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A commonly assumed reason for the delegation of authority from a legislature (politicians) to bureaucracies is that the bureaucrats have an information advantage over the politicians, including knowledge of cost–benefit analysis (CBA). But it is reasonable to assume that the bureaucrats use their information advantage by taking all relevant aspects of policy into account? We model the use of CBA using a delegation model and then test the theoretical predictions with empirical data collected from five Swedish government agencies. The empirical results lend support both for the hypothesis that risk aversion concerning the environmental outcome, the bureaucrats’ environmental attitudes, and the cost of taking CBA information into account have a considerable impact on the probability of using information from a CBA. Hence risk averse and bureaucrats with strong environmental preferences are less likely and bureaucrats with low cost of doing a CBA more likely than other bureaucrats to use CBA information. Finally, a binding governmental budget constraint may positively influence a bureaucrat’s choice of using CBA information. A tentative conclusion is therefore that it may be possible to increase the use of CBA by making the budgetary consequences of policies much clearer and demanding due consideration of costs.
Shared decision-making (SDM) is a critical component of delivering patient-centered care. Members of vulnerable populations may play a passive role in clinical decision-making; therefore, understanding their prior decision-making experiences is a key step to engaging them in SDM.
Objective:
To understand the previous healthcare experiences and current expectations of vulnerable populations on clinical decision-making regarding therapeutic options.
Methods:
Clients of a local food bank were recruited to participate in focus groups. Participants were asked to share prior health decision experiences, explain difficulties they faced when making a therapeutic decision, describe features of previous satisfactory decision-making processes, share factors under consideration when choosing between treatment options, and suggest tools that would help them to communicate with healthcare providers. We used the inductive content analysis to interpret data gathered from the focus groups.
Results:
Twenty-six food bank clients participated in four focus groups. All participants lived in areas of socioeconomic disadvantage. Four themes emerged: prior negative clinical decision-making experience with providers, patients preparing to engage in SDM, challenges encountered during the decision-making process, and patients’ expectations of decision aids. Participants also reported they were unable to discuss therapeutic options at the time of decision-making. They also expressed financial concerns and the need for sufficiently detailed information to evaluate risks.
Conclusion:
Our findings suggest the necessity of developing decision aids that would improve the engagement of vulnerable populations in the SDM process, including consideration of affordability, use of patient-friendly language, and incorporation of drug–drug and drug–food interactions information.
The Bipolar Functional Status Questionnaire (BFSQ) is a novel patient-reported instrument designed to assess day-to-day functioning among patients with bipolar disorder. The development and psychometric evaluation of the BFSQ are described.
Methods:
Constructs of the BFSQ were identified through literature review, expert consultation, and patient interviews. Iterative sets of interviews with additional patients were conducted to inform item reduction and revisions. 596 patients completed the BFSQ and a series of other patient- and clinician-reported health assessments during a multi-site validation study. Participants included three patient groups: 148 patients who were hypomanic or recently recovered from a manic episode within the last month, 215 patients who were currently depressed or recently recovered from a dysthymic episode within the last month, and 233 patients whose mood had been stable for a minimum of 2 months. Test-retest was assessed in 187 stable patients using data from a second administration. Additional analysis evaluated the factor structure, internal consistency, reliability, and validity.
Results:
Exploratory and confirmatory factor analyses indicated that a one-factor structure best fit the data, providing support for a total score. Item-level descriptive statistics, Cronbach's alphas, and validity correlations all met standard criteria. Furthermore, the BFSQ demonstrated superior ability to discriminate among the three subgroups.
Conclusions:
The BFSQ is a psychometrically sound measure of functional status among bipolar patients. Efforts are underway to gather evidence for its responsiveness. The ultimate goal is for the BFSQ to facilitate the identification of treatments, which maximize functional status and ultimately improve patient adherence to treatment.
This article examines self and identity in the “Inner Chapters” (neipian 內篇) of the Zhuangzi 莊子. Previous scholarship on this topic has tended to support its arguments by defining the “Way” (dao 道) as either a normative order or an objective reality. By contrast, this article argues that the Way is a neutral designation for the composite, ever-changing patterns of the cosmos that does not provide normative guidance.
