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Our research speaks to the ongoing debate over the extent and severity of partisan political divisions in American society. We employ behavioral experiments to probe for affective polarization using dictator, trust, and public goods games with party identification treatments. We find that subjects who identify politically with the Democratic or Republican Party and ideologically as liberals and conservatives display stronger affective biases than politically unaffiliated and ideological moderates. Partisan subjects are less altruistic, less trusting, and less likely to contribute to a mutually beneficial public good when paired with members of the opposing party. Compared to other behavioral studies, our research suggests increasing levels of affective polarization in the way Americans relate to one another politically, bordering on the entrenched divisions one commonly sees in conflict or post-conflict societies. To overcome affective polarization, our research points to inter-group contact as a mechanism for increasing trust and bridging political divides.
Are the sources of a combatant's knowledge in war morally relevant? This article argues that privacy is relevant to just war theory in that it draws attention to privacy harms associated with the conduct of war. Since we cannot assume that information is made available to combatants in a morally neutral manner, we must therefore interrogate the relationship between privacy harms and the acts that they enable in war. Here, I argue that there is ample evidence that we cannot discount the analysis of privacy harms in war, and that analysis of such harms requires us to examine social goods. I develop this point to demonstrate the problems that this poses for aspects of revisionist just war theory; namely, reductivism and individualism. In order to evaluate the moral consequences of privacy harms in war, we must understand the unilateral and adversarial character of balancing privacy harms against social goods in the context of war, which, in turn, requires that we consider social goods and social institutions as objects of moral evaluation. Further, concepts drawn from privacy scholarship, such as Helen Nissenbaum's concept of contextual integrity, enable us to identify a range of moral problems associated with contemporary war that deserve further attention from just war theorists.
Background: The NHSN has used positive laboratory tests for surveillance of Clostridioides difficile infection (CDI) LabID events since 2009. Typically, CDIs are detected using enzyme immunoassays (EIAs), nucleic acid amplification tests (NAATs), or various test combinations. The NHSN uses a risk-adjusted, standardized infection ratio (SIR) to assess healthcare facility-onset (HO) CDI. Despite including test type in the risk adjustment, some hospital personnel and other stakeholders are concerned that NAAT use is associated with higher SIRs than are EIAs. To investigate this issue, we analyzed NHSN data from acute-care hospitals for July 1, 2017 through June 30, 2018. Methods: Calendar quarters for which CDI test type was reported as NAAT (includes NAAT, glutamate dehydrogenase (GDH)+NAAT and GDH+EIA followed by NAAT if discrepant) or EIA (includes EIA and GDH+EIA) were selected. HO CDI SIRs were calculated for facility-wide inpatient locations. We conducted the following analyses: (1) Among hospitals that did not switch their test type, we compared the distribution of HO incident rates and SIRs by those reporting NAAT vs EIA. (2) Among hospitals that switched their test type, we selected quarters with a stable switch pattern of 2 consecutive quarters of each of EIA and NAAT (categorized as pattern EIA-to-NAAT or NAAT-to-EIA). Pooled semiannual SIRs for EIA and NAAT were calculated, and a paired t test was used to evaluate the difference of SIRs by switch pattern. Results: Most hospitals did not switch test types (3,242, 89%), and 2,872 (89%) reported sufficient data to calculate SIRs, with 2,444 (85%) using NAAT. The crude pooled HO CDI incidence rates for hospitals using EIA clustered at the lower end of the histogram versus rates for NAAT (Fig. 1). The SIR distributions of both NAAT and EIA overlapped substantially and covered a similar range of SIR values (Fig. 1). Among hospitals with a switch pattern, hospitals were equally likely to have an increase or decrease in their SIR (Fig. 2). The mean SIR difference for the 42 hospitals switching from EIA to NAAT was 0.048 (95% CI, −0.189 to 0.284; P = .688). The mean SIR difference for the 26 hospitals switching from NAAT to EIA was 0.162 (95% CI, −0.048 to 0.371; P = .124). Conclusions: The pattern of SIR distributions of both NAAT and EIA substantiate the soundness of NHSN risk adjustment for CDI test types. Switching test type did not produce a consistent directional pattern in SIR that was statistically significant.
