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Over the past century, countries around the globe have empowered constitutional courts to safeguard the rule of law. But when can courts effectively perform this vital task? Drawing upon a series of survey experiments fielded in the United States, Germany, Hungary, and Poland, this book demonstrates that judicial independence is critical for judicial efficacy, showing that independent courts are uniquely capable of empowering citizens to punish executives who flout the rule of law, while also demonstrating that weak courts are unable to generate public support for upholding the rule of law. This important work concludes that, while judicial efficacy is neither universal nor automatic, courts-so long as they are viewed by the public as independent-can provide an effective check on executives and promote the rule of law.
The authors offer reflections and lessons learned in a single pediatric tertiary center’s experience during a pediatric mass casualty incident (MCI). The MCI occurred at a holiday parade and the patients were brought to multiple community emergency departments for initial resuscitation prior to transfer to the Pediatric level 1 trauma center. In total, 18 children presented with severe blunt force trauma after a motor vehicle entered the parade route. Following initial triage in emergency departments, 10 of 18 children injured during the incident were admitted to the Pediatric Intensive Care Unit, collectively representing a system-wide stressor of emergency medicine, critical care, and surgical services. Institutional characteristics, activation of personnel and supplies, and psychosocial support for families during an MCI are important to consider in children’s hospitals’ disaster preparedness planning.
Schizophrenia is one of the top 15 causes of disability worldwide and among the most expensive mental disorders to treat. Relapse, commonly associated with healthcare utilization including hospitalization, is prevalent and progressive in schizophrenia. Electronic health record (EHR) data could be used for timely identification of those at highest risk for relapse. This study utilized a large sample of Midwestern healthcare patients (pts) diagnosed with schizophrenia and schizoaffective disorders to identify demographic, clinical, and utilization characteristics that predicted relapse.
Methods
This retrospective study includes EHR data from all pts between Oct 15, 2016, and Dec 31, 2021, who had at least 1 y of encounters. Patients’ first encounter with a schizophrenia or schizoaffective disorder diagnosis (ICD-10 F20 or F25) in this timeframe was defined as their index date, and all encounters up to 3 y post-index date (PID) were explored. Patient-level variables within the first 6 mo of follow-up (FU) were assessed as potential relapse predictors, and first relapse at or after 6 mo of FU within the system was explored as the outcome. Relapse was defined as occurrence of any behavioral health-related emergency room or inpatient encounter after 6 mo of FU within the system. Potential variables assessed include pt characteristics at index date, comorbidities diagnosed, healthcare encounter settings utilized, medication classes prescribed, and disorder-related outcomes experienced.
Results
The study sample included 8119 pts with 325,745 total FU encounters, with an average of 28.0 mo of FU data PID. Among all pts, 30.5% experienced relapse by this study’s definition. Analyses revealed differences in insurance type, race/ethnicity, and age, and differences across a breadth of comorbid diagnoses, healthcare encounter settings utilized, disorder-related outcomes experienced, and medical classes prescribed. Adjusted analysis revealed pts who relapsed were more likely to be younger (RR=0.99[0.99,0.99]; p<0.0001); identify as Hispanic or Latino (RR=1.15[1.03,1.28]; p=0.0121) or Non-Hispanic (NH) Pacific Islander (RR=1.83[1.16,2.89]; p=0.0090) vs. NH White; have Medicare (RR=1.22[1.08,1.39]; p=0.0018) or Medicaid (RR=1.33[1.17,1.51]; p<0.0001) vs. Private insurance; have diagnoses of substance use (RR=1.33[1.24,1.43]; p<0.0001) and EPS (RR=1.78[1.65,1.92]; p<0.0001); utilize more ER (RR=1.02[1.01,1.02]; p<0.0001) and BH inpatient (RR=1.10[1.06,1.14]; p<0.0001) encounters; experience more prior relapse (RR=1.05;[1.03,1.06]; p<0.0001), and receive more LAI prescriptions (RR=1.01[1.00,1.02]; p=0.0349).
