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Decentralized research has many advantages; however, little is known about the representativeness of a source population in decentralized studies. We recruited participants aged 18-64 years from four states from June to December 2022 for a prospective cohort study to assess viral epidemiology. Our aim was to determine the association between age, gender, race/ethnicity, rurality, and socioeconomic status (SES) on study participation in a decentralized prospective cohort study.
Methods:
We consented 9,286 participants from 231,099 (4.0%) adults with the mean age of 45.6 years (±12.0). We used an electronic decentralized approach for recruitment. Consented participants were more likely to be non-Hispanic White, female, older, urban residents, have more health conditions, and possessed higher socioeconomic status (SES) compared to those non-consented.
Results:
We observed an interaction between SES and race-ethnicity on the odds of consent (P = 0.006). Specifically, SES did not affect non-Hispanic white participation rates(OR 1.24 95% CI 1.16 – 1.32] for the highest SES quartile compared to those with the lowest SES quartile) as much as it did participants combined across the other races (OR 1.73; 95% CI 1.45 – 2.98])
Conclusion:
The relationship between SES and consent rates might be disproportionately greater in historically disadvantaged groups, compared to non-Hispanic White. It suggests that instead of focusing on enrollment of specific minority groups in research, there is value in future research exploring and addressing the diversity of barriers to trials within minority groups. Our study highlights that decentralized studies need to address social determinants of health, especially in under-resourced populations.
Kant’s aim in the Transcendental Deduction is to prove that the a priori categories of the understanding necessarily apply to objects of experience. He claims that he will do this simply by explaining how they could so apply. But the idea that a mere explanation of this possibility should provide a defence of the categories’ actual (let alone necessary) applicability is surprising. We argue that it can be understood by attending to the source of the scepticism that the Critique’s Analytic is supposed to overcome: Hume’s inability to explain causal knowledge in the Enquiry.
England's primary care service for psychological therapy (Improving Access to Psychological Therapies [IAPT]) treats anxiety and depression, with a target recovery rate of 50%. Identifying the characteristics of patients who achieve recovery may assist in optimizing future treatment. This naturalistic cohort study investigated pre-therapy characteristics as predictors of recovery and improvement after IAPT therapy.
Methods
In a cohort of patients attending an IAPT service in South London, we recruited 263 participants and conducted a baseline interview to gather extensive pre-therapy characteristics. Bayesian prediction models and variable selection were used to identify baseline variables prognostic of good clinical outcomes. Recovery (primary outcome) was defined using (IAPT) service-defined score thresholds for both depression (Patient Health Questionnaire [PHQ-9]) and anxiety (Generalized Anxiety Disorder [GAD-7]). Depression and anxiety outcomes were also evaluated as standalone (PHQ-9/GAD-7) scores after therapy. Prediction model performance metrics were estimated using cross-validation.
Results
Predictor variables explained 26% (recovery), 37% (depression), and 31% (anxiety) of the variance in outcomes, respectively. Variables prognostic of recovery were lower pre-treatment depression severity and not meeting criteria for obsessive compulsive disorder. Post-therapy depression and anxiety severity scores were predicted by lower symptom severity and higher ratings of health-related quality of life (EuroQol questionnaire [EQ5D]) at baseline.
Conclusion
Almost a third of the variance in clinical outcomes was explained by pre-treatment symptom severity scores. These constructs benefit from being rapidly accessible in healthcare services. If replicated in external samples, the early identification of patients who are less likely to recover may facilitate earlier triage to alternative interventions.
The stakeholder analysis approach has historically been top-down rather than collaborative with key partners. However, this approach poses challenges for key partner engagement and community-engaged research, which aims to incorporate key partners throughout the project. This study, conducted by the Community Engagement Network at a Midwest Academic Medical Center, seeks to examine the value of community-engaged research for diverse key partners to increase collaboration, strengthen partnerships, and enhance impact, ultimately driving key partner engagement.
Methods:
The study involved semi-structured interviews with 38 key partners from diverse groups, including community members, community organizations, Practice-Based Research Network members, researchers, research administration, university administration, and potential funders. The interview guide, informed by an extensive literature review, assessed perceived value, barriers, and improvement strategies for community-engaged research, supplemented by value proposition statements.
