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Many observers were casting doubts about the existence of a strategic partnership between Russia and the European Union long before the annexation of Crimea and the subsequent strained relations between the two blocs. Nevertheless, the main challenge of this article is to prove that there was indeed a positive effect regarding the strategic partnership on bilateral trading – together with such factors as the growth of the Russian and EU GDPs per capita, the devaluation of the Russian currency and the oil price increase – by applying the Gravity Model. Based on this model, it was also confirmed that there was a negative effect of the geographical distance and sanctions between parties on the EU–Russia trade flow. Moreover, we tried to predict by means of the Error Correction Models how EU–Russia bilateral trade would have changed according to a scenario wherein the parties continued being strategic partners, and had the sanctions not been imposed. As such, and by the method described, not only was it empirically confirmed that the major partners would have received the most benefit from the strategic partnership with Russia but even Russia’s smaller trading partners are incurring significant welfare losses from sanctions, along with Russia itself.
Food security status is a continuum ranging from high to very low food security. While marginal food security falls next to high food security on the spectrum, new quantitative research indicates marginal food security status is associated with negative health outcomes and poor academic performance among college students. Qualitative research focusing on college students experiencing marginal food security has not been conducted. The current study aims to qualitatively explore experiences of college students with marginal food security and to identify themes to better understand and provide context regarding how marginal food security impacts students.
Students were recruited for semi-structured interviews with questions designed to study the challenges associated with students’ food situations. All interviews were recorded and transcribed with themes identified via an inductive approach.
A large public university on the US west coast.
Thirty college students.
Key themes that emerged: purchasing cheap unhealthy foods, insufficient time to prepare and eat meals on a regular basis, stress and anxiety around the inability to eat healthy food and future health issues, self-perception of health when eating poorly along with physical symptoms and low academic motivation by not fully participating in their courses due to few healthy food options or missing meals.
Marginal food security can potentially diminish students’ health and their capacity to learn and succeed in their coursework. The results emphasise that students experiencing marginal food security should not be grouped with students experiencing high food security.
Previous studies have shown that intake of sugary drinks in Mexico has increased, while intake of whole milk has decreased. Yet, in-depth analyses of the changes in solid foods, overall and in specific generations and urban/rural subpopulation, are scarce. We aimed to analyse changes in solid foods intake in Mexican children, adolescent girls and adult women through a single 24-h dietary recall from the Mexican Nutrition Survey 1999 (n 5627) and 2012 (n 6712). Foods were classified into twenty-two healthy and unhealthy food groups without considering beverages. We estimated the crude and adjusted change in the energy contribution of solid foods by age group and birth cohort and tested if the changes differed by urban/rural area. The contribution of fruits, vegetables and unsweetened dairy increased, while sweet bread from bakery decreased. However, the total contribution of healthy food groups (67–70 % kj in 1999) decreased −4·3 and −7·2 percentage points (pp) (P < 0·05) among children and adolescents, respectively, but only −1·7 pp (P > 0·05) among adult women. Likewise, those born in 1980–1984 changed little in comparison with those born in 1993–1997, and there were greater increases in unhealthy foods in urban compared with rural areas. In conclusion, from 1999 to 2012, there were negative changes in the intake of foods, specifically healthy foods, which mainly affected Mexican youth. These findings, along with previous reports on the increased intake of sugary drinks in the same population, that emphasise the need to reinforce strategies aimed at improving dietary intake of the Mexican population need to be reinforced.