Conclusions
An algorithm of these variables could conceivably be used to proactively assess relapse risk among pts with schizophrenia to ultimately decide on and implement appropriate relapse prevention plans. Further exploration may be required to better understand underlying modifiable factors that put pts at increased risk of poor outcomes.
Funding
Sumitomo Pharma America, Inc. and Otsuka Pharmaceuticals Development & Commercialization, Inc.
The gut microbiome is impacted by certain types of dietary fibre. However, the type, duration and dose needed to elicit gut microbial changes and whether these changes also influence microbial metabolites remain unclear. This study investigated the effects of supplementing healthy participants with two types of non-digestible carbohydrates (resistant starch (RS) and polydextrose (PD)) on the stool microbiota and microbial metabolite concentrations in plasma, stool and urine, as secondary outcomes in the Dietary Intervention Stem Cells and Colorectal Cancer (DISC) Study. The DISC study was a double-blind, randomised controlled trial that supplemented healthy participants with RS and/or PD or placebo for 50 d in a 2 × 2 factorial design. DNA was extracted from stool samples collected pre- and post-intervention, and V4 16S rRNA gene sequencing was used to profile the gut microbiota. Metabolite concentrations were measured in stool, plasma and urine by high-performance liquid chromatography. A total of fifty-eight participants with paired samples available were included. After 50 d, no effects of RS or PD were detected on composition of the gut microbiota diversity (alpha- and beta-diversity), on genus relative abundance or on metabolite concentrations. However, Drichlet’s multinomial mixture clustering-based approach suggests that some participants changed microbial enterotype post-intervention. The gut microbiota and fecal, plasma and urinary microbial metabolites were stable in response to a 50-d fibre intervention in middle-aged adults. Larger and longer studies, including those which explore the effects of specific fibre sub-types, may be required to determine the relationships between fibre intake, the gut microbiome and host health.
Anxiety is a common comorbid feature of late-life depression (LLD) and is associated with poorer global cognitive functioning independent of depression severity. However, little is known about whether comorbid anxiety is associated with a domain-specific pattern of cognitive dysfunction. We therefore examined group differences (LLD with and without comorbid anxiety) in cognitive functioning performance across multiple domains.
Method:
Older adults with major depressive disorder (N = 228, ages 65–91) were evaluated for anxiety and depression severity, and cognitive functioning (learning, memory, language, processing speed, executive functioning, working memory, and visuospatial functioning). Ordinary least squares regression adjusting for age, sex, education, and concurrent depression severity examined anxiety group differences in performance on tests of cognitive functioning.
Results:
Significant group differences emerged for confrontation naming and visuospatial functioning, as well as for verbal fluency, working memory, and inhibition with lower performance for LLD with comorbid anxiety compared to LLD only, controlling for depression severity.
Conclusions:
Performance patterns identified among older adults with LLD and comorbid anxiety resemble neuropsychological profiles typically seen in neurodegenerative diseases of aging. These findings have potential implications for etiological considerations in the interpretation of neuropsychological profiles.
Neuropsychiatric symptoms are common after traumatic brain injury (TBI) and often resolve within 3 months post-injury. However, the degree to which individual patients follow this course is unknown. We characterized trajectories of neuropsychiatric symptoms over 12 months post-TBI. We hypothesized that a substantial proportion of individuals would display trajectories distinct from the group-average course, with some exhibiting less favorable courses.
Methods
Participants were level 1 trauma center patients with TBI (n = 1943), orthopedic trauma controls (n = 257), and non-injured friend controls (n = 300). Trajectories of six symptom dimensions (Depression, Anxiety, Fear, Sleep, Physical, and Pain) were identified using growth mixture modeling from 2 weeks to 12 months post-injury.