Within this cosmos, the human “self” (shen 身) is likewise defined as a composite, mutable entity that displays “tendencies” (qing 情) of behavior and thought. Two of these tendencies include the positing of unitary agents and the creation of “identities” (ming 名)—imaginative constructs used for self-definition. As a result of combining and reifying the two tendencies, most humans conflate their identities with their larger selves. The result is a simplified vision of an essential self that gives rise to normative judgements, blinds humans to the changing cosmos, and creates problematic social structures.
The text advocates that one should retrain the tendency toward identity by cultivating an inviolate “sense of self” or “virtue” (de 德) that is empty of specific identity. Virtue acts as an emotionally safe space in which the mirror-like mind can temporarily take on the identities of other creatures. This practice increases practitioners’ empathetic understanding of the world, detaches them from destructive social structures, and has the potential to generate new versions of human society.
The Área de Conservación Osa (ACOSA) contains the largest population of Scarlet Macaws Ara macao in Costa Rica. Despite their influence on ecosystem dynamics and status as a flagship species, empirical data on the foraging patterns of this population is lacking. This information is crucial in implementing effective conservation strategies, particularly reintroduction attempts. Observations of feeding behaviour were made systematically over a 12-month period to provide the first direct examination of Scarlet Macaw diet within the ACOSA region. Scarlet Macaws feed on various items including seeds, flowers, bark, and leaf-gall larvae. Key findings included a demonstration of a smaller dietary niche breadth than that recorded for other Central American populations, use of button mangrove Conocarpus erectus, a species not previously recognised as a food source for Scarlet Macaws, and a heavy reliance on an exotic non-native species, Terminalia catappa. We argue that whilst human-modified coastal locations may present viable habitat for Scarlet Macaws, anthropogenic influences including the removal of native food sources and proliferation of exotic and cultivated species have left the Scarlet Macaws of the ACOSA particularly dependent on a small number of species.
We investigate the Gibbs–Wilbraham phenomenon for generalized sampling series, and related interpolation series arising from cardinal functions. We prove the existence of the overshoot characteristic of the phenomenon for certain cardinal functions, and characterize the existence of an overshoot for sampling series.
A family of sets is intersecting if no two of its members are disjoint, and has the Erdős–Ko–Rado property (or is EKR) if each of its largest intersecting subfamilies has non-empty intersection.
Denote by
${{\cal H}_k}(n,p)$
the random family in which each k-subset of {1, …, n} is present with probability p, independent of other choices. A question first studied by Balogh, Bohman and Mubayi asks:
\begin{equation} {\rm{For what }}p = p(n,k){\rm{is}}{{\cal H}_k}(n,p){\rm{likely to be EKR}}? \end{equation}
Here, for fixed c < 1/4, and
$k \lt \sqrt {cn\log n} $
we give a precise answer to this question, characterizing those sequences p = p(n, k) for which
OBJECTIVES/SPECIFIC AIMS: o To review the community’s recommendations on how to rebuild trust in the Flint community. o To review effective community engagement strategies utilized with the Flint Special Projects for project conceptualization, participant recruitment, data analysis, project oversight, and dissemination. METHODS/STUDY POPULATION: The study population includes nearly two hundred residents representing seniors, youth and diverse ethnicities recruited to participate in eleven focus group meetings. The population also represents the general public who attended informational meetings in Flint, Michigan to learn about the crisis and allow residents to voice their opinions and concerns during the onset of the crisis. The project is a mixed methods community based participatory research effort that utilized community decision making in all phases of the effort such as pre-conception, implementation, dissemination and advocacy to encourage the community’s recommendations are adopted at policy and institutional responsiveness levels. It includes three community engaged research efforts: (project 1) A qualitative analysis of community sentiment provided during 17 recorded legislative, media and community events, and (projects 2-3) two mixed methods efforts utilizing purposive sampling of stakeholders whose voice may not have been heard. RESULTS/ANTICIPATED RESULTS: The project presents a qualitative analysis of the community’s voice during the onset of the man-made disaster when the community first became aware of the emergency manager’s plans to switch the water source. It also reflects current perspectives of community voice since the projects are scheduled to end late February 2019. Findings from a trust measure administered to nearly two hundred residents will be presented, along with a qualitative analysis of focus group findings among segments of the population (seniors, youth, and