idealized decision maker utilizing more information. We lay a theoretical foundation for the use of single-variable heuristics such as the Recognition Heuristic as an optimal decision strategy within a linear modeling framework. We identify conditions under which over-weighting a single predictor is a mini-max strategy among a class of a priori chosen weights based on decision heuristics with respect to a measure of statistical lack of fit we call “risk”. These strategies, in turn, outperform standard multiple regression as long as the amount of data available is limited. We also show that, under related conditions, weighting only one variable and ignoring all others produces the same risk as ignoring the single variable and weighting all others. This approach has the advantage of generalizing beyond the original environment of the Recognition Heuristic to situations with more than two choice options, binary or continuous representations of recognition, and to other single variable heuristics. We analyze the structure of data used in some prior recognition tasks and find that it matches the sufficient conditions for optimality in our results. Rather than being a poor or adequate substitute for a compensatory model, the Recognition Heuristic closely approximates an optimal strategy when a decision maker has finite data about the world.
The COVID-19 pandemic has harmed many people's mental health globally. Whilst the evidence generated thus far from high-income countries regarding the pandemic's impact on suicide rates is generally reassuring, we know little about its influence on this outcome in lower- and middle-income countries or among marginalised and disadvantaged people. There are some signals for concern regarding the pandemic's potentially unequal impact on suicide rates, with some of the affected demographic subgroups and regions being at elevated risk before the pandemic began. However, the evidence-base for this topic is currently sparse, and studies conducted to date have generally not taken account of pre-pandemic temporal trends. The collection of accurate, complete and comparable data on suicide rate trends in ethnic minority and low-income groups should be prioritised. The vulnerability of low-income groups will likely be exacerbated further by the current energy supply and cost-of-living crises in many countries. It is therefore crucial that reassuring messaging highlighting the stability of suicide rates during the pandemic does not lead to complacency among policymakers.
North Dakota’s unique statewide parking-meter ban was instituted by initiated measure in 1948. The 2017 legislative session witnessed the most credible effort to repeal the ban in decades. The legislative debate centered on tradition, the state’s long-standing urban–rural split, and its lingering populist roots. The authors place this debate within a larger rural-consciousness literature and examine how the politics of rural resentment contributed to maintaining the parking-meter ban, as well as the willingness of state lawmakers to use preemption as a tool to constrain the authority of larger cities. The authors also examine the complexity surrounding individual place-based identities. The extent to which urban residents in a rural state can simultaneously identify as “urban” relative to state-based policies and politics and “rural” relative to federal-based policies and politics merits further consideration.
Evidence on the impact of the pandemic on healthcare presentations for self-harm has accumulated rapidly. However, existing reviews do not include studies published beyond 2020.
Aims
To systematically review evidence on presentations to health services following self-harm during the COVID-19 pandemic.
Method
A comprehensive search of databases (WHO COVID-19 database; Medline; medRxiv; Scopus; PsyRxiv; SocArXiv; bioRxiv; COVID-19 Open Research Dataset, PubMed) was conducted. Studies published from 1 January 2020 to 7 September 2021 were included. Study quality was assessed with a critical appraisal tool.
Results
Fifty-one studies were included: 57% (29/51) were rated as ‘low’ quality, 31% (16/51) as ‘moderate’ and 12% (6/51) as ‘high-moderate’. Most evidence (84%, 43/51) was from high-income countries. A total of 47% (24/51) of studies reported reductions in presentation frequency, including all six rated as high-moderate quality, which reported reductions of 17–56%. Settings treating higher lethality self-harm were overrepresented among studies reporting increased demand. Two of the three higher-quality studies including study observation months from 2021 reported reductions in self-harm presentations. Evidence from 2021 suggests increased numbers of presentations among adolescents, particularly girls.
Conclusions
Sustained reductions in numbers of self-harm presentations were seen into the first half of 2021, although this evidence is based on a relatively small number of higher-quality studies. Evidence from low- and middle-income countries is lacking. Increased numbers of presentations among adolescents, particularly girls, into 2021 is concerning. Findings may reflect changes in thresholds for help-seeking, use of alternative sources of support and variable effects of the pandemic across groups.
Deliberative processes for health technology assessment (HTA) are intended to facilitate participatory decision making, using discussion and open dialogue between stakeholders. Increasing attention is being given to deliberative processes, but guidance is lacking for those who wish to design or use them. Health Technology Assessment International (HTAi) and ISPOR—The Professional Society for Health Economics and Outcomes Research initiated a joint Task Force to address this gap.
Methods
The joint Task Force consisted of fifteen members with different backgrounds, perspectives, and expertise relevant to the field. It developed guidance and a checklist for deliberative processes for HTA. The guidance builds upon the few, existing initiatives in the field, as well as input from the HTA community following an established consultation plan. In addition, the guidance was subject to two rounds of peer review.