Results
Depression, Anxiety, Fear, and Physical symptoms displayed three trajectories: Stable-Low (86.2–88.6%), Worsening (5.6–10.9%), and Improving (2.6–6.4%). Among symptomatic trajectories (Worsening, Improving), lower-severity TBI was associated with higher prevalence of elevated symptoms at 2 weeks that steadily resolved over 12 months compared to all other groups, whereas higher-severity TBI was associated with higher prevalence of symptoms that gradually worsened from 3–12 months. Sleep and Pain displayed more variable recovery courses, and the most common trajectory entailed an average level of problems that remained stable over time (Stable-Average; 46.7–82.6%). Symptomatic Sleep and Pain trajectories (Stable-Average, Improving) were more common in traumatically injured groups.
Conclusions
Findings illustrate the nature and rates of distinct neuropsychiatric symptom trajectories and their relationship to traumatic injuries. Providers may use these results as a referent for gauging typical v. atypical recovery in the first 12 months post-injury.
Social workers are vital in delivering psychosocial services in palliative care, yet their specific roles in palliative oncology remain undefined. This study aimed to delineate the current practice role of oncology social workers involvement in palliative care in the United States.
Methods
This study utilized a cross-sectional design and involved secondary analysis of data from a nationwide survey focused on workforce conditions for oncology social workers. The participants were social workers who were directly involved in providing care to cancer patients and delivering palliative care services. They completed an online survey in which they indicated the relevance of 91 tasks related to their practice. The survey also collected individual demographic and work-related characteristics. Exploratory factor analysis was used to achieve the study objective.
Results
Responses from a secondary data set of 243 oncology social workers involved in palliative care results in a 6-factor solution comprising 34 tasks. These factors were identified as: Therapeutic Interventions for Individuals, Couples, and Families; Facilitate Patient Care Decision-making; Care Coordination; Assessment and Emotional Support; Organization and Community Service; and Equity and Justice. All 6 factors demonstrated good internal reliability, as indicated by Cronbach’s alpha scores above 0.70.
Significance of results
The findings can be used to develop job descriptions and education for social workers employed in palliative cancer care. The clear role descriptions also make social work visible to other professionals in palliative oncology. By clarifying the roles of oncology social workers, this study contributes to the improvement of palliative care delivery and enhances interprofessional collaboration within cancer care teams.
OBJECTIVES/GOALS: Fluid boluses are administered to hypotensive, critically ill children but may not reverse hypotension, leading to delay of vasoactive infusion, end-organ damage, and mortality. We hypothesize that a machine learning-based model will predict which children will have sustained response to fluid bolus. METHODS/STUDY POPULATION: We will conduct a single-center retrospective observational cohort study of hypotensive critically ill children who received intravenous isotonic fluid of at least 10 ml/kg within 72 hours of pediatric intensive care unit admission between 2013 and 2023. We will extract physiologic variables from stored bedside monitors data and clinical variables from the EHR. Fluid responsive (FR) will be defined as a MAP increase by 310%. We will construct elastic net, random forest, and a long short-term memory models to predict FR. We will compare complicated course (multiple organ dysfunction on day 7 or death by day 28) between: 1) FRs and non-FRs, 2) predicted FRs and non-FRs, 3), FRs and non-FRs stratified by race/ethnicity, and 4) FRs and non-FRs stratified by sex as a biologic variable. RESULTS/ANTICIPATED RESULTS: We anticipate approximately 800 critically ill children will receive 2,000 intravenous isotonic fluid boluses, with a 60% rate of FR. We anticipate being able to complete all three models. We hypothesize that the model with the best performance will be the long short-term memory model and the easiest to interpret will be the tree-based random forest model. We hypothesize non-FRs will have a higher complicated course than FRs and that predicted non-FRs will have a higher rate of complicated course than FRs. Based on previous adult studies, we hypothesize that there will be a higher rate of complicated course in patients of black race and/or Hispanic ethnicity when compared to non-Hispanic white patients. We also hypothesize that there will be no difference in complicated course when comparing sex as a biologic variable. DISCUSSION/SIGNIFICANCE: We have a critical need for easily-deployed, real-time prediction of fluid response to personalize and improve resuscitation for children in shock. We anticipate the clinical application of such a model will decrease time with hypotension for critically ill children, leading to decreased morbidity and mortality.