Background: The National Healthcare Safety Network (NHSN) has used positive laboratory tests for surveillance of Clostridioides difficile infection (CDI) LabID events since 2009. Typically, CDIs are detected using enzyme immunoassays (EIAs), nucleic acid amplification tests (NAATs), or various test combinations. The NHSN uses a risk-adjusted, standardized infection ratio (SIR) to assess healthcare facility-onset (HO) CDI. Despite including test type in the risk adjustment, some hospital personnel and other stakeholders are concerned that NAAT use is associated with higher SIRs than EIA use. To investigate this issue, we analyzed NHSN data from acute-care hospitals for July 1, 2017, through June 30, 2018. Methods: Calendar quarters where CDI test type was reported as NAAT (includes NAAT, glutamate dehydrogenase (GDH)+NAAT and GDH+EIA followed by NAAT if discrepant) or EIA (includes EIA and GDH+EIA) were selected. HO-CDI SIRs were calculated for facility-wide inpatient locations. We conducted the following 2 analyses: (1) Among hospitals that did not switch their test type, we compared the distribution of HO incident rates and SIRs by those reporting NAAT versus EIA. (2) Among hospitals that switched their test type, we selected quarters with a stable switch pattern of 2 consecutive quarters of each of EIA and NAAT (categorized as EIA-to-NAAT or NAAT-to-EIA). Pooled semiannual SIRs for EIA and NAAT were calculated, and a paired t test was used to evaluate the difference in SIRs by switch pattern. Results: Most hospitals did not switch test types (3,242, 89%), and 2,872 (89%) reported sufficient data to calculate an SIR, with 2,444 (85%) using NAAT. The crude pooled HO CDI incidence rates for hospitals using EIAs clustered at the lower end of the histogram versus rates for NAATs (Fig. 1). The SIR distributions, both NAATs and EIAs, overlapped substantially and covered a similar range of SIR values (Fig. 1). Among hospitals with a switch pattern, hospitals were equally likely to have an increase or decrease in their SIRs (Fig. 2). The mean SIR difference for the 42 hospitals switching from EIA to NAAT was 0.048 (95% CI, −0.189 to 0.284; P = .688). The mean SIR difference for the 26 hospitals switching from NAAT to EIA was 0.162 (95% CI, −0.048 to 0.371; P = .124). Conclusions: The pattern of SIR distribution for both NAAT and EIA substantiate the soundness of the NHSN’s risk adjustment for CDI test types. Switching test type did not produce a consistent directional pattern in SIR that was statistically significant.
Social distancing policies are key in curtailing severe acute respiratory coronavirus virus 2 (SARS-CoV-2) spread, but their effectiveness is heavily contingent on public understanding and collective adherence. We studied public perception of social distancing through organic, large-scale discussion on Twitter.
Retrospective cross-sectional study.
Between March 27 and April 10, 2020, we retrieved English-only tweets matching two trending social distancing hashtags, #socialdistancing and #stayathome. We analyzed the tweets using natural language processing and machine-learning models, and we conducted a sentiment analysis to identify emotions and polarity. We evaluated the subjectivity of tweets and estimated the frequency of discussion of social distancing rules. We then identified clusters of discussion using topic modeling and associated sentiments.
We studied a sample of 574,903 tweets. For both hashtags, polarity was positive (mean, 0.148; SD, 0.290); only 15% of tweets had negative polarity. Tweets were more likely to be objective (median, 0.40; IQR, 0–0.6) with ~30% of tweets labeled as completely objective (labeled as 0 in range from 0 to 1). Approximately half of tweets (50.4%) primarily expressed joy and one-fifth expressed fear and surprise. Each correlated well with topic clusters identified by frequency including leisure and community support (ie, joy), concerns about food insecurity and quarantine effects (ie, fear), and unpredictability of coronavirus disease 2019 (COVID-19) and its implications (ie, surprise).