Results:
The analysis revealed three main themes: 1) Fostering Community Buy-In: Authentic representation and inclusive partnerships were essential for trust and commitment; 2) Enhancing Communication and Dissemination: Effective communication strategies were vital for maintaining engagement and sharing research outcomes; and 3) Building Capacity and Ensuring Sustainability: Continuous learning and long-term investments were crucial for sustaining community-engaged research efforts.
Discussion:
This study underscores the value of incorporating key partners into stakeholder analyses to enhance collaboration, strengthen partnerships, and improve the impact of community-engaged research. The findings offer valuable insight for institutional transformation and implementation of effective stakeholder analyses and engagement tools, ultimately enhancing the effectiveness of research strategies and initiatives.
We explore some of the risks related to Artificial Intelligence (AI) from an actuarial perspective based on research from a transregional industry focus group. We aim to define the key gaps and challenges faced when implementing and utilising modern modelling techniques within traditional actuarial tasks from a risk perspective and in the context of professional standards and regulations. We explore best practice guidelines to attempt to define an ideal approach and propose potential next steps to help reach the ideal approach. We aim to focus on the considerations, initially from a traditional actuarial perspective and then, if relevant, consider some implications for non-traditional actuarial work, by way of examples. The examples are not intended to be exhaustive. The group considered potential issues and challenges of using AI, related to the following key themes:
Ethical
○ Bias, fairness, and discrimination
○ Individualisation of risk assessment
○ Public interest
Professional
○ Interpretability and explainability
○ Transparency, reproducibility, and replicability
○ Validation and governance
Lack of relevant skills available
Wider themes
This paper aims to provide observations that could help inform industry and professional guidelines or discussion or to support industry practitioners. It is not intended to replace current regulation, actuarial standards, or guidelines. The paper is aimed at an actuarial and insurance technical audience, specifically those who are utilising or developing AI, and actuarial industry bodies.
A straight cylindrical duct is considered containing an axial mean flow that is uniform everywhere except within a boundary layer near the wall, which need not be thin. Within this boundary layer the mean flow varies parabolically. The linearized Euler equations are Fourier transformed to give the Pridmore-Brown equation, for which the Green's function is constructed using Frobenius series. The critical layer gives a non-modal contribution from the continuous spectrum branch cut, and dominates the downstream pressure perturbation in certain cases, particularly for thicker boundary layers. The continuous spectrum branch cut is also found to stabilize what are otherwise convectively unstable modes by hiding them behind the branch cut. Overall, the contribution from the critical layer is found to give a neutrally stable non-modal wave when the source is located within the sheared flow region, and to decay algebraically along the duct as $O(x^{-{5}/{2}})$ for a source located with the uniform flow region. The Frobenius expansion, in addition to being numerically accurate close to the critical layer where other numerical methods lose accuracy, is also able to locate modal poles hidden behind the branch cut, which other methods are unable to find; this includes the stabilized hydrodynamic instability. Matlab code is provided to compute the Green's function.
Data suggest poorer bereavement outcomes for lesbian, gay and bisexual people, but this has not been estimated in population-based research. This study compared bereavement outcomes for partners of same-gender and different-gender decedents.
Methods
In this population-based, cross-sectional survey of people bereaved of a civil partner or spouse 6–10 months previously, we used adjusted logistic and linear regression to investigate outcomes of interest: (1) positive screen on Inventory of Complicated Grief (ICG), (2) positive screen on General Health Questionnaire (GHQ), (3) grief intensity (ICG) and (4) psychiatric symptoms (GHQ-12).
Results
Among 233 same-gender partners and 329 of different-gender partners, 66.1% [95% confidence interval (CI) 60.0–72.2] and 59.2% [95% CI (53.9–64.6)] respectively screened positive for complicated grief on the ICG, whilst 76.0% [95% CI (70.5–81.5)] and 69.3% [95% CI (64.3–74.3)] respectively screened positive on the GHQ-12. Same-gender bereaved partners were not significantly more likely to screen positive for complicated grief than different-gender partners [adjusted odds ratio (aOR) 1.56, 95% CI (0.98–2.47)], p = 0.059, but same-gender bereaved partners were significantly more likely to screen for psychiatric caseness [aOR 1.67 (1.02, 2.71) p = 0.043]. We similarly found no significant association of partner gender with grief intensity [B = 1.86, 95% CI (−0.91to 4.63), p = 0.188], but significantly greater psychological distress for same-gender partners [B = 1.54, 95% CI (−0.69–2.40), p < 0.001].
