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 firstname.lastname@example.org
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.
OBJECTIVES/SPECIFIC AIMS: This study aims to understand the factors influencing engagement with out-patient services from pregnancy to 1 year postpartum among women in recovery from opioid use disorders (OUD). METHODS/STUDY POPULATION: We conducted semi-structured qualitative interviews and a brief survey with 20 mothers in OUD recovery recruited from health care and community organizations in Western MA. Transcripts were coded by two independent coders and analyzed using a qualitative descriptive approach. RESULTS/ANTICIPATED RESULTS: The average duration of any addiction treatment among the 20 participants was 5.6 years with 80% receiving medication-assisted treatment during a pregnancy. Approximately two-thirds experienced relapse during pregnancy or the first year postpartum. We identified 3 themes elucidating women’s experiences around service engagement: “How I see myself” (personal development), “How services see me” (service delivery quality), and “Are you with me?” Personal development included response to past trauma, coping strategies and self-advocacy, and adjusting to parenthood. Service delivery quality was influenced by service design, efficacy of individual providers, and cultural norms (organizational and societal). In the final theme, intersection of individual and service-level factors influenced the degree and quality of the women’s experience engaging with services. DISCUSSION/SIGNIFICANCE OF IMPACT: Women describe successful engagement when they experience service providers as being emotionally supportive, delivering relevant services, and advocating on their behalf. To best support and engage families affected by OUD, relevant and timely services should be linked with compassionate delivery.
Amphibole in the lower parts of the Lilloise layered intrusion occurs interstitially and as a replacement of pyroxene; in the upper rocks it is a major cumulus phase. There is an overall trend of increasing Fe/(Fe + Mg) with height. Coupled substitutions which effect the variation in composition of the amphiboles are chiefly Na,K(A)+Al(T) for □A+SiT) and Ti+Al(T) for Fe3+(C)+ Si(T). There is considerable variation in composition both on the specimen scale and within individual grains. This variation, plus scatter found in plots of the coupled substitutions, is partly attributed to many of the amphiboles having replaced pyroxene and also to the effects of magmatic-hydrothermal fluids.
To date, Ireland has been a leading light in the provision of youth mental health services. However, cognisant of the efforts of governmental and non-governmental agencies working in youth mental health, there is much to be done. Barriers into care as well as discontinuity of care across the spectrum of services remain key challenges. This editorial provides guidance for the next stage of development in youth mental care and support that will require significant national engagement and resource investment.
The original research by Mullen et al. in this issue is a welcome contribution to the increasingly important research area concerned with mental health and internet use. There is a persistent and growing tension between harmful online content and the potential to support vulnerable people online. Although current research has established both negative and positive influences of the internet on mental health, a policy framework to guide the development of online mental health resources is lacking. Based on 20 years of online service provision (in Australia originally and now in Ireland), ReachOut.com has gained important insights into young people’s online behaviour and help-seeking preferences. Given that young people have expressed concerns about the impact of the internet and social media on their mental health, yet they will go online for support, there is a clear need for leadership and the resourcing of quality assured, engaging online mental health supports. Such an approach will be the most effective way of mitigating the threat posed by harmful online content.
Objectives: The aim of this study was to examine the evidence payers cited in their coverage policies for multi-gene panels and sequencing tests (panels), and to compare these findings with the evidence payers cited in their coverage policies for other types of medical interventions.
Methods: We used the University of California at San Francisco TRANSPERS Payer Coverage Registry to identify coverage policies for panels issued by five of the largest US private payers. We reviewed each policy and categorized the evidence cited within as: clinical studies, systematic reviews, technology assessments, cost-effectiveness analyses (CEAs), budget impact studies, and clinical guidelines. We compared the evidence cited in these coverage policies for panels with the evidence cited in policies for other intervention types (pharmaceuticals, medical devices, diagnostic tests and imaging, and surgical interventions) as reported in a previous study.