Considering the positive sentiment, preponderance of objective tweets, and topics supporting coping mechanisms, we concluded that Twitter users generally supported social distancing in the early stages of their implementation.
In March 2020, Prime Minister Abe Shinzō, the Tokyo Olympic Organising Committee, and the International Olympic Committee postponed the 2020 Tokyo Olympics for one year. The delay is the most prominent consequence of the COVID-19 crisis in Japan thus far. But the “Corona Calamity” (korona ka) is bigger than the Olympics. The totality of the disaster is impossible to capture. The very thing that makes it a calamity are the myriad rhythms of crisis that intersect at COVID-19. If there is a shared theme to be found in these rhythms, it is the question of recovery. When will it happen? What will it look like? And what, exactly, will we recover? In what follows, I share three rhythms of crisis and recovery: national history, the tourism industry, and the parcel delivery industry.
Acoustic cues to deception on a picture-naming task were analyzed in three groups of English speakers: monolinguals, bilinguals with English as their first language, and bilinguals with English as a second language. Results revealed that all participants had longer reaction times when generating falsehoods than when producing truths, and that the effect was more robust for English as a second language bilinguals than for the other two groups. Articulation rate was higher for all groups when producing lies. Mean fundamental frequency and intensity cues were not reliable cues to deception, but there was lower variance in both of these parameters when generating false versus true labels for all participants. Results suggest that naming latency was the only cue to deception that differed by language background. These findings broadly support the cognitive-load theory of deception, suggesting that a combination of producing deceptive speech and using a second language puts an extra load on the speaker.
How do the costs of conflict influence public support for the use of force? Existing research finds that weapons that eliminate the possibility of military casualties, such as drones, increase popular support for engaging in conflict. We argue that this effect may be overstated because the choice of weapons technology is endogenous to conflict. Leaders may select to use drones in conflicts where the risk of harm to ground forces is especially high. To address this, we replicate and extend the research design of Walsh and Schulzke across three survey experiments. The key innovation in our experiments is that subjects are led to believe that the choice of attack type – drones or ground troops – is determined by weather conditions rather than strategic considerations. We find that support for military action does not differ across treatments in which subjects are told that the attack involves drone strikes or ground troops.
Using a national survey of Generation Z conducted in late May 2020, we measure attitudes about the impact of the coronavirus on personal health, financial and job concerns, views about shelter-in-place laws, and 2020 voting intentions. Gen Z women express greater health and economic concerns and support for shelter-in-place measures than their male counterparts, but this gender gap is largely mitigated by party and other covariates. Party also mediates the differences between young male and female voters concerning the influence of the coronavirus on their vote choice in 2020. Notably, women have significantly greater concern about the impact of COVID-19 on their personal financial situation, while Gen Z men express more concern about their personal health amid COVID-19 in more fully specified statistical models. This research contributes to the growing literature that examines not only the sorting effect of party on the gender gap but also how different identities—in this case, generation—can help explain the persistent political divides between men and women.
This report describes the evaluation of the psychometric and clinimetric properties of nine self-report measures completed by informal care partners of individuals with mild cognitive impairment or dementia in Parkinson’s disease and dementia with Lewy bodies. One hundred thirty-six care partners completed measures on relationship satisfaction, burden, stress, mood, resilience, health, quality of life, and feelings related to care provision. Psychometric properties, such as internal consistency, convergent validity, floor and ceiling effects, completion rate and data missingness, as well as clinimetric properties, such as time to administer, ease of scoring, readability and availability of the scales, were examined. Additionally, the design of the measure development studies was assessed with the 2018 COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) Risk of Bias checklist. Participants were mostly married women (>85%) with a mean age of 69.4 years. The methodological quality of the design of all measure development studies was “inadequate.” Five widely applied measures (Zarit Burden Interview, Hospital Anxiety and Depression Scale, Short Form 12 Health Survey, Relatives’ Stress Scale, and EuroQoL-5D) and two less researched instruments (Brief Resilience Scale and Relationship Satisfaction Scale) had high internal consistency and completion rates, moderate to strong convergent validity, low missingness and floor effects, and excellent clinical utility ratings. Two scales (Dyadic Relationship Scale and Family Caregiving Role) received poor psychometric ratings, and their usage among informal care partners is not recommended. In conclusion, well-validated and widely used measures received strong psychometric and clinimetric ratings. Future studies are required to determine the most reliable, valid and robust caregiver-reported measures.
