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Proximal environments could facilitate smoking cessation among low-income smokers by making cessation appealing to strive for and tenable.
We sought to examine how home smoking rules and proximal environmental factors such as other household members' and peers' smoking behaviors and attitudes related to low-income smokers' past quit attempts, readiness, and self-efficacy to quit.
This analysis used data from Offering Proactive Treatment Intervention (OPT-IN) (randomized control trial of proactive tobacco cessation outreach) baseline survey, which was completed by 2,406 participants in 2011/12. We tested the associations between predictors (home smoking rules and proximal environmental factors) and outcomes (past-year quit attempts, readiness to quit, and quitting self-efficacy).
Smokers who lived in homes with more restrictive household smoking rules, and/or reported having ‘important others’ who would be supportive of their quitting, were more likely to report having made a quit attempt in the past year, had greater readiness to quit, and greater self-efficacy related to quitting.
Adjustments to proximal environments, including strengthening household smoking rules, might encourage cessation even if other household members are smokers.
Including information and values from patients in HTA has the potential to improve both the process and outcomes of health technology policy decisions. Accordingly, funding and structural incentives to include patients in HTA activities have increased over the past several years. Unfortunately, these incentives have not yet been accompanied by a corresponding increase in resources, time, or commitment to responsiveness. In this Perspectives piece, we reflect on our collective experiences participating in, conducting, and overseeing patient engagement activities within HTA to highlight the ethical challenges associated with this area of activity. While we remain committed to the idea that patient engagement activities strengthen the findings, relevance, and legitimacy of health technology policy, we are deeply concerned about the potential for these activities to do ethical harm. We use this analysis to call for action to introduce strong protections against ethical violations that may harm patients participating in HTA engagement activities.
Previous studies reported that Good Friday Glacier had been actively surging in the 1950–60s, 1990s and again in 2000–15. Based on observations of terminus position change from air photos and satellite imagery, we fill the gaps between previous studies and conclude that the glacier has been advancing continuously since 1959. Ice surface velocities extracted from optical and synthetic aperture radar satellite images show higher flow rates than on most other marine-terminating glaciers in the region. This behaviour contrasts with the regional trend of glacier retreat over this period. Possible explanations involve a delayed response to positive mass-balance conditions of the Little Ice Age, or a dynamic instability. There is, however, insufficient evidence to attribute this behaviour to classical glacier surging as suggested in previous studies. Based on present-day ice velocity and glacier geometry patterns in the terminus region, we reconstruct the evolution of ice motion throughout the advance, and suggest that what has previously been interpreted as a surge, may instead have been a localised response to small-scale perturbations in bedrock topography.
We present a scaling theory that links the frequency of long frontal waves to the kinetic energy decay rate and inverse transfer of potential energy in freely evolving equivalent barotropic turbulence. The flow energy is predominantly potential, and the streamfunction makes the dominant contribution to potential vorticity (PV) over most of the domain, except near PV fronts of width
is the Rossby deformation length. These fronts bound large vortices within which PV is well-mixed and arranged into a staircase structure. The jets collocated with the fronts support long-wave undulations, which facilitate collisions and mergers between the mixed regions, implicating the frontal dynamics in the growth of potential-energy-containing flow features. Assuming the mixed regions grow self-similarly in time and using the dispersion relation for long frontal waves (Nycander et al., Phys. Fluids A, vol. 5, 1993, pp. 1089–1091) we predict that the total frontal length and kinetic energy decay like
, while the length scale of the staircase vortices grows like
. High-resolution simulations confirm our predictions.
A statewide health technology assessment (HTA) program was implemented to increase equity of access and support robust assessment of technologies, with a focus on those that are high-cost, high-risk, or have state-wide impact.
Local hospital networks and clinicians refer technologies to the South Australia Policy Advisory Committee on Technology (SAPACT) for assessment. Independently produced, comprehensive HTA reports are developed using internationally recognized evidence and critical appraisal methodologies. Clinical and economic systematic analyses are utilized, with extensive clinical consultation, to develop recommendations for new technologies and their role in models of care. Feasibility of adoption and local implementation are considered, including existing service delivery and appropriate training and credentialing. For approved technologies, SAPACT may also develop audit criteria and seek implementation reports on clinical outcomes.
The HTA framework has been successfully adopted across South Australia Health, increasing the incorporation of evidence-based decision making in the use of high-cost and high-risk health technologies. Over 35 evidence evaluations for high-risk and high-cost health technologies have been conducted for a broad range of treatment interventions. SAPACT develops and utilizes HTA decision-making criteria for transparency of Committee considerations. The program recommends adoption or rejection of technologies, or it may request a re-submission due to safety concerns or a lack of proven effectiveness. SAPACT has also granted temporary approval through adoption under clinical evaluation to inform investment decisions. A key component is working with clinicians to define specific treatment criteria and patient selection. SAPACT continues to strengthen relationships with all stakeholders, increase patient input through the development of public summary documents for technologies, and improve monitoring and reporting of clinical outcomes.