Conclusions
Same-gender bereaved partners report significantly more psychological distress. In view of their poorer sub-clinical mental health, clinical and bereavement services should refine screening processes to identify those at risk of poor mental health outcomes.
The wide-ranging studies collected here reflect the latest concerns of and trends in fourteenth-century research, including work on politics, the law, religion, and chronicle writing. The lively (andcontroversial) debate around the death of Edward II, and the brief but eventful career of John of Eltham, earl of Cornwall, receive detailed treatment, as does the theory and implementation of both the law of treason in England and high status execution in Ireland. There is an investigation of the often overlooked, yet ever present, lesser parish clergy of pre-Black Death England, along with the notable connections between Roman remains and craft guild piety in fourteenth-century York. There are also chapters shedding new light on fourteenth-century chronicles: one examines the St Albans chronicle through the prism of chivalric culture, another analyses the importance of the Chester Annals of 1385-8 in the writing culture of the Midlands. Introduced with this volume is a new section on "Notes and Documents"; re-examined here is an often-cited letter from the reign of Richard II and the problematic, yet crucial, issue of its authorship and dating.
James Bothwell is Lecturer in Later Medieval History at the University of Leicester; Gwilym Dodd is Associate Professor of Medieval History at the University of Nottingham
Contributors: Paul Dryburgh, ine Foley, Christopher Guyol, Andy King, Jessica Knowles, E. Amanda McVitty, D.A.L. Morgan, Philip Morgan, David Robinson.
This study investigates the extent to which the GHQ-12 exhibits configural, metric and scalar invariance across six ethnic groups in Britain and Northern Ireland, using the UK Household Longitudinal Study (N = 35 410).
Methods
A confirmatory factor analysis was carried out on a white British group in order to establish an adequate measurement model. Secondly, a multi-group confirmatory factor analysis was conducted in order to assess measurement invariance. A sensitivity analysis comparing summated and latent means across groups was carried out. Finally, revised estimates of scale reliability were derived using two different methods.
Results
A one-factor model including correlated error terms on the negatively phrased items showed superior fit in all ethnic groups. Tests for equal factor loadings and intercepts also showed adequate fit demonstrating metric and scalar invariance. Latent and summated scale estimates of mean group differences were similar for all groups. Scale reliability using McDonald's ω is lower than when using the more conventional Cronbach's α. Reliability across groups is reasonably consistent.
Conclusions
We find that the GHQ-12 does not display obvious bias in regard to ethnic groups in the UK and that valid comparisons across these groups can be made for the purposes of population research. Caution is needed when using as a screening tool for individuals.
Understanding, categorizing, and using implementation science theories, models, and frameworks is a complex undertaking. The issues involved are even more challenging given the large number of frameworks and that some of them evolve significantly over time. As a consequence, researchers and practitioners may be unintentionally mischaracterizing frameworks or basing actions and conclusions on outdated versions of a framework.
Methods:
This paper addresses how the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework has been described, summarizes how the model has evolved over time, and identifies and corrects several misconceptions.
Results:
We address 13 specific areas where misconceptions have been noted concerning the use of RE-AIM and summarize current guidance on these issues. We also discuss key changes to RE-AIM over the past 20 years, including the evolution to Pragmatic Robust Implementation and Sustainability Model, and provide resources for potential users to guide application of the framework.
Conclusions:
RE-AIM and many other theories and frameworks have evolved, been misunderstood, and sometimes been misapplied. To some degree, this is inevitable, but we conclude by suggesting some actions that reviewers, framework developers, and those selecting or applying frameworks can do to prevent or alleviate these problems.
