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.
It is unclear if mild-to-moderate dehydration independently affects mood without confounders like heat exposure or exercise. This study examined the acute effect of cellular dehydration on mood. Forty-nine adults (55 % female, age 39 (sd 8) years) were assigned to counterbalanced, crossover trials. Intracellular dehydration was induced with 2-h (0·1 ml/kg per min) 3 % hypertonic saline (HYPER) infusion or 0·9 % isotonic saline (ISO) as a control. Plasma osmolality increased in HYPER (pre 285 (sd 3), post 305 (sd 4) mmol/kg; P < 0·05) but remained unchanged in ISO (pre 285 (sd 3), post 288 (sd 3) mmol/kg; P > 0·05). Mood was assessed with the short version of the Profile of Mood States Questionnaire (POMS). The POMS sub-scale (confusion-bewilderment, depression-dejection, fatigue-inertia) increased in HYPER compared with ISO (P < 0·05). Total mood disturbance score (TMD) assessed by POMS increased from 10·3 (sd 0·9) to 16·6 (sd 1·7) in HYPER (P < 0·01), but not in ISO (P > 0·05). When TMD was stratified by sex, the increase in the HYPER trial was significant in females (P < 0·01) but not in males (P > 0·05). Following infusion, thirst and copeptin (surrogate for vasopressin) were also higher in females than in males (21·3 (sd 2·0), 14·1 (sd 1·4) pmol/l; P < 0·01) during HYPER. In conclusion, cellular dehydration acutely degraded specific aspects of mood mainly in women. The mechanisms underlying sex differences may be related to elevated thirst and vasopressin.
The regression discontinuity design (RDD) is a valuable tool for identifying causal effects with observational data. However, applying the traditional electoral RDD to the study of divided government is challenging. Because assignment to treatment in this case is the result of elections to multiple institutions, there is no obvious single forcing variable. Here, we use simulations in which we apply shocks to real-world election results in order to generate two measures of the likelihood of divided government, both of which can be used for causal analysis. The first captures the electoral distance to divided government and can easily be utilized in conjunction with the standard sharp RDD toolkit. The second is a simulated probability of divided government. This measure does not easily fit into a sharp RDD framework, so we develop a probability restricted design (PRD) which relies upon the underlying logic of an RDD. This design incorporates common regression techniques but limits the sample to those observations for which assignment to treatment approaches “as-if random.” To illustrate both of our approaches, we reevaluate the link between divided government and the size of budget deficits.
OBJECTIVES/GOALS: Clinical research is the backbone of the medical community. However, there are few regulations to ensure clinical trial participants can understand their results, leading to volunteers feeling unvalued and unlikely to enroll in trials1. This study examines the need of lay summaries METHODS/STUDY POPULATION: To understand the current landscape of clinical trial summaries, literature searches were conducted using the University of Southern California Library database with keywords Title contains “lay language” OR “lay summary” AND any field contains “Trial” OR “clinical”, and Title contains “natural language processing” AND “clinical trial” OR “Summary”. Studies were deemed relevant if they discussed lay language summaries for health care realms or using Natural Language Processing (NLP) to increase comprehension. Papers published by the Center for Information and Study on Clinical Research Participation (CISCRP) were reviewed and their Associate Director was interviewed. RESULTS/ANTICIPATED RESULTS: Of 67 total results, 14 were determined to be relevant. Ten of the relevant results examined lay language summaries and their regulation and 4 were NLP studies. The European Medicines Agency set regulations mandating clinical trial summaries. However, researchers have difficulty validating to an appropriate reading level2. Difficulty and potential bias halted a U.S. mandate of lay summaries3. The nonprofit CISCRP has partnered with industry to develop unbiased clinical trial summaries resulting in all volunteers feeling appreciated and 91% understanding clinical trial results post summary1. Similarly, NLP software for annotating Electronic Health Records increased comprehension for 77% of patients4. DISCUSSION/SIGNIFICANCE OF IMPACT: In the U.S., a lack of regulations mandating lay summaries may be related to concerns by regulatory agencies that summaries in plain language may introduce bias3. Future looks into integration of NLP systems to clinical trials may create unbiased summaries and allow for FDA regulation.