ABSTRACT IMPACT: This presentation highlights an integrated curriculum in CTR and a scientific entrepreneurship approach to entice and support students and faculty in HP programs into CTR and SE thus expanding the pool of new minority CTR researchers. OBJECTIVES/GOALS: To present the TVMSC as a hub for trainings, mentoring programs, courses, entrepreneurship and support activities for health professionals(HP) and HP students :graduate (GS) and UgS and UgF. Responding to the need for CTR minority researchers, in a virtual setting due to COVID-19 crisis. METHODS/STUDY POPULATION: TVMSC will offer an educational program based in the Center for Research,Entrepreneurship and Scientific Collaboration (CRESCO) with on line courses and workshops in CTR and SE, for HP and students and a continued education curriculum for HP and clinician scientists toward a certification in CTR. Two hands-on experiences: a) a Pilot project program(PiP) with teams composed of an F, that previously completed training cycles and a research experience from a previous project in CTR as PI, with a research mentor and students or an established researcher as a PI with UgS and UgF, and b) participation in a SE team which will engage in training and submission of an SE project proposal. RESULTS/ANTICIPATED RESULTS: By the end of the five-year period the project will have had 200 UgS, 200 GS and 200 F that received online assistance in CTR skills, statistics and SE; 48 UgS and 48 GS with the skills in SEFL. In curricular development the project expects to have 6 online tutorials created, one FLSE online course and 18 modules in CTR content areas available for continued education of HP. Certifications in CTR will be completed by 160F/HPs. The expected participation in CTR on-hands experiences is 32 F, 64 students and 32 established researchers. PiP teams will publish at least 8 scientific papers and SEFL teams will submit at least 5 SE project proposals and 100% increase in CRESCO web based resources DISCUSSION/SIGNIFICANCE OF FINDINGS: This Project and its expected results will provide students and faculty members island-wide with the knowledge, skills and experiences in CTR with IE approach to foster the expansion of a cadre of Hispanic minority CTR researchers in direct benefit of the health of the people of Puerto Rico.
ABSTRACT IMPACT: Summarize the burden of diabetes comorbidities and its impact in healthcare utilization in Puerto Rico OBJECTIVES/GOALS: To estimate the prevalence of common comorbidities and describe the healthcare utilization patterns in patients with type 2 diabetes mellitus (T2DM) in Puerto Rico. METHODS/STUDY POPULATION: This is a descriptive study using healthcare claims data from patients with T2DM (based on ICD-9 diagnosis code) from most public and private healthcare insurance companies providing services in Puerto Rico in 2013 (representing more than 90% of insured population). Descriptive analyses by age, sex, type of insurance, health region, and type of medical encounter were done using frequency and percent for categorical data or means or median (with corresponding standard deviation or interquartile range) for continuous variables RESULTS/ANTICIPATED RESULTS: A total of 3,100,636 claims were identified from 485,866 adult patients with T2DM. Most patients were women (276,400; 57%), older than 65 years (235,390; 48%), from the Puerto Rico health regions of Caguas (79,604; 16%), Metro (66,280; 14%), or Bayamon (62,673; 13%) with private health insurance (371,806; 77%). The number of claims per patient ranged from 1 to 339. A mean of 6.3 claims (SD ±9.99) and a median of 3 claims (Q1 1- Q3 8) per subject were identified. Most (74%) were related to the diagnosis of diabetes (1,829,2015; 59%) or to cardiovascular diseases (458,219; 15%) and associated to outpatient services (2,722,727; 88%). The most prevalent comorbidities were hypertension (235,277; 48%), hyperlipidemia (197,449; 41%), neuropathy (100,471; 21%); renal disease (71,517; 15%), and retinopathy (61,837; 13%) DISCUSSION/SIGNIFICANCE OF FINDINGS: A high prevalence of comorbidities and use of healthcare services were identified in patients with T2DM, especially in older adults. Most comorbidities were due to diabetes-related conditions, highlighting the importance of early diagnosis and adequate management of T2DM patients to avoid preventable burden to the patient and the healthcare system
ABSTRACT IMPACT: The importance of this study is to evaluate the responses following the exposure of opioid drugs in young adults to address the current opioid epidemics OBJECTIVES/GOALS: To compare the proportion of patients between 18 and 25 years of age, who develop an opioid abuse disorder following dental surgery, to those following other surgical procedures, when an opioid drug is used for acute postoperative pain control. METHODS/STUDY POPULATION: We fashioned an IRB-sponsored retrospective cohort study of patients, ages 18 to 25 years old, who presented for dental surgery or other medical surgical procedures, at Strong Memorial Hospital Medical Center, at the University of Rochester and received opioid drug treatments, for acute surgical pain management. Patients with the diagnosis of acute surgical pain were included in the study. However, those with chronic pain or other related abnormalities were excluded, even if a diagnosis of acute surgical pain was present in the electronic chart. The clinical data were retrieved from electronic medical records and NYS-iStop records. All statistics were significant at the level of <0.1 RESULTS/ANTICIPATED RESULTS: We identified 167 subjects, of whom, only 150 subjects met inclusion criteria (n=100) in dentistry and (n=50) in other medical specialties. Patients were followed up in a 7-year period. Most of the subjects were females (n=91), Caucasian (n=80), and lived in a suburban location (n=78). The most frequently prescribed opioid included hydrocodone (n=119). A significantly higher proportion (8.7%) of patients developed opioid abuse disorders in the control group, compared to 1% of subjects in the experimental group (p 0.02). Those in the control group received marginally significant higher doses of MMEs 447.2 +/-644.8 mg vs 306.2 +/-354.7mg in the experimental group (p 0.086). Those in the control group had significantly longer periods of opioid treatment 10 (+/-12) compared to 6(+/-6) days in the experimental group DISCUSSION/SIGNIFICANCE OF FINDINGS: It is paramount to evaluate the morphine milligram equivalents, and duration of opioid treatment given to the young population with acute surgical pain, to prevent opioid abuse disorders in this vulnerable cohort.