Results
A deliberative process for HTA consists of procedures, activities, and events that support the informed and critical examination of an issue and the weighing of arguments and evidence to guide a subsequent decision. Guidance and an accompanying checklist are provided for (i) developing the governance and structure of an HTA program and (ii) informing how the various stages of an HTA process might be managed using deliberation.
Conclusions
The guidance and the checklist contain a series of questions, grouped by six phases of a model deliberative process. They are offered as practical tools for those wishing to establish or improve deliberative processes for HTA that are fit for local contexts. The tools can also be used for independent scrutiny of deliberative processes.
OBJECTIVES/GOALS: Osteoarthritis (OA) is a cartilage destroying disease. We are investigating abaloparatide (ABL) activation of parathyroid hormone receptor type 1 (PTH1R), which is expressed by articular chondrocytes in OA. We propose ABL treatment is chondroprotective in murine PTOA via stimulation of matrix production and inhibition of chondrocyte maturation. METHODS/STUDY POPULATION: 16-week-old C57BL/6 male mice received destabilization of the medial meniscus (DMM) surgery to induce knee PTOA. Beginning 2 weeks post-DMM, 40 μg/kg of ABL (or saline) was administered daily via subcutaneous injection and tissues were harvested after 6 weeks of daily injections and 8 weeks after DMM surgery. Harvested joint tissues were used for histological and molecular assessment of OA using three 5 μm thick sagittal sections from each joint, 50 μm apart, cut from the medial compartment of injured knees. Safranin O/Fast Green tissue staining and immunohistochemistry-based detection of type 10 collagen (Col10) and lubricin (Prg4) was performed using standard methods. Histomorphometric quantification of tibial cartilage area and larger hypertrophic-like cells was performed using the Osteomeasure system. RESULTS/ANTICIPATED RESULTS: Safranin O/Fast Green stained sections showed a decreased cartilage loss in DMM joints from ABL-treated versus saline-treated mice. Histomorphometric analysis of total tibial cartilage area revealed preservation of cartilage tissue on the tibial surface. Immunohistochemical analyses showed that upregulation of Col10 in DMM joints was mitigated in the cartilage of ABL-treated mice, and chondrocyte expression of Prg4 was increased in uncalcified cartilage areas in ABL-treated group. The Prg4 finding suggests a matrix anabolic effect that may counter OA cartilage loss. Quantification of chondrocytes in uncalcified and calcified tibial cartilage areas revealed a reduction in the number of larger hypertrophic-like cells in ABL treated mice, suggesting deceleration of hypertrophic differentiation. DISCUSSION/SIGNIFICANCE: Cartilage preservation/regeneration therapies would fill a critical unmet need. We demonstrate that an osteoporosis drug targeting PTH1R decelerates PTOA in mice. ABL treatment was associated with preservation of cartilage, decreased Col10, increased Prg4, and decreased number of large hypertrophic-like chondrocytes in the tibial cartilage.
The use of older data and references is becoming increasingly disfavored for publication. A myopic focus on newer research risks losing sight of important research questions already addressed by now-invisible older studies. This creates a ‘Groundhog Day’ effect as illustrated by the 1993 movie of this name in which the protagonist has to relive the same day (Groundhog Day) over and over and over within a world with no memory of it. This article examines the consequences of the recent preference for newer data and references in current publication practices and is intended to stimulate new consideration of the utility of selected older data and references for the advancement of scientific knowledge.
Methods
Examples from the literature are used to exemplify the value of older data and older references. To illustrate the recency of references published in original medical research articles in a selected sample of recent academic medical journals, original research articles were examined in recent issues in selected psychiatry, medicine, and surgery journals.
Results
The literature examined reflected this article's initial assertion that journals are emphasizing the publication of research with newer data and more recent references.
Conclusions
The current valuation of newer data above older data fails to appreciate the fact that new data eventually become old, and that old data were once new. The bias demonstrated in arbitrary policies pertaining to older data and older references can be addressed by instituting comparable treatment of older and newer data and references.
The early modern era produced the Scientific Revolution, which originated our present understanding of the natural world. Concurrently, philosophers established the conceptual foundations of modernity. This rich and comprehensive volume surveys and illuminates the numerous and complicated interconnections between philosophical and scientific thought as both were radically transformed from the late sixteenth to the mid-eighteenth century. The chapters explore reciprocal influences between philosophy and physics, astronomy, mathematics, medicine, and other disciplines, and show how thinkers responded to an immense range of intellectual, material, and institutional influences. The volume offers a unique perspicuity, viewing the entire landscape of early modern philosophy and science, and also marks an epoch in contemporary scholarship, surveying recent contributions and suggesting future investigations for the next generation of scholars and students.