diverse ethnicities) who may have been left out of narratives on the water crisis. Finally, the project will compare empowerment and resiliency approaches being utilized in Flint, Michigan to recover from the disaster with other approaches grounded in literature and theory. DISCUSSION/SIGNIFICANCE OF IMPACT: Communities of color often experience social determinants of health which negatively impact their health, well-being and human rights. Some Flint citizens are experiencing negative health consequences (i.e., rashes, brain and behavioral sequelle, fertility, etc.) as a result of the disaster, and are uncertain of health outcomes in the future. This is the first project to rigorously document and analyze levels of trust and mistrust in the city of Flint since the water disaster occurred. The qualitative research will guide future clinical research that will benefit this traumatized community experiencing high levels of mistrust (i.e., government, elected officials, etc.). The community engaged methodology involved residents and study participants in all phases of the project including project oversight, validating and analyzing data, and dissemination. This methodology will contribute to existing literature and theory on community based participatory research, community engaged research, team science and citizen science. The approaches empowered a call to action among residents, for example, seniors who attended two senior focus group sessions shared “they are hopeful and have a purpose,” resulting in the creation of a council (with officers) at their housing complex to advocate for the well-being of seniors during the recovery process. Recruitment methodologies were extremely successful due to resident level trust in community leaders and community partner organizations. Finally, the project’s examination of approaches encouraging empowerment and resiliency will provide lessons learned for other communities challenged with crisis.
Price premiums are considered as major purchase barriers for organic products and therefore may prevent organic market growth. For wine, however, prices take a double and conflicting effect: they also serve as quality signal for consumers. Therefore, it is of high relevance to examine if price is a major barrier for organic wine as well.
Even though many studies already examined price behavior for organic wine through surveys and experiments, it is still to be clarified how consumers’ react to price changes in a real market context. So far, no study analyzed consumer preferences for organic labeled wine in daily shopping situations. Through the analysis of the GfK household panel—a high-frequency data set of extensive population coverage—implications for price setting and price promotions in different market segments can be given.
In contrast to previous studies, consumers’ overall price sensitivity was found to be low for organic wine and consumers’ preferred organic over conventional wine. The effect of price as quality cue or purchase barrier and the effect of an organic label on consumers’ behavior varied between price categories. Organic wine was valued highest in the low-price category, whereas no price premium for the organic label was examined in the high-price segment. Price sensitivity was extremely high for organic wine in the low-price segment, while price functioned as quality signal in the premium segment for organic and conventional wine similarly.
This study verified previous stated preference studies on organic wine through the analysis of actual purchase data. Moreover, new insights for price setting in different price categories were generated through the examination of a large amount of disaggregated data on single consumer purchases.
Denote by
${\mathcal H}_k$
(n, p) the random k-graph in which each k-subset of {1,. . .,n} is present with probability p, independent of other choices. More or less answering a question of Balogh, Bohman and Mubayi, we show: there is a fixed ε > 0 such that if n = 2k + 1 and p > 1 - ε, then w.h.p. (that is, with probability tending to 1 as k → ∞),
${\mathcal H}_k$
(n, p) has the ‘Erdős–Ko–Rado property’. We also mention a similar random version of Sperner's theorem.
Introduction: Early team experiences can influence the professional trajectories of early-career investigators profoundly, yet they remain underexplored in the team science literature, which has focused primarily on large, multisite teams led by established researchers. To better understand the unique challenges of teams led by early-career investigators, we conducted a qualitative pilot study.
Methods: Interviews were conducted with the principal investigator and members of 5 teams led by KL2 and K12 scholars at the University of Pittsburgh. A code book was developed and thematic analysis was conducted.
Results: Seven distinct themes emerged. Interview subjects reported a high level of trust and strong communication patterns on their teams; however, the data also suggested underlying tensions that have the potential to escalate into larger problems if unaddressed.
Conclusions: This study yields a deeper understanding of teams led by early-career investigators, which can help us provide appropriately targeted training and support.