To examine the psychological and social impact of the COVID-19 pandemic on patients with established anxiety disorders during a period of stringent mandated social restrictions.
Semi-structured interviews were conducted with 30 individuals attending the Galway-Roscommon Mental Health Services with an International Classification of Diseases diagnosis of an anxiety disorder to determine the impact of the COVID-19 restrictions on anxiety and mood symptoms, social and occupational functioning and quality of life.
Twelve (40.0%) participants described COVID-19 restrictions as having a deleterious impact on their anxiety symptoms. Likert scale measurements noted that the greatest impact of COVID-19 related to social functioning (mean = 4.5, SD = 2.9), with a modest deleterious effect on anxiety symptoms noted (mean = 3.8, SD = 2.9). Clinician rated data noted that 8 (26.7%) participants had disimproved and 14 (46.7%) participants had improved since their previous clinical review, prior to commencement of COVID-19 restrictions. Conditions associated with no ‘trigger’, such as generalised anxiety disorder, demonstrated a non-significant increase in anxiety symptoms compared to conditions with a ‘trigger’, such as obsessive compulsive disorder. Psychiatric or physical comorbidity did not substantially impact on symptomatology secondary to COVID-19 mandated restrictions.
The psychological and social impact of COVID-19 restrictions on individuals with pre-existing anxiety disorders has been modest with only minimal increases in symptomatology or social impairment noted.
Novel neurointerventions present innovative therapeutic approaches to a range of treatment-refractory disorders. We sought to characterize factors that inform and define translational readiness for first-in-human (FIH) neuromodulatory trials.
We used a two-part methodology involving a scoping review of the biomedical literature on the readiness of FIH trials for both neurological and non-neurological applications, and semi-structured interviews with stakeholders about decision-making for neuromodulation using magnetic resonance-guided focused ultrasound as a case example.
One hundred and thirty factors relevant to FIH readiness were identified in the scoping review. Trial design, adequacy of preclinical evidence, and risk were ubiquitous across biotechnologies. Target organ, target function, and inadequacy of animal models were dominant in the neurointervention literature. Interview results on the relative importance of these factors reveal divergent values, priorities, and understandings both between patients and clinicians and between patients affected by different conditions.
Readiness of neurotechnology for FIH trials is defined by a multitude of interacting factors that pertain to clinical and nonclinical priorities, perceptions, and values.
OBJECTIVES/GOALS: In March 2019, Duke updated recruitment guidelines and adopted an “Engagement” policy that requires patients to ‘opt-out’ of communications regarding potential research participation. This created an opportunity to evaluate recruitment for ongoing clinical studies pre and post implementation. METHODS/STUDY POPULATION: Implementation of the new policy required new training for study teams, modification to recruitment plans, and expansion of ongoing efforts to improve direct-to-patient messaging through EPIC/MyChart tools. The impact of this new policy on overall recruitment was monitored and characterized both prior to and after implementation of the policy. Customized MyChart messages have been generated for over 22 studies, with a total of 41,386 messages sent to potential participants. RESULTS/ANTICIPATED RESULTS: Only a small number of study teams have modified their recruitment plans with transition to the new policy. This may be related to lack of understanding about policy implementation, potential recruitment opportunities, required training, resource limitations, etc. However, our case study, TMIST, had an 48% improvement in average enrollment within the first 2 months of implementation, and an almost 40% improvement in recruitment efficiency. Since becoming an “opt-out” institution, 11 study teams have implemented direct-to-patient recruitment via the MyChart patient portal. One unintended consequence we’ve noted is several different study invitations to potential participants within some patient populations. DISCUSSION/SIGNIFICANCE OF IMPACT: The new policy allows study teams to engage in direct-to-patient outreach, leading to an increase in enrollment for some studies. Incorporation of direct-to-patient messaging strategies can be a cost and resource saving measure to improve recruitment. The need to recruit similar populations demonstrated that strategic, thoughtful approaches are needed.
