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Farm-to-school (F2S) local food procurement must be cost-effective to be financially sustainable without policy support. We test, among schools participating in F2S programs, whether market channel procurement strategies for local foods affect schools’ perceptions of whether meal costs decline as a result of F2S participation. Schools that buy local foods exclusively from intermediaries are 7 percentage points less likely to report lower costs from undertaking F2S initiatives. We further demonstrate that the probability that schools source local foods exclusively from intermediaries is influenced by the number of direct marketing farmers in their county.
This paper presents a numerical performance evaluation of the leading edge tubercles hydrofoil with particular focus on a fully turbulent flow regime. Efforts were focused on the setting up of an appropriate numerical approach required for an in-depth analysis of this phenomenon, being able to predict the main flow features and the hydrodynamic performance of the foil when operating at high Reynolds numbers. The numerical analysis was conducted using an improved delayed detached eddy simulation for Reynolds numbers corresponding to the transitional and fully turbulent flow regimes at different angles of attack for the pre-stall and post-stall regimes. The results show that tubercles operating in turbulent flow improve the hydrodynamic performance of the foil when compared to a transitional flow regime. Flow separation was identified behind the tubercle troughs, but was significantly reduced when operating in a turbulent regime and for which we have identified the main flow mechanisms. This finding confirms that the tubercle effect identified in a transitional regime is not lost in a turbulent flow. Furthermore, when the hydrofoil operates in the turbulent flow regime, the transition to a turbulent regime takes place further upstream. This phenomenon suppresses a formation of a laminar separation bubble and therefore the hydrofoil exhibits a superior hydrodynamic performance when compared to the same foil in the transitional regime.
The SUPEREDEN3 study, a phase II randomized controlled trial, suggests that social recovery therapy (SRT) is useful in improving functional outcomes in people with first episode psychosis. SRT incorporates cognitive behavioural therapy (CBT) techniques with case management and employment support, and therefore has a different emphasis to traditional CBT for psychosis, requiring a new adherence tool.
This paper describes the SRT adherence checklist and content of the therapy delivered in the SUPEREDEN3 trial, outlining the frequency of SRT techniques and proportion of participants who received a full therapy dose. It was hypothesized that behavioural techniques would be used frequently, consistent with the behavioural emphasis of SRT.
Research therapists completed an adherence checklist after each therapy session, endorsing elements of SRT present. Data from 1236 therapy sessions were reviewed to determine whether participants received full, partial or no therapy dose.
Of the 75 participants randomized to receive SRT, 57.3% received a full dose, 24% a partial dose, and 18.7% received no dose. Behavioural techniques were endorsed in 50.5% of sessions, with cognitive techniques endorsed in 34.9% of sessions.
This report describes an adherence checklist which should be used when delivering SRT in both research and clinical practice. As hypothesized, behavioural techniques were a prominent feature of the SRT delivered in SUPEREDEN3, consistent with the behavioural emphasis of the approach. The use of this adherence tool would be considered essential for anyone delivering SRT looking to ensure adherence to the model.
OBJECTIVES/SPECIFIC AIMS: Among college students with binge-type eating disorders who are overweight (BMI >25), does use of an online, guided self-help program for EDs combined with healthy weight-loss (WL) methods lead to reductions in ED symptoms and weight loss compared to controls referred to standard in-person treatment (Student Health Services)? Aim 1: Develop online, guided self-help program for intervention of ED psychopathology and weight reduction. Aim 2: Implement online, guided self-help program for intervention of ED psychopathology and weight reduction. Aim 3: Follow-up to track remission of ED psychopathology and symptoms and WL maintenance. METHODS/STUDY POPULATION: Up to N=60 college students who meet the criteria (clinical or sub-clinical binge-type ED and have a BMI > 25) and elect to participate will complete a baseline survey to enroll in the study, then will be randomized into a condition. Students in the intervention group (n=30) will be offered 8 weeks of online, guided self-help intervention for ED and WL. Students in the control group (n=30) will receive an email message encouraging them to seek support from Student Health Services for their WL and eating behavior concerns, along with appropriate contact information. All participants will receive follow-up 9 weeks after completing initial baseline, and a final follow-up survey 6-months after completing their baseline. RESULTS/ANTICIPATED RESULTS: Analysis of intervention and control groups will compare average Eating Disorder Examination Questionnaire (EDEQ) scores and WL (change in BMI) at the end of the intervention (9 weeks) and at 6-month follow-up. Group comparisons will be assessed via two-way mixed model ANOVA. DISCUSSION/SIGNIFICANCE OF IMPACT: Online, guided self-help interventions have been used for WL, as well as for treatment of EDs separately, but no program exists to manage these conditions together. Thus, the use of online intervention for ED psychopathology and WL in individuals with clinical and sub-clinical EDs is the next step. The goal of this study is to implement a program to reduce weight and shape concerns, reduce disordered eating symptoms, such as bingeing, and compensatory behaviors associated with binge-type EDs, while also reducing weight for individuals with EDs and comorbid overweight/obesity. This project will pilot an online, guided self-help ED intervention that offers cognitive behavioral based tools to improve ED symptoms in college students, while also teaching the healthy methods of behavioral WL, for students with clinical/sub-clinical binge-type EDs with comorbid overweight/obesity in order to examine effectiveness of the program compared to referral to Student Health Services for ED and WL concerns. Furthermore, the use of an online, guided self-help intervention is more scalable and can circumvent many of the barriers to traditional in-person treatment.