This study aimed to identify features to include in online grocery stores to support healthful food purchasing by those striving to lose weight.
A Value Proposition Design Approach was used to gain shopper insights, devise potential online grocery store features, and obtain feedback on these features.
Telephone interviews were conducted to gain insight into shoppers’ needs and perceptions. Results were used by the research team to identify potential online grocery shopping features that may support healthful purchase decisions, and interviews were conducted with a different sample of shoppers to gather feedback on features.
Insight (n=25) and feedback (n=25) interviews were conducted with convenience samples of adults trying to lose weight.
Participants were primarily female, white, college educated, and with obesity or overweight. Online grocery features devised by the research team based on findings from the insight interviews included a: 1) shopping cart nutrition rating tool; 2) healthy meal planning tool; 3) interactive healthy eating inspiration aisle; and 4) healthy shopping preference settings option. Findings from the feedback interviews indicated that the healthy meal planning tool, healthy shopping preference settings option and shopping cart nutrition rating tool features were positively rated by most participants.
There are multiple features grocers should consider including in their online stores to attract and support customers striving to eat healthy for weight loss.
The household setting has some of the highest coronavirus disease 2019 (COVID-19) secondary-attack rates. We compared the air contamination in hospital rooms versus households of COVID-19 patients. Inpatient air samples were only positive at 0.3 m from patients. Household air samples were positive even without a COVID-19 patient in the proximity to the air sampler.
Double inverted pendulum model, stationary or on a cart, is computationally the simplest out of the range of reasonable models used for anthropomorphic robots motion synthesis. However, it is still not sufficient for describing more complex situations. The novel concept of variable double inverted pendulum (VDIP) for static postures and VDIP on cart (VDIPC) for dynamic cases is proposed. It provides a simplified but a sufficiently accurate tool for planning the human-like static and dynamic robot postures. Its variable parameters enable the description of both human static postures and motion dynamics. The variable length of the lower link is essential for the representation of postures attained by bending legs. The studies of a set of static and dynamic postures were used for deducing and verifying the locations of lower and upper joint of a double pendulum and the point masses. To justify the concept, human body and pendulum behaviors are compared taking into account a typical model of the human body. Static analysis was conducted by considering static human postures. Dynamic conditions were analyzed using the data acquired from human motion and thus the VDIPC definition was established. The zero moment point trajectories of the human and of VDIPC were compared, validating the correctness of VDIPC in dynamic situations. The formal description of VDIPC is provided together with the torques equilibrium condition needed for evaluating the dynamic postural stability, with the VDPIC representing the robot configuration. The VDPIC state equations are formulated in a form required by the predictive control method. The paper contributes to the motion synthesis methods of anthropomorphic robots taking into account postural control.