Results: Fifty-five coverage policies for panels were included. On average, payers cited clinical guidelines in 84 percent of their coverage policies (range, 73–100 percent), clinical studies in 69 percent (50–87 percent), technology assessments 47 percent (33–86 percent), systematic reviews or meta-analyses 31 percent (7–71 percent), and CEAs 5 percent (0–7 percent). No payers cited budget impact studies in their policies. Payers less often cited clinical studies, systematic reviews, technology assessments, and CEAs in their coverage policies for panels than in their policies for other intervention types. Payers cited clinical guidelines in a comparable proportion of policies for panels and other technology types.
Conclusions: Payers in our sample less often cited clinical studies and other evidence types in their coverage policies for panels than they did in their coverage policies for other types of medical interventions.
OBJECTIVES/SPECIFIC AIMS: The goal of this study is to develop an effective and efficient STI preventive intervention among college students following the principles and phases of MOST. METHODS/STUDY POPULATION As part of the preparation phase, an explicit conceptual model, drawing heavily on theory and prior research, was used to translate the existing science into 5 candidate intervention components (ie, descriptive norms, injunctive norms, expectancies, perceived benefits of protective behavioral strategies, and self-efficacy). For the optimization phase, in Fall 2016 all first-year students (n=3547) from 4 universities were recruited to participate. Students were randomized to 1 of 32 different experimental conditions that included a combination of the candidate intervention components. Component effectiveness was evaluated using data from an immediate post-intervention survey on respective component mediators (eg, alcohol and sex-related descriptive norms). After a second factorial experiment (Fall 2017), only those intervention components that meet the pre-specified criteria of day ≥0.15 will be included in the optimized intervention. The evaluation phase will evaluate the effectiveness of the optimized STI preventive intervention via a randomized-control trial (Fall 2018). RESULTS/ANTICIPATED RESULTS: Preliminary results from the first factorial experiment suggest that descriptive norms and injunctive norms intervention components were significantly effective in reducing post-intervention perceived alcohol prevalence (β=−0.28, p<0.001) and approval of alcohol (β=−0.33, p<0.001), and sex-related norms (β=−0.23, p<.001). These results, in combination with process data, are being used to inform revisions of the intervention components to be included in a second factorial screening experiment. DISCUSSION/SIGNIFICANCE OF IMPACT: This study demonstrates how an iterative approach to engineering an STI preventive intervention using MOST can affect the behaviors of college students and serve as a foundation for other translational science.
The Farmers’ Market Fresh Fund Incentive Program is a policy, systems and environmental intervention to improve access to fresh produce for participants on governmental assistance in the USA. The current study examined factors associated with ongoing participation in this matched monetary incentive programme.
Relationship of baseline factors with number of Fresh Fund visits was assessed using Poisson regression. Mixed-effects modelling was used to explore changes in consumption of fruits and vegetables and diet quality.
San Diego, California.
Recipients of Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Supplemental Security Income (SSI) who attended participating farmers’ markets from 2010 to 2012 (n 7298).
Among those with participation for ≤6 months, factors associated with increased visits included reporting more daily servings of fruits and vegetables (F&V) at baseline, being Vietnamese or Asian/Pacific Islander, and eligibility because of SNAP/CalFresh or SSI (v. WIC). Among those who came for 6–12 months, being Asian/Pacific Islander, eligibility because of SNAP/CalFresh and enrolling in the autumn, winter or spring were associated with a greater number of Fresh Fund visits. Among those who came for >12 months, being male and eligibility because of SSI were associated with a greater number of visits. Overall, the odds of increasing number of servings of F&V consumed increased by 2 % per month, and the odds of improved perception of diet quality increased by 10 % per month.
Sustaining and increasing Fresh Fund-type programme operations should be a top priority for future policy decisions concerning farmers’ market use in low-income neighbourhoods.