ABSTRACT IMPACT: This abstract presents a generalizable process to evaluate, and act on, community advisory board perceptions of collaboration effectiveness to improve clinical and translational research network function. OBJECTIVES/GOALS: Community advisory boards (CAB) play an important role in facilitating relevant and externally valid, clinical and translational research (CTR). The objective of this presentation is to describe a participatory process to derive collaboration metrics that can be used to assess CAB effectiveness. METHODS/STUDY POPULATION: During the 4th and 5th years of the Great Plains IDeA CTR award, we used a mixed-methods approach that included CAB (1) discussions related to the need to assess collaboration effectiveness, (2) review of the validated Wilder Collaboration Inventory to identify factors that, if maximized, would improve a sense of team science and enhance productivity, (3) planning for assessment frequency and follow-up processes, and (4) review of collaboration data to determine necessary actions for improvement. Qualitative data were gathered across components of the mixed-methods approach. Quantitative data were collected and reviewed by the CAB (n=11 members) during the 1st quarter of award year 5. RESULTS/ANTICIPATED RESULTS: CAB members expressed an interest in assessing collaboration effectiveness, identified important factors to assess, and agreed that annual assessment and follow-up would be appropriate. Key factors identified and assessed (5-point agreement scale--higher score reflects stronger agreement) were 1) mutual respect/trust (m=4.2); 2) appropriate cross section of members (m=3.6); 3) a shared stake in the process and outcomes (m=3.9); 4) flexibility in decision-making/collaboration (m=4.1); 5) roles and policy guidelines (m=3.6); 6) open communication (m=3.9); 7) goal achievement (m=4.0); 8) shared vision (m=4.0); and 9) skilled leadership (m=4.4). DISCUSSION/SIGNIFICANCE OF FINDINGS: CAB reflection on the initial collaboration assessment resulted in developing plans to broaden membership and clarify roles and policy guidelines related to CAB participation. There was strong consensus related to the utility of this assessment approach.
ABSTRACT IMPACT: Regional health issues can be best addressed at the population-level and input from the communities is vital for prioritization of health issues. OBJECTIVES/GOALS: The Great Plains IDeA-CTR (GP IDeA-CTR) was developed to increase clinical and translational research (CTR) that can address regional health priorities. Here we describe a collaborative process used to identify regional health priorities using existing surveillance data and community input. METHODS/STUDY POPULATION: We used a participatory approach that included a partnership between the GP IDeA CTR Community-Engagement and Biostatistics, Epidemiology, and Research Design Cores to ensure priorities were data driven and also aligned with community-based perceptions of need. First, aggregated surveillance data across Nebraska, North Dakota, and South Dakota was presented to the GP IDeA CTR Community Advisory Board (CAB). Second, CAB members formed small groups and considered the information and generated priority health area lists. Third, small group lists were considered and discussed by the full CAB to finalize priority areas. Finally, the CAB reviewed the priorities annually thereafter. RESULTS/ANTICIPATED RESULTS: We identified priority areas for CTR that included (1) behavioral health, (2) injury prevention, (3) obesity, (4) technology to improve health care access, (5) connecting clinical/community services, and (5) addressing health disparities. These priorities align with population-based surveillance data that show lack of mental health care access, high prevalence of obesity, higher incidence of accidents, and existing racial, ethnic, and geographic health disparities. The CAB highlighted that research was also needed to improve how people can access the health innovations developed through CTR to address the other priority health issues with a goal to have an impact on population health. DISCUSSION/SIGNIFICANCE OF FINDINGS: By integrating data- and community-driven approaches we identified regional health priority areas that if addressed, can have significant impact in the GP IDeA CTR region. The priorities are listed on all GP IDeA-CTR funding announcements to encourage CTR in these areas.