Late-life depression (LLD) is common and frequently co-occurs with neurodegenerative diseases of aging. Little is known about how heterogeneity within LLD relates to factors typically associated with neurodegeneration. Varying levels of anxiety are one source of heterogeneity in LLD. We examined associations between anxiety symptom severity and factors associated with neurodegeneration, including regional brain volumes, amyloid beta (Aβ) deposition, white matter disease, cognitive dysfunction, and functional ability in LLD.
Participants and Measurements:
Older adults with major depression (N = 121, Ages 65–91) were evaluated for anxiety severity and the following: brain volume (orbitofrontal cortex [OFC], insula), cortical Aβ standardized uptake value ratio (SUVR), white matter hyperintensity (WMH) volume, global cognition, and functional ability. Separate linear regression analyses adjusting for age, sex, and concurrent depression severity were conducted to examine associations between anxiety and each of these factors. A global regression analysis was then conducted to examine the relative associations of these variables with anxiety severity.
Results:
Greater anxiety severity was associated with lower OFC volume (β = −68.25, t = −2.18, p = .031) and greater cognitive dysfunction (β = 0.23, t = 2.46, p = .016). Anxiety severity was not associated with insula volume, Aβ SUVR, WMH, or functional ability. When examining the relative associations of cognitive functioning and OFC volume with anxiety in a global model, cognitive dysfunction (β = 0.24, t = 2.62, p = .010), but not OFC volume, remained significantly associated with anxiety.
Conclusions:
Among multiple factors typically associated with neurodegeneration, cognitive dysfunction stands out as a key factor associated with anxiety severity in LLD which has implications for cognitive and psychiatric interventions.
Tippins et al. (2023) challenge I-O psychologists to more actively – in Miller’s oft-quoted APA presidential address – “give psychology away.” Their article provides stirring examples of the impact several of our colleagues have made in giving psychology away. In thinking about how to encourage and facilitate more of us to volunteer, we’d like to share several thoughts on our roles as I-Os, both as individuals and as a community. In particular, we propose that volunteerism is an expression of our calling as I-Os; suggest five roles we can play as individuals; discuss three roles for the community at-large; and conclude with a call to action.
In 2016, the National Center for Advancing Translational Science launched the Trial Innovation Network (TIN) to address barriers to efficient and informative multicenter trials. The TIN provides a national platform, working in partnership with 60+ Clinical and Translational Science Award (CTSA) hubs across the country to support the design and conduct of successful multicenter trials. A dedicated Hub Liaison Team (HLT) was established within each CTSA to facilitate connection between the hubs and the newly launched Trial and Recruitment Innovation Centers. Each HLT serves as an expert intermediary, connecting CTSA Hub investigators with TIN support, and connecting TIN research teams with potential multicenter trial site investigators. The cross-consortium Liaison Team network was developed during the first TIN funding cycle, and it is now a mature national network at the cutting edge of team science in clinical and translational research. The CTSA-based HLT structures and the external network structure have been developed in collaborative and iterative ways, with methods for shared learning and continuous process improvement. In this paper, we review the structure, function, and development of the Liaison Team network, discuss lessons learned during the first TIN funding cycle, and outline a path toward further network maturity.
To assess whether measurement and feedback of chlorhexidine gluconate (CHG) skin concentrations can improve CHG bathing practice across multiple intensive care units (ICUs).
Design:
A before-and-after quality improvement study measuring patient CHG skin concentrations during 6 point-prevalence surveys (3 surveys each during baseline and intervention periods).
Setting:
The study was conducted across 7 geographically diverse ICUs with routine CHG bathing.
Participants:
Adult patients in the medical ICU.
Methods:
CHG skin concentrations were measured at the neck, axilla, and inguinal region using a semiquantitative colorimetric assay. Aggregate unit-level CHG skin concentration measurements from the baseline period and each intervention period survey were reported back to ICU leadership, which then used routine education and quality improvement activities to improve CHG bathing practice. We used multilevel linear models to assess the impact of intervention on CHG skin concentrations.