Complex oxides and semiconductors exhibit distinct yet complementary properties owing to their respective ionic and covalent natures. By electrically coupling complex oxides to traditional semiconductors within epitaxial heterostructures, enhanced or novel functionalities beyond those of the constituent materials can potentially be realized. Essential to electrically coupling complex oxides to semiconductors is control of the physical structure of the epitaxially grown oxide, as well as the electronic structure of the interface. Here we discuss how composition of the perovskite A- and B-site cations can be manipulated to control the physical and electronic structure of semiconductor—complex oxide heterostructures. Two prototypical heterostructures, Ba1−xSrxTiO3/Ge and SrZrxTi1−xO3/Ge, will be discussed. In the case of Ba1−xSrxTiO3/Ge, we discuss how strain can be engineered through A-site composition to enable the re-orientable ferroelectric polarization of the former to be coupled to carriers in the semiconductor. In the case of SrZrxTi1−xO3/Ge we discuss how B-site composition can be exploited to control the band offset at the interface. Analogous to heterojunctions between compound semiconducting materials, control of band offsets, i.e., band-gap engineering, provides a pathway to electrically couple complex oxides to semiconductors to realize a host of functionalities.
This paper applies the theory of the quasi-likelihood method to model-based inference for sample surveys. Currently, much of the theory related to sample surveys is based on the theory of maximum likelihood. The maximum likelihood approach is available only when the full probability structure of the survey data is known. However, this knowledge is rarely available in practice. Based on central limit theory, statisticians are often willing to accept the assumption that data have, say, a normal probability structure. However, such an assumption may not be reasonable in many situations in which sample surveys are used. We establish a framework for sample surveys which is less dependent on the exact underlying probability structure using the quasi-likelihood method.
Complex oxides and semiconductors exhibit distinct yet complementary properties
owing to their respective ionic and covalent natures. By electrically coupling
oxides to semiconductors within epitaxial heterostructures, enhanced or novel
functionalities beyond those of the constituent materials can potentially be
realized. Key to electrically coupling oxides to semiconductors is controlling
the physical and electronic structure of semiconductor – crystalline
oxide heterostructures. Here we discuss how composition of the oxide can be
manipulated to control physical and electronic structure in
Ba1-xSrxTiO3/ Ge and
SrZrxTi1-xO3/Ge heterostructures. In the
case of the former we discuss how strain can be engineered through composition
to enable the re-orientable ferroelectric polarization to be coupled to carriers
in the semiconductor. In the case of the latter we discuss how composition can
be exploited to control the band offset at the semiconductor - oxide interface.
The ability to control the band offset, i.e. band-gap engineering, provides a
pathway to electrically couple crystalline oxides to semiconductors to realize a
host of functionalities.
Objectives: The Centers for Medicare and Medicaid Services (CMS) issues National Coverage Determinations (NCDs) for medical interventions expected to have a significant impact on Medicare, the health insurance program for US citizens aged 65 years and older and certain people with disabilities under the age of 65 years. The objective of this study was to evaluate NCDs issued from 1999 to 2013 to identify key trends, and to discuss implications for future CMS policy.
Methods: We used the Tufts Medical Center Medicare National Coverage Determination Database to examine characteristics of NCDs from 1999 through 2013. We examined various characteristics of NCDs, including: whether the intervention under review is used for prevention or treatment of disease, the type of intervention considered, evidence limitations cited by CMS, and coverage determination outcome. We evaluated longitudinal trends in categorical and continuous variables in the database, using Cochran-Armitage trend tests and linear regression, respectively.
Results: We found that NCDs increasingly focus on preventive care (p = 0.072), pertain to diagnostic imaging (p = 0.033), and evaluate health education/behavioral therapy interventions (p = 0.051). CMS increasingly cites the lack of relevant outcomes (p = 0.019) and the lack of applicability of study results to the Medicare population (p < 0.001) as evidence limitations. CMS less often restricts coverage to certain population subgroups in NCDs (p < 0.001), but increasingly applies coverage with evidence development policies (p < 0.001).
Conclusions: Identified trends reflect broader changes in Medicare as CMS shifts its focus from treatment to prevention of disease, addresses potentially overutilized technologies, and attempts to issue flexible coverage policies.