OBJECTIVES/GOALS: The modified Atkins diet (MAD) is used in the management of drug-resistant epilepsy in adults. Some patients on MAD show an increase in serum levels of total cholesterol and low-density lipoprotein (LDL) cholesterol. We explored whether dietary fat composition predicts short-term elevations in serum lipid levels in diet-naïve adults who begin MAD. METHODS/STUDY POPULATION: Participants self-reported their diet intake with 3-day food records at baseline, 1 month and 2 months. Food records were analyzed using Nutrition Data System for Research software. Fasting serum levels of total cholesterol (TC), high-density lipoprotein (HDL) cholesterol, and triglycerides were also collected and LDL level calculated at baseline, 1 month, and 2 months. RESULTS/ANTICIPATED RESULTS: 38 patients submitted complete food records at each study visit (baseline, 1 month, and 2 month). Compared to baseline diet intake, there was a significant reduction in daily carbohydrate intake at 1 and 2 months months (p<0.001). There was also a significant increase in daily saturated fatty acid (SFA) intake at 1 and 2 months (p<0.001), daily mono-unsaturated fatty acid (MUFA) intake at 1 and 2 months (p<0.001), and daily cholesterol intake at 1 month (p<0.05) and 2 months (p<0.001), but no change in daily poly-unsaturated fatty acid (PUFA) intake over time. Compared to baseline, there was a significant increase in serum LDL at 1 month (p<0.001) and 2 months (p<0.01) and an increase in serum TC at 1 month (p<0.01) but not 2 months. DISCUSSION/SIGNIFICANCE OF IMPACT : Despite a significant increase in total fat, saturated fat and mono-unsaturated fat intake as well as an increase in total cholesterol and LDL levels following MAD initiation, dietary fat composition appears to minimally predict serum lipid values in the short term. CONFLICT OF INTEREST DESCRIPTION: Tanya McDonald has received speaking honoraria from Nutricia North America. Bobbie Henry-Barron receives grants from Johns Hopkins Institute for Clinical and Translational Research (ICTR) which is funded in part by Grant Number UL1 TR 001079 from the National Center for Advancing Translational Sciences (NCATS) a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research, Nutricia and Vitaflo. Diane Vizthum receives grants from the Johns Hopkins Institute for Clinical and Translational Research (ICTR) which is funded in part by Grant Number UL1 TR 001079 from the National Center for Advancing Translational Sciences (NCATS) a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Mackenzie C. Cervenka has received grant support from Nutricia North America, Vitaflo, Army Research Laboratory, The William and Ella Owens Medical Research Foundation and BrightFocus Foundation. She receives speaking honoraria from LivaNova, Epigenix, Nutricia North America and the Glut1 Deficiency Foundation and performs consulting with Nutricia North America and Sage Therapeutics and receives Royalties from Demos Health.
Artisans and craftsmen in Southern Italy participated in complex networks of interactions which are not yet fully understood. Although we know the broad outlines of the kind of mobility driven by trade, the movements of individual artists or artefacts are much harder to track and, unlike the careers of elite men or soldiers, craftsmen’s lives are rarely memorialised in literature or outlined on gravestones. Instead, their work provides our main insight into how artisans lived, worked and travelled. The style, function and decoration of paintings, ceramics and other products provides some clues, but text is also used for decorative and practical purposes on a wide range of different objects. Many of these inscriptions show the writer’s familiarity with multiple languages, alphabets or dialects and, in some cases, may show evidence for movement across language or dialect boundaries.