People with traumatic brain injuries (TBIs) commonly report memory impairments which are persistent, debilitating, and reduce quality of life. As part of the Rehabilitation of Memory in Brain Injury trial, a cost-effectiveness analysis was undertaken to examine the comparative costs and effects of a group memory rehabilitation program for people with TBI.
Individual-level cost and outcome data were collected. Patients were randomized to usual care (n=157) or usual care plus memory rehabilitation (n=171). The primary outcome for the economic analysis was the EuroQol-5D quality of life score at 12 months. A UK NHS costing perspective was used. Missing data was addressed by multiple imputation. One-way sensitivity analyses examined the impact of varying different parameters, and the impact of available cases, on base case findings whilst non-parametric bootstrapping examined joint uncertainty.
At 12 months, the intervention was GBP 26.89 (USD 35.76) (SE 249.15) cheaper than usual care; but this difference was statistically non-significant (p=0.914). At 12 months, a QALY loss of −0.007 was observed in the intervention group confidence interval (95% CI: −0.025–0.012) and a QALY gain seen in the usual care group 0.004 (95% CI: -0.017–0.025). This difference was not statistically significant (p=0.442). The base case analysis gave an ICER of GBP 2,445 (USD 3,252) reflecting that the intervention was less effective and less costly compared to usual care. Sensitivity analyses illustrated considerable uncertainty. When joint uncertainty was examined, the probability of the intervention being cost-effective at a willingness-to-pay threshold of GBP 20,000 per QALY gain was 29 percent and 24 percent at GBP 30,000.
Our cost-utility analysis indicates that memory rehabilitation was cheaper but less effective than usual care but these findings must be interpreted in the light of small statistically non–significant differences and considerable uncertainty was evident. The ReMemBrIn intervention is unlikely to be considered cost-effective for people with TBI.
In September 2016, the annual meeting of the International Union for Quaternary Research’s Loess and Pedostratigraphy Focus Group, traditionally referred to as a LoessFest, met in Eau Claire, Wisconsin, USA. The 2016 LoessFest focused on “thin” loess deposits and loess transportation surfaces. This LoessFest included 75 registered participants from 10 countries. Almost half of the participants were from outside the United States, and 18 of the participants were students. This review is the introduction to the special issue for Quaternary Research that originated from presentations and discussions at the 2016 LoessFest. This introduction highlights current understanding and ongoing work on loess in various regions of the world and provides brief summaries of some of the current approaches/strategies used to study loess deposits.
We report on a loess-paleosol sequence (LPS) near Remizovka, located in the northern Tian Shan piedmont of southeastern Kazakhstan. This site represents a key record for Late Pleistocene climatic fluctuations at the intersection of major northern hemisphere climate subsystems. This paper develops a synthesized dataset of previous conflicting studies at Remizovka by characterizing their (paleo)topographic context, which had remained previously overlooked. Digital elevation models, satellite images, and archival photography characterize recent topographic developments. Two well-developed pedocomplexes, which we investigate in detail and date by luminescence mark the paleotopography during Marine Oxygen Isotope Stage (MIS) 5. Peak dust accumulation rates here occurred during the middle MIS 5 and MIS 4/early MIS 3. These are partially comparable with records from neighboring regions, but not in phase with global ice volume records. This discrepancy may be related to a distinct regional environmental response to larger-scale climatic drivers and local topographic influences on dust deposition patterns. Our findings confirm the potential of the LPS Remizovka to provide high-resolution paleoclimate data for the Late Pleistocene. The three-dimensional stratigraphic reconstruction reinforces the caution required to correctly interpret loess formation processes prior to their interpretation as paleoclimate archives, and provides guidelines for a more suitable approach.