Both law and medicine rely on self-regulation and codes of professionalism to ensure duties are performed in a competent, ethical manner. Unlike physicians, however, judges are lawyers themselves, so judicial oversight is also self-regulation. As previous literature has highlighted, the hesitation to report a cognitively-compromised judge has resulted in an “opensecret” amongst lawyers who face numerous conflicts of interest.
Through a case study involving a senior judge with severe cognitive impairment, this article considers the unique ethical dilemmas that cognitive specialists may encounter when navigating duties to patient, society, and the medical profession, without clear legal guidance.
Systemic self-regulatory inadequacies in the legal profession are addressed, as well as challenges that arise when trying to preserve the trust and dignity of an incapacitated patient who must fulfill special duties to society.
Ultimately, because of their unique neurological expertise and impartial assessments, we submit that allowing cognitive specialists to submit their assessments to an internal judiciary board may act as an additional check and balance to ensure the fair and competent administration of justice.
OBJECTIVES/SPECIFIC AIMS: Explore perceptions of Flint stakeholders on the water crisis regarding trust and the capacity of faith and community-based organizations providing public health services to address community needs. Analyze the community’s voice shared at (1) 17 key community communications (community/congressional meetings and events), and (2) during 9 focus group sessions, in which residents, faith-based leadership and other stakeholders discuss issues and concerns on the Flint Water Crisis, and recommend ways to address them. Develop a framework that defines core theories, concepts and strategies recommended by the community to help rebuild trust and the quality of life in Flint, Michigan, and support other communities experiencing environmental stress. METHODS/STUDY POPULATION: Study population: faith-based leaders, seniors, youth, Hispanic/Latino and African American stakeholders, and others experiencing inequities in the city of Flint. Convene 9 focus group sessions (recorded and transcribed) to learn community perceptions on trust and ways to address it. Validate accuracy of the transcriptions with community consultants to reconcile any inaccurate information. Through a community engaged research (CEnR) process, review and analyze qualitative data from the 9 focus group sessions, and quantitative data from 2 surveys documenting (1) demographic backgrounds of focus group participants, and (2) their perceptions on trust and mistrust. Prepare a codebook to qualitatively analyze the focus group data summarizing community input on trust, mistrust, changes in service delivery among community and faith-based organizations, and ways to re-build trust in the city of Flint. Transcribe the community’s voice shared during 17 key events, identified by a team of community-academic stakeholders (i.e., UM Flint water course, congressional and community events, etc.), in which residents and other stakeholders discuss issues and concerns on the Flint Water Crisis, and recommend ways to address it. Qualitatively analyze the transcriptions, using a CEnR process to prepare a codebook on key themes from the community’s voice shared at these events, and recommendations on ways to address it. Compare and contrast findings between the two codebooks developed from (1) the focus group data and (2) qualitative analysis of community voice during public meetings and events. Synthesize this information into a framework of core theories, concepts and rebuilding strategies for Flint, Michigan. RESULTS/ANTICIPATED RESULTS: It is important to note many undocumented immigrant populations in Flint fear deportation and other consequences, hampering their ability to obtain service and provide community voice. Through our purposive sampling approach, we will hear from community voices not often included in narratives (i.e., seniors, youth, Hispanic/Latino residents). The presentation will present findings documenting levels of trust and mistrust in the city of Flint; and a framework of recommendations, core theories and concepts on ways to reduce, rebuild and eliminate stress that will be helpful to other communities experiencing distress. DISCUSSION/SIGNIFICANCE OF IMPACT: To our knowledge, levels of trust and mistrust in Flint have not been documented thus far. We will compare and contrast common themes presented by the community at public meetings and events with themes presented in our focus group effort on trust. Faith and community-based providers were among the first responders to the Flint Water Crisis. The effort will also share perceptions on changes in public health service delivery, and observations on preparedness for these roles that occurred among community and faith-based providers. Finally, the effort will (1) support the design of a research agenda, (2) define a framework of core theories, concepts and recommendations developed by the community to help rebuild trust in Flint, Michigan; and (3) support other communities addressing environmental distress.