Results:
We enrolled 681 (93%) of 736 eligible patients; 92% received a CHG bath prior to survey. At baseline, CHG skin concentrations were lowest on the neck, compared to axillary or inguinal regions (P < .001). CHG was not detected on 33% of necks, 19% of axillae, and 18% of inguinal regions (P < .001 for differences in body sites). During the intervention period, ICUs that used CHG-impregnated cloths had a 3-fold increase in patient CHG skin concentrations as compared to baseline (P < .001).
Conclusions:
Routine CHG bathing performance in the ICU varied across multiple hospitals. Measurement and feedback of CHG skin concentrations can be an important tool to improve CHG bathing practice.
One challenge for multisite clinical trials is ensuring that the conditions of an informative trial are incorporated into all aspects of trial planning and execution. The multicenter model can provide the potential for a more informative environment, but it can also place a trial at risk of becoming uninformative due to lack of rigor, quality control, or effective recruitment, resulting in premature discontinuation and/or non-publication. Key factors that support informativeness are having the right team and resources during study planning and implementation and adequate funding to support performance activities. This communication draws on the experience of the National Center for Advancing Translational Science (NCATS) Trial Innovation Network (TIN) to develop approaches for enhancing the informativeness of clinical trials. We distilled this information into three principles: (1) assemble a diverse team, (2) leverage existing processes and systems, and (3) carefully consider budgets and contracts. The TIN, comprised of NCATS, three Trial Innovation Centers, a Recruitment Innovation Center, and 60+ CTSA Program hubs, provides resources to investigators who are proposing multicenter collaborations. In addition to sharing principles that support the informativeness of clinical trials, we highlight TIN-developed resources relevant for multicenter trial initiation and conduct.
Early in the Russian-Ukrainian conflict, the Ukrainian Ministry of Health (MoH) implemented policy reform to allow for pre-hospital whole blood transfusion (pWBT). Team Rubicon (TR) worked with a multinational group of experts to disseminate training that accelerated the implementation of pWBT across the country.
Method:
TR utilized an assess, align, and act (A3) approach to drive the pWBT implementation. TR established relationships with Ukrainian providers to understand current needs, restrictions, and protocols for pWBT. TR aligned pWBT advocacy efforts, working with the disaster medicine program at Ivano-Frankivsk Medical National University to create a local lead advocate. Existing and novel coordination mechanisms were used to unite and inform MoH, World Health Organization, Non-Governmental Organizations, and local health systems. Finally, TR coordinated a multispecialty, multi-national team of healthcare providers who developed and delivered a training package in alignment with national guidelines utilizing a combination of didactics, videos, and demonstrations. From August to October of 2022, TR conducted pWBT trainings across Ukraine. Pre- and post-surveys were utilized to determine comfort with pWBT and usefulness of the training.
Results:
TR emerged as the point of reference for pWBT in Ukraine. 109 individuals from over 14 organizations were trained. Participants included 69 physicians, 23 paramedics, 7 nurses, and 10 other professionals. 95% of those surveyed had not received prior pWBT training. Participants reported increased comfort levels, with average pre- and post-course comfort scores of 1.7 and 3.2 (4=very comfortable), respectively. The majority of participants found the training useful (average score of 3.8, 4=very useful). Feedback demonstrated high satisfaction ratings and an increased awareness of the regulatory changes.
Conclusion:
TR utilized the A3 model to drive a coalition that supported policy reform and trauma system improvements in Ukraine. TR’s ability to leverage international medical expertise, work collaboratively with MoH, and provide material resources supported local implementation of pWBT.