1. Identify patient-level factors associated with hemoglobin A1c reduction and sustained device use after 12months of participation in a diabetes and hypertension remote monitoring program
2. Utilize qualitative methodology to characterize key barriers and facilitators to remote monitoring engagement
METHODS/STUDY POPULATION: All participants in statewide quality improvement initiative utilizing a cellular-enabled device with glucose and blood pressure monitoring capability will be included in quantitative analysis (N = 302 at baseline and N = 125 at 6 months at the time of analysis). We developed multilevel regression analyses to model factors associated with clinical outcome (hemoglobin A1c change) and transmission frequency over time. Focus groups and surveys will be conducted to identify barriers and facilitators to continued data transmission and hemoglobin A1c change over 12 months. Semi-structured interview guides are mapped to Wagner’s Chronic Care Model. RESULTS/ANTICIPATED RESULTS: Overall, program participation was associated with 1.8% and 1.3% A1c reduction at 6 (n = 302) and 12 months (n = 125). Regression models showed no association of age, gender, race, income, or insurance with hemoglobin A1c change. Modeling of patient factors associated with sustained transmission frequency or device use is ongoing. Patient focus groups and surveys are currently being scheduled and qualitative data will be analyzed using content analysis. After completing qualitative and quantitative data analyses independently, we will use graphical matrix configurations (“joint displays”) to synthesize findings. DISCUSSION/SIGNIFICANCE OF IMPACT: Our goal is to identify variables associated with the likelihood of patients to engage in and benefit from sustained remote monitoring. Results may inform health policy and guide recruitment approaches, implementation strategies, and methodologic design for future trials. CONFLICT OF INTEREST DESCRIPTION: The authors have no conflicts of interest or disclosures to report
There is increasing recognition that using assistive devices can support healthy aging. Minimizing discomfort and loss of function and increasing independence can have a substantial impact physically, psychologically, and financially on persons with functional impairments and resulting activity limitations, as well as on caregivers and communities. However, it remains unclear who uses assistive devices and how device use can influence social participation. The current analysis used CLSA baseline data from 51,338 older adults between the ages of 45 and 85. Measures of socio-demographic, health, and social characteristics were analyzed by sex and age groups. Weighted cross-tabulations were used to report correlations between independent variables and assistive device use for hearing, vision, and mobility. We found that assistive device use was higher among those who were of older age, had less education, were widowed, had lower income, and had poorer health. Assistive devices were used differently according to sex and social participation, providing insight into assistive device use for the well-being of older adults and their families.
Introduction: Patients frequently present to the Emergency Department (ED) with predictable complications associated with radiation and chemotherapy for active cancer. Care alternatives have been proposed to reduce ED visits; however, no systematic review related to ED presentations has been completed. The objective of this scoping review was to examine the effectiveness of interventions designed to reduce ED visits among patients receiving active cancer treatment. Methods: A comprehensive literature search involving nine electronic databases and the grey literature was completed. Inclusion criteria considered studies assessing the impact of any intervention to reduce ED utilization among patients with active cancer. Two reviewers independently assessed relevance and inclusion; disagreements were resolved through third party adjudication. Dichotomous and continuous outcomes were summarized as risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CIs) using a random-effects model, wherever appropriate. Results: From 3303 citations, a total of 25 studies were included. Interventions identified in these studies comprised: routine and symptom-based patient follow-up, oncology outpatient clinics, early symptom detection, comprehensive inpatient management, hospital at home, and patient navigators. Six out of eight studies assessing oncology outpatient clinics reported a decrease in the proportion of patients presenting to the ED. A meta-analysis of three of these studies did not demonstrate reduction in ED utilization (RR 0.78; 95% CI: 0.56 to 1.08; I2 = 77%) when comparing oncology outpatient clinics to standard care; however, sensitivity analysis removing one study reporting rare events supported a decrease in ED visits (RR 0.86; 95% CI: 0.74 to 0.99; I2 = 47%). Three studies assessing patient follow-up interventions showed no difference in ED utilization (RR 0.69; 95% CI: 0.38 to 1.25; I2 = 86%). Conclusion: A variety of interventions designed to mitigate ED presentations by patients receiving active cancer treatment have been developed and evaluated. Limited evidence suggests that an oncology outpatient clinic may be an effective strategy to reduce ED utilization; however, additional high-quality studies are needed.
Mobile containers are a keystone human innovation. Ethnographic data indicate that all human groups use containers such as bags, quivers and baskets, ensuring that individuals have important resources at the ready and are prepared for opportunities and threats before they materialize. Although there is speculation surrounding the invention of carrying devices, the current hard archaeological evidence only reaches back some 100,000 years. The dearth of ancient evidence may reflect not only taphonomic processes, but also a lack of attention to these devices. To begin investigating the origins of carrying devices we focus on exploring the basic cognitive processes involved in mobile container use and report an initial study on young children's understanding and deployment of such devices. We gave 3- to 7-year-old children (N = 106) the opportunity to spontaneously identify and use a basket to increase their own carrying capacity and thereby obtain more resources in the future. Performance improved linearly with age, as did the likelihood of recognizing that adults use mobile carrying devices to increase carrying capacity. We argue that the evolutionary and developmental origins of mobile containers reflect foundational cognitive processes that enable humans to think about their own limits and compensate for them.
Over the past two decades, there has been a marked increase in partisan social polarization, leaving scholars in search of solutions to partisan conflict. The psychology of intergroup relations identifies empathy as one of the key mechanisms that reduces intergroup conflict, and some have suggested that a lack of empathy has contributed to partisan polarization. Yet, empathy may not always live up to this promise. We argue that, in practice, the experience of empathy is biased toward one’s ingroup and can actually exacerbate political polarization. First, using a large, national sample, we demonstrate that higher levels of dispositional empathic concern are associated with higher levels of affective polarization. Second, using an experimental design, we show that individuals high in empathic concern show greater partisan bias in evaluating contentious political events. Taken together, our results suggest that, contrary to popular views, higher levels of dispositional empathy actually facilitate partisan polarization.