A predictive risk stratification tool (PRISM) to estimate a patient's risk of an emergency hospital admission in the following year was trialled in general practice in an area of the United Kingdom. PRISM's introduction coincided with a new incentive payment (‘QOF’) in the regional contract for family doctors to identify and manage the care of people at high risk of emergency hospital admission.
Alongside the trial, we carried out a complementary qualitative study of processes of change associated with PRISM's implementation. We aimed to describe how PRISM was understood, communicated, adopted, and used by practitioners, managers, local commissioners and policy makers. We gathered data through focus groups, interviews and questionnaires at three time points (baseline, mid-trial and end-trial). We analyzed data thematically, informed by Normalisation Process Theory (1).
All groups showed high awareness of PRISM, but raised concerns about whether it could identify patients not yet known, and about whether there were sufficient community-based services to respond to care needs identified. All practices reported using PRISM to fulfil their QOF targets, but after the QOF reporting period ended, only two practices continued to use it. Family doctors said PRISM changed their awareness of patients and focused them on targeting the highest-risk patients, though they were uncertain about the potential for positive impact on this group.
Though external factors supported its uptake in the short term, with a focus on the highest risk patients, PRISM did not become a sustained part of normal practice for primary care practitioners.
New approaches are needed to safely reduce emergency admissions to hospital by targeting interventions effectively in primary care. A predictive risk stratification tool (PRISM) identifies each registered patient's risk of an emergency admission in the following year, allowing practitioners to identify and manage those at higher risk. We evaluated the introduction of PRISM in primary care in one area of the United Kingdom, assessing its impact on emergency admissions and other service use.
We conducted a randomized stepped wedge trial with cluster-defined control and intervention phases, and participant-level anonymized linked outcomes. PRISM was implemented in eleven primary care practice clusters (total thirty-two practices) over a year from March 2013. We analyzed routine linked data outcomes for 18 months.
We included outcomes for 230,099 registered patients, assigned to ranked risk groups.
Overall, the rate of emergency admissions was higher in the intervention phase than in the control phase: adjusted difference in number of emergency admissions per participant per year at risk, delta = .011 (95 percent Confidence Interval, CI .010, .013). Patients in the intervention phase spent more days in hospital per year: adjusted delta = .029 (95 percent CI .026, .031). Both effects were consistent across risk groups.
Primary care activity increased in the intervention phase overall delta = .011 (95 percent CI .007, .014), except for the two highest risk groups which showed a decrease in the number of days with recorded activity.
Introduction of a predictive risk model in primary care was associated with increased emergency episodes across the general practice population and at each risk level, in contrast to the intended purpose of the model. Future evaluation work could assess the impact of targeting of different services to patients across different levels of risk, rather than the current policy focus on those at highest risk.
Emergency admissions to hospital are a major financial burden on health services. In one area of the United Kingdom (UK), we evaluated a predictive risk stratification tool (PRISM) designed to support primary care practitioners to identify and manage patients at high risk of admission. We assessed the costs of implementing PRISM and its impact on health services costs. At the same time as the study, but independent of it, an incentive payment (‘QOF’) was introduced to encourage primary care practitioners to identify high risk patients and manage their care.
We conducted a randomized stepped wedge trial in thirty-two practices, with cluster-defined control and intervention phases, and participant-level anonymized linked outcomes. We analysed routine linked data on patient outcomes for 18 months (February 2013 – September 2014). We assigned standard unit costs in pound sterling to the resources utilized by each patient. Cost differences between the two study phases were used in conjunction with differences in the primary outcome (emergency admissions) to undertake a cost-effectiveness analysis.
We included outcomes for 230,099 registered patients. We estimated a PRISM implementation cost of GBP0.12 per patient per year.