The HTA program has been very productive and positively received. The success of the program is underpinned by its engagement with clinicians, hospital networks, and consumers. The completion of SAPACT HTA reviews and the publication of the SAPACT decision-making criteria have increased the credibility of decisions, supporting enhancements in patient care and cost efficiency for the state government.
The best available research and funding policy evidence regarding the regulatory status, patient selection criteria, safety, clinical effectiveness, and financial impact of peroral endoscopic myotomy (POEM) for the treatment of achalasia was synthesized for statewide decision making for a South Australian local health network.
A comprehensive systematic search of twenty-three gray literature sources and three published literature databases for international evidence was conducted, based on a priori inclusion criteria. The methodological quality of the included studies was critically appraised. Data extraction and synthesis were conducted in narrative form.
Short-term safety and clinical data from very low-level studies showed that POEM appears to be a relatively safe and clinically effective endoscopic treatment for esophageal achalasia, compared with laparoscopic Heller myotomy (LHM). One primary safety concern consistently highlighted by the literature was gastroesophageal reflux (GER) after POEM, since no anti-reflux procedure is involved. Operative time and length of hospital stay for POEM were comparable with LHM and potentially favor POEM. The comparative long-term outcomes for the POEM procedure are not known. No studies have investigated the cost-effectiveness of POEM. Conflicting findings were reported on whether POEM is cheaper or more expensive than LHM. POEM is a technically challenging procedure with a substantial learning curve. Patients who undergo POEM may require postoperative surveillance and testing to evaluate procedural success and to identify potential complications. Current literature showed limited analysis and systematic elucidation of an optimal patient group that may best benefit from POEM.
The POEM procedure should be carried out at an experimental or trial level only, with strict auditing of results. POEM procedures should ideally be performed at institutions where an adequate level of surgical and critical care backup is available to provide expert care should complications arise. Monitoring of patient outcomes, including symptom improvement, is recommended for clinical assessment and reporting to determine future adoption in the South Australian public health sector.
This essay critically examines Keith Bybee's All Judges Are Political, Except When They Are Not. Although Bybee's creative use of the cultural form of courtesy helps us better understand the consensus-building and legitimating features of rule-of-law systems, it overlooks the role that rude dissent can play in exposing the violent, exclusionary, and materially disadvantaging aspects of such systems. Using examples of outing closeted public figures and the rude AIDS activism of the 1990s, this essay explores the rule of law from the perspective of those who are subject to it.
Since Donald Trump took office in 2017, the White House has issued several clear anti-LGBTQIA signals and initiatives. Reflecting on Trump's election as U.S. president, many political scientists have analyzed his rise in the context of the literature on American political development (e.g., Skowronek 2017) and comparative governments (e.g., Levitsky and Ziblatt 2018). Some of this work has received significant media attention and attained a popular readership. The American political development analyses have often focused on the lens of political time and potential party realignment, exploring the possibility of a “disjunctive presidency,” which foretells the demise of the coalition that has enabled the Republican Party to dominate U.S. politics since the Reagan Revolution of the 1980s. Comparative work in the discipline argues that Trump initiatives are threatening to democratic principles, portending a turn toward authoritarianism that parallels the rise of right-wing authoritarian leaders across the globe.
The group ring AG of a group G and a ring A is the ring of all formal sums Σg∈G agg with ag ∈ A and with only finitely many non-zero ag. Elements of A are assumed to commute with the elements of G. In (2), Connell characterized or completed the characterization of Artinian, completely reducible and (von Neumann) regular group rings ((2) also contains many other basic results). In (3, Appendix 3) Connell used a theorem of Passman (6) to characterize semi-prime group rings. Following in the spirit of these investigations, this paper deals with the complete ring of (right) quotients Q(AG) of the group ring AG. It is hoped that the methods used and the results given may be useful in characterizing group rings with maximum condition on right annihilators and complements, at least in the semi-prime case.
The only known examples of nondegenerate homogeneous plane continua are the simple closed curve, the circle of pseudo-arcs (6), and the pseudo-arc (1; 13). Another example, called the pseudo-circle, has been suggested by Bing (2), but it has not been proved to be homogeneous. (Definitions of some of these terms and a history of results on homogeneous plane continua can be found in (6).) Of the three known examples, the pseudo-arc is both linearly chainable and circularly chainable, and the simple closed curve and the circle of pseudo-arcs are circularly chainable but not linearly chainable. It is not known whether every homogeneous plane continuum is either linearly chainable or circularly chainable. Bing has shown that a homogeneous continuum is a pseudo-arc provided it is linearly chainable (4).