ABSTRACT IMPACT: Leverage community engagement to continue moving translational science and research forward. OBJECTIVES/GOALS: Engaging community in translational research improves innovation and speeds the movement of evidence into practice. Yet, it is unclear how community is engaged across the translational research spectrum or the degree of community-engagement used. We conducted a scoping review to fill this gap. METHODS/STUDY POPULATION: We used the PRISMA model search strategy with a range of databases (e.g., PubMed/Medline, Scopus) to identify articles published between January 2008 and November 2018 (n=167) and eliminated studies that did not use any level of community-engagement (n=102). Studies were coded for translational stage-corresponding to T0 (basic science), T1 (basic science to clinical research in humans; n=6), T2 (clinical efficacy and effectiveness research, n=45), T3 (dissemination and implementation research, n=95), and T4 (population health, n=21) as well as the degree of community engagement from least to most intensive (i.e., outreach, consultation, involvement, collaboration, shared leadership). RESULTS/ANTICIPATED RESULTS: The final number of eligible articles was 65. There was a relatively balanced distribution across levels of community engagement across articles (i.e., outreach, n=14; consultation, n=13; involvement, n=7; collaboration, n=15; shared leadership, n=16). Within these articles, the depth of community engagement varied with higher engagement typically occurring at later stages of translational research (T3 and T4), but more specifically in the dissemination and implementation science stage (T3). However, shared leadership, the most intensive form of engagement, was found in T2, T3, and T4 studies suggesting the value of community-engagement across the translational research spectrum. DISCUSSION/SIGNIFICANCE OF FINDINGS: A strong understanding of how various levels of community engagement are used in translational research, and the outcomes they produce, may to expedite the translation of knowledge into practice and enable practice-based needs to inform policy.
This paper solves an approximate form of conservation of mass and momentum for a turbine in a wind farm array. The solution is a fairly simple explicit relationship that predicts the streamwise velocity distribution within a wind farm with an arbitrary layout. As this model is obtained by solving flow-governing equations directly for a turbine that is subject to upwind turbine wakes, no ad hoc superposition technique is needed to predict wind farm flows. A suite of large-eddy simulations (LES) of wind farm arrays is used to examine self-similarity as well as validity of the so-called conservation of momentum deficit for turbine wakes in wind farms. The simulations are performed with and without the presence of some specific turbines in the wind farm. This allows us to systematically study some of the assumptions made to develop the analytical model. A modified version of the conservation of momentum deficit is also proposed to provide slightly better results at short downwind distances, as well as in the far wake of turbines deep inside a wind farm. Model predictions are validated against the LES data for turbines in both full-wake and partial-wake conditions. While our results highlight the limitation in capturing the flow speed-up between adjacent turbine columns, the model is overall able to acceptably predict flow distributions for a moderately sized wind farm. Finally, the paper employs the new model to provide insights on the accuracy of common wake superposition methods.
A new ichnospecies, Glossifungites gingrasi n. isp., is described from multiple locations in basal sand-filled coastal plain distributary channels of the Turonian (Upper Cretaceous) Ferron Sandstone (central Utah). Glossifungites gingrasi n. isp. is attributed to the ichnogenus Glossifungites based on the presence of scratch imprints, passive fill, and a tongue-shaped structure, yet the new ichnospecies is distinct because it displays transverse bioglyphs that run perpendicular to the planiform structure, which contrasts to the axis parallel bioglyphs present in the ichnospecies G. saxicava. The transverse arrangement of ornamentation exhibited by G. gingrasi n. isp. is observed in modern subaqueous insect burrows produced by mayfly and chironomid larvae, and constitutes a way to differentiate insect-generated burrows from structures produced by crustaceans that are known to create other Glossifungites ichnospecies. Differentiating insect- from crustacean-generated burrows is significant because it provides a way to distinguish bioturbation by marine-recruited fauna from that produced by freshwater fauna in the rock record, making G. gingrasi n. isp. a valuable ichnological tool for paleoenvironmental and stratigraphic interpretation. While G. gingrasi n. isp. may represent a burrow created by a variety of filter-feeding subaqueous insects, the large size of G. gingrasi n. isp. in the Ferron Sandstone suggests that the largest specimens are probable mayfly burrows and supports the assertion that burrowing mayflies (e.g., Polymitarcyidae and Ephemeridae) adapted to domicile filter-feeding during or prior to the Turonian.