Costs of emergency department attendances, outpatient visits, emergency and elective admissions to hospital, and general practice activity were higher per patient per year in the intervention phase than control phase (adjusted δ = GBP76, 95 percent Confidence Interval, CI GBP46, GBP106), an effect that was consistent and generally increased with risk level.
Despite low reported use of PRISM, it was associated with increased healthcare expenditure. This effect was unexpected and in the opposite direction to that intended. We cannot disentangle the effects of introducing the PRISM tool from those of imposing the QOF targets; however, since across the UK predictive risk stratification tools for emergency admissions have been introduced alongside incentives to focus on patients at risk, we believe that our findings are generalizable.
A number of laser facilities coming online all over the world promise the capability of high-power laser experiments with shot repetition rates between 1 and 10 Hz. Target availability and technical issues related to the interaction environment could become a bottleneck for the exploitation of such facilities. In this paper, we report on target needs for three different classes of experiments: dynamic compression physics, electron transport and isochoric heating, and laser-driven particle and radiation sources. We also review some of the most challenging issues in target fabrication and high repetition rate operation. Finally, we discuss current target supply strategies and future perspectives to establish a sustainable target provision infrastructure for advanced laser facilities.
A unique approach for permeation filling of nonpermeable inertial confinement fusion target capsules with deuterium–tritium (DT) is presented. This process uses a permeable capsule coupled into the final target capsule with a 0.03-mm-diameter fill tube. Leak free permeation filling of glow-discharge polymerization (GDP) targets using this method have been successfully demonstrated, as well as ice layering of the target, yielding an inner ice surface roughness of 1-
m rms (root mean square). Finally, the measured DT ice-thickness profile for this experiment was used to validate a thermal model’s prediction of the same thickness profile.
Commission 15 of the International Astronomical Union (IAU), entitled Physical Study of Comets and Minor Planets, was founded in 1935 and dissolved in 2015, following the reorganization of IAU. In 80 years of Commission 15, tremendous progress has been made on the knowledge of these objets, thanks to the combined efforts of ground- and space-based observations, space mission rendezvous and flybys, laboratory simulation and analyses of returned samples, and theoretical and numerical modeling. Together with dynamical studies of the Solar System, this discipline has provided a much deeper understanding of how the Solar System formed and evolved. We present a legacy report of Commission 15, which highlights key milestones in the exploration and knowledge of the small bodies of the Solar System.
Despite more than a decade of heightened defence spending and active fighting in the War in Afghanistan, the longest combat operation in the history of the Canadian Forces, scholars know precious little about how the socio-demographic characteristics and attitudes of Canadians may influence their views about taking part in overseas combat operations and funding the institution charged with carrying out these dangerous activities. By testing a range of hypotheses, which purport to explain the influence of multiple socio-demographic and attitudinal factors on Canadians' attitudes toward defence spending and the participation of the Canadian Forces in overseas combat operations, against data from the 2004 and 2011 Canadian Election Study, this article ascertains the most important determinants of Canadians' preferences about defence spending and the use of military force by the Government of Canada.
Cannabis use is high amongst young people who have recently had their first episode of psychosis, and is associated with worse outcomes. To date, interventions to reduce cannabis consumption have been largely ineffective, and it has been suggested that longer treatment periods are required.
In a pragmatic single-blind randomized controlled trial 110 participants were randomly allocated to one of three conditions: a brief motivational interviewing and cognitive behavioural therapy (MI-CBT) intervention (up to 12 sessions over 4.5 months) with standard care from an early intervention service; a long MI-CBT intervention (up to 24 sessions over 9 months) with standard care; or standard care alone. The primary outcome was change in cannabis use as measured by Timeline Followback.
Neither the extended nor the brief interventions conferred benefit over standard care in terms of reductions in frequency or amount of cannabis use. Also the interventions did not result in improvements in the assessed clinical outcomes, including symptoms, functioning, hospital admissions or relapse.
Integrated MI and CBT for people with cannabis use and recent-onset psychosis does not reduce cannabis use or improve clinical outcomes. These findings are consistent with those in the published literature, and additionally demonstrate that offering a more extended intervention does not confer any advantage. Many participants were not at an action stage for change and for those not ready to reduce or quit cannabis, targeting associated problems rather than the cannabis use per se may be the best current strategy for mental health services to adopt.