How does the public respond to court-packing attempts? Longstanding accounts of public support for courts suggest voters retaliate against incumbents who seek to manipulate well-respected courts. Yet incumbents might strategically frame their efforts in bureaucratic terms to minimize the public’s outcry or use court-packing proposals to activate a partisan base of support. Drawing on a series of survey experiments, we demonstrate that strategic politicians can minimize electoral backlash by couching court reform proposals in apolitical language, and institutional legitimacy’s shielding effect dissolves in the face of shared partisanship. These results shed new light on how ambitious politicians might avoid electoral consequences for efforts to bend the judiciary to their will.
Second language learners’ reading is less efficient and more effortful than native reading. However, the source of their difficulty is unclear; L2 readers might struggle with reading in a different orthography, or they might have difficulty with later stages of linguistic interpretation of the input, or both. The present study explored the source of L2 reading difficulty by analyzing the distribution of fixation durations in reading. In three studies, we observed that L2 readers experience an increase in Mu, which we interpret as indicating early orthographic processing difficulty, when the L2 has a significantly different writing system than the L1 (e.g., Chinese and English) but not when the writing systems were similar (e.g., Portuguese and English). L2 readers also experienced an increase in Tau, indicating later-arising processing difficulty which likely reflects later-stage linguistic processes, when they read for comprehension. L2 readers of Chinese also experienced an additional increase in Tau.
Despite the public health burden of traumatic brain injury (TBI) across broader society, most TBI studies have been isolated to a distinct subpopulation. The TBI research literature is fragmented further because often studies of distinct populations have used different assessment procedures and instruments. Addressing calls to harmonize the literature will require tools to link data collected from different instruments that measure the same construct, such as civilian mild traumatic brain injury (mTBI) and sports concussion symptom inventories.
Method:
We used item response theory (IRT) to link scores from the Rivermead Post Concussion Symptoms Questionnaire (RPQ) and the Sport Concussion Assessment Tool (SCAT) symptom checklist, widely used instruments for assessing civilian and sport-related mTBI symptoms, respectively. The sample included data from n = 397 patients who suffered a sports-related concussion, civilian mTBI, orthopedic injury control, or non-athlete control and completed the SCAT and/or RPQ.
Results:
The results of several analyses supported sufficient unidimensionality to treat the RPQ + SCAT combined item set as measuring a single construct. Fixed-parameter IRT was used to create a cross-walk table that maps RPQ total scores to SCAT symptom severity scores. Linked and observed scores were highly correlated (r = .92). Standard errors of the IRT scores were slightly higher for civilian mTBI patients and orthopedic controls, particularly for RPQ scores linked from the SCAT.
Conclusion:
By linking the RPQ to the SCAT we facilitated efforts to effectively combine samples and harmonize data relating to mTBI.
While panel effects—instances in which panel composition affects the votes cast by judges—have been widely documented, scholars are unsure why these patterns persist. We outline three possible mechanisms, acquiescence, deliberation, and strategy, through which panel effects might occur; develop indicators for each; and test them using a data set of search and seizure cases decided by the US courts of appeals between 1953 and 2010. Our analysis provides some evidence that counterjudge success stems from a combination of all three theories, although strategic considerations have the substantively strongest and most consistent effects.
Human capital theory suggests that work experience acquired through on-the-job-training primes people to be more successful. Empirical validations of this hypothesis are numerous, but limited evidence of the relevance of human capital for courtroom advocacy exists. We examine whether the outcomes obtained by experienced attorneys are significantly better than the outcomes they would have obtained as novices. Adopting a strategy for credible causal inference that could be applied to almost any peak court, the analysis shows that attorneys with experience, relative to first timers, are significantly and consistently more likely to win their cases and capture the votes of judges.
In 2011, Bolivia became the first modern country to directly elect national judges. Reformers heralded the adoption of judicial elections as a “democratization of justice,” by which institutional independence would be assured, public confidence in the judiciary might be expanded, and various maladies of the judicial system would find resolution. We evaluate the elections in light of these objectives. We show candidates were advantaged when voters shared their partisan and demographic traits, resulting in unprecedented diversity on the national courts. Also, public confidence in the judiciary increased among government supporters but declined overall. We offer preliminary reflections for would-be reformers.