This article focuses on the way that staff and guardians in the rural Nottinghamshire workhouse of Southwell sought to exert control and containment over pauper inmates. Fusing together local and central records for the period 1834–71, including locally held punishment books and correspondence at The National Archives, Kew (TNA), we argue that the notional power of the workhouse authorities was heavily shaded. Most paupers most of the time did not find their behaviour heavily and clumsily controlled. Rather, staff focused their attention in terms of detecting and punishing disorderly behaviour on a small group of long-term and often mentally ill paupers whose actions might create enmities or spiral into larger conflicts and dissent in the workhouse setting. Both inmates and those under threat of workhouse admission would have seen or heard about punishment of ‘the usual characters’. This has important implications for how we understand the intent and experience of the New Poor Law up to the formation of the Local Government Board (LGB) in 1871.
Around 60 000 people in England live in mental health supported accommodation. There are three main types: residential care, supported housing and floating outreach. Supported housing and floating outreach aim to support service users in moving on to more independent accommodation within 2 years, but there has been little research investigating their effectiveness.
Aims
A 30-month prospective cohort study investigating outcomes for users of mental health supported accommodation.
Method
We used random sampling, accounting for relevant geographical variation factors, to recruit 87 services (22 residential care, 35 supported housing and 30 floating outreach) and 619 service users (residential care 159, supported housing 251, floating outreach 209) across England. We contacted services every 3 months to investigate the proportion of service users who successfully moved on to more independent accommodation. Multilevel modelling was used to estimate how much of the outcome and cost variations were due to service type and quality, after accounting for service-user characteristics.
Results
Overall 243/586 participants successfully moved on (residential care 15/146, supported housing 96/244, floating outreach 132/196). This was most likely for floating outreach service users (versus residential care: odds ratio 7.96, 95% CI 2.92–21.69, P < 0.001; versus supported housing: odds ratio 2.74, 95% CI 1.01–7.41, P < 0.001) and was associated with reduced costs of care and two aspects of service quality: promotion of human rights and recovery-based practice.
Conclusions
Most people do not move on from supported accommodation within the expected time frame. Greater focus on human rights and recovery-based practice may increase service effectiveness.
Chondritic meteorites, and especially the most volatile-rich chondrites, the carbonaceous chondrites, preserve a record of the solar protoplanetary disk dust component and how it has been changed both in the disk environment itself and in its asteroidal parent body. Here we review some of the key features of carbonaceous chondrites and report some new data on their organics component. These show that the nebula reached temperature of >10000C, but only very locally, to produce chondrules. Most meteoritic material underwent thermal and/or aqueous processing, but some retain delicate nebular components such as complex organic molecules and amorphous silicates.
To Investigate the peripheral inflammatory profile in patients with mild cognitive impairment (MCI) from three subgroups – probable Lewy body disease (probable MCI-LB), possible Lewy body disease, and probable Alzheimer’s disease (probable MCI-AD) – as well as associations with clinical features.
Setting:
Memory clinics and dementia services.
Participants:
Patients were classified based on clinical symptoms as probable MCI-LB (n = 38), possible MCI-LB (n = 18), and probable MCI-AD (n = 21). Healthy comparison subjects were recruited (n = 20).
Measurements:
Ten cytokines were analyzed from plasma samples: interferon (IFN)-gamma, interleukin (IL)-1beta, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, and tumor necrosis factor (TNF)-alpha. C-reactive protein levels were investigated.
Results:
There was a higher level of IL-10, IL-1beta, IL-2, and IL-4 in MCI groups compared to the healthy comparison group (p < 0.0085). In exploratory analyses to understand these findings, the MC-AD group lower IL-1beta (p = 0.04), IL-2 (p = 0.009), and IL-4 (p = 0.012) were associated with increasing duration of memory symptoms, and in the probable MCI-LB group, lower levels of IL-1beta were associated with worsening motor severity (p = 0.002). In the possible MCI-LB, longer duration of memory symptoms was associated with lower levels of IL-1beta (p = 0.003) and IL-4 (p = 0.026).
Conclusion:
There is increased peripheral inflammation in patients with MCI compared to healthy comparison subjects regardless of the MCI subtype. These possible associations with clinical features are consistent with other work showing that inflammation is increased in early disease but require replication. Such findings have importance for timing of putative therapeutic strategies aimed at lowering inflammation.