To send 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 sending content to .
To send content items to your Kindle, first ensure email@example.com
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 sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent 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.
The Longitudinal Aging Study in India (LASI) was initiated to capture data to be comparable to the Health and Retirement Survey (HRS) and hence used study instruments from the HRS. However, a rigorous psychometric evaluation before adaptation of cognitive tests may have indicated bias due to diversities across Indian states such as education, ethnicity, and urbanicity. In the present analysis, we evaluated if items show differential item functioning (DIF) by literacy, urbanicity, and education status.
We calculated proportions for each item and weighted descriptive statistics of demographic characteristics in LASI. Next, we evaluated item-level measurement differences by testing for DIF using the alignment approach implemented using Mplus software.
We found that cognitive items in the LASI interview demonstrate bias by education and literacy, but not urbanicity. Items relating to animal (word) fluency show DIF. The model rates correct identification of the prime minister as the most difficult binary response item whereas the day of the week and numeracy items are rated comparatively easier.
Our study would facilitate comparison across education, literacy and urbancity to support analyses of differences in cognitive status. This would help future instrument development efforts by recognizing potentially problematic items in certain subgroups.
OBJECTIVES/SPECIFIC AIMS: Calls for health care organizations to promote health equity, through reducing health care disparities and addressing the social determinants of health, are growing and disrupt assumptions about equal care and the role of the health care delivery system more generally. This paper uses qualitative data to explore the emotions that health care personnel express as they make sense of the newfound emphasis on equity. To do so, we consider the relationships between social identity, sense of control, emotion, cognition, and action. METHODS/STUDY POPULATION: The principle investigator conducted 21 semistructured interviews with senior leaders and equity team members and 7 focus groups with providers and staff employed at one of Minnesota’s largest health care system. The PI asked respondents to describe recent conversations about equity in their workplaces and to identify barriers and facilitators to addressing equity. Focus group participants were also asked to imagine colleagues’ reactions—“what would they say, think, and feel”—should they be asked to adapt practices to address the social determinants of health, community health, and healthcare disparities. Interviews and focus groups were audiotaped and transcribed. Two coders independently coded each transcript for themes and then compared and reconciled their coding. Reactions to equity work emerged inductively during the coding process. RESULTS/ANTICIPATED RESULTS: Findings suggest that discourses on health equity can disrupt personal and professional identities and trigger a mixture of emotions, including fear, sadness, and excitement. Personnel with broad, or flexible, constructions of their work roles experienced less disruption, and more positive emotions, than those personnel who constructed narrow, or rigid, professional identities. Those who expressed a stronger sense of control also expressed more positive emotions, such as happiness and hope, and were excited about the prospect of greater accountabilities related to equity. Those who doubted the existence of disparities were defensive and pointed to cues such as standardized care protocols and perceptions of colleagues’ professionalism to oppose change. Those who perceived low organizational self-efficacy, due to a lack of time, skills, or knowledge, often expressed frustration and helplessness. Their sensemaking focused on the lack of progress and sought sensegiving about ways to “make it workable.” DISCUSSION/SIGNIFICANCE OF IMPACT: Discussions about equity are new in healthcare and trigger mixed reactions, drawing out provider and staff’s hopes, fears, and anxieties. Variations in emotional reactions may be related to differing perceptions about sense of control over disparities and the social determinants of health. If we want to enlist health care providers, nurses, and managers in efforts to improve health equity, we need to understand these emotions and sensemaking processes.
Approximately 32,000 infants are born with CHDs each year in the United States of America. Of every 1000 live births, 2.3 require surgical or transcatheter intervention in the first year of life. There are few more stressful times for parents than when their neonate receives a diagnosis of complex CHD requiring surgery. The stress of caring for these infants is often unrelenting and may last for weeks, months, and often years, placing parents at risk for developing post-traumatic stress disorder, as well as a drastic decrease in quality of life. Anxiety often peaks in the days and weeks after discharge from the hospital as families no longer have immediate access to nursing and medical staff. The purpose of this paper is to describe the methods of a randomised controlled trial that was designed to determine whether REACH would favourably affect parental and infant outcomes by decreasing parental stress, improve parental quality of life, increase infant stability, and decrease resource utilisation in infants with complex CHD.
Compulsory acquisition of land by the state for public purposes is an entrenched feature of national constitutions. Yet the scope of private property is rarely defined. This is problematic in agrarian economies where millions own land under non-statutory arrangements that were historically excluded from recognition as property. This study examines the case in Africa where more than 650 million people are untitled customary landowners. Despite vibrant constitutional change, protection of these rights remains disappointing, while the grounds for taking land have expanded. However, this article concludes that reining in the scope of public purpose is not the most useful way forward. It would be more productive to persist in bringing constitutional force to bear on the standing of customary rights, along with democratizing procedures towards full community participation in deciding how public purpose acquisitions should proceed. The result would be greater tenure security, good governance and more peaceful relations between the state and people regarding land.