Little is known about the consequences of viral infection for pregnant woman or for the fetus. This issue became important with the appearance of the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). The infection with SARS-CoV-2 causes a respiratory syndrome known as COVID-19. The fast spreading around the world and the fact that without a treatment or vaccine humans are completely exposed, converts emerging viral diseases in a significant risk for pregnant women and their infants. At this time, during SARS-CoV-2 pandemics pregnant women are not considered as a risk population and little is known about the effects of viral infections over the offspring although the amount of emerging evidence showing detrimental effects for the mother and the fetus. This issue highlights the importance to understand the effects of viral infections during pregnancy. In this work, we analyze the effects of viral infections, like SARS-CoV-2 and other related viruses during pregnancy over the mother and the consequences for the offspring.
Structural vegetation damage and food limitation are important effects of major hurricanes, particularly for fruit/seed-eating, forest-dependent Caribbean birds with restricted distributions and small populations, such as the Bridled Quail-dove Geotrygon mystacea. Motivated by the lack of abundance estimates, corrected for detection probability, we conducted distance-sampling surveys inside and outside the Quill National Park each May in 2016-2019. Detection mode was the most important covariate, with others receiving no support from the data. Detectability of available single individuals and clusters of individuals within 60 m of transect centrelines averaged 0.957 ± 0.114 standard error for audio detections, 0.434 ± 0.052 for visual detections, and 0.693 ± 0.064 for detection modes combined. Availability averaged 0.475 ± 0.138 and the product of detectability and availability averaged 0.329 ± 0.098. Density averaged 1.459 ± 0.277 individuals ha-1 and population size averaged 642 ± 122 individuals in 440 ha. Density did not differ along and away from forest trails, but was higher inside than outside the park and at elevations within 201-400 m than 100-200 m and 401-600 m. Density declined by 76% after hurricanes Irma and Maria in 2017. We suggest that major hurricanes together with free-ranging livestock overgrazing degraded foraging habitats, limited food supply, and caused a population bottleneck. Our methodology can be implemented across the distribution range to assess population status and trends and evaluate the result of management actions at key conservation sites. Bridled Quail-dove populations probably were declining on most islands before the 2017 hurricanes and population status warrants revision.
The number of adults requiring surgeries for CHD is increasing. We sought to evaluate the utility of the vasoactive-ventilation-renal (VVR) score as a predictor of prolonged length of stay in adults following CHD surgery.
This is a retrospective review of 158 adult patients who underwent CHD surgery involving cardiopulmonary bypass. VVR score was calculated upon arrival to ICU and every 6 hours for the first 48 hours post-operatively. Our primary outcome was prolonged length of stay defined as hospital length of stay greater than 75th percentile for the cohort (≥8 days).
The study cohort had a median age of 25.6 years (18–60 years), and 83 (52.5%) were male. The groups with and without prolonged length of stay were comparable in age, gender, race, and surgical severity score. VVR score was significantly higher at all time points in the group with prolonged length of stay. The first post-operative day peak VVR score ≥13 had a sensitivity of 81% and specificity of 75% for predicting prolonged length of stay (p = 0.0001). On regression analysis, peak VVR score during the first day was independently associated with prolonged length of stay.
Peak VVR score during the first post-operative day was a strong predictor of prolonged length of stay in adults following CHD surgery.
Decision making in publicly funded healthcare systems must rely on patient-relevant outcomes that directly measure clinical benefit, such as overall survival and quality of life (QoL). However, studies that support market authorization of oncology drugs usually assess surrogate outcomes, without having previously demonstrated that these intermediate outcomes reliably predict clinical outcomes. As part of an HTA process, we evaluated the clinical benefit of osimertinib, compared with platinum-pemetrexed combination chemotherapy, in patients with epidermal growth factor receptor (EGFR) T790M mutation-positive advanced non-small cell lung cancer (NSCLC) that has progressed after first-line EGFR tyrosine kinase inhibitor (TKI) therapy.
We conducted a systematic search of the PubMed database for randomized controlled trials (RCT) published from inception to January 2019. The clinical outcomes of interest were overall survival and QoL. Where trials reported surrogate outcomes, we conducted additional PubMed searches for evidence of validity for predicting clinical outcomes and used guidance on surrogate outcome validation in oncology from the Institute for Quality and Efficiency in Health Care.
Evidence on osimertinib, compared with chemotherapy, for patients with T790M-positive advanced NSCLC that has progressed after EGFR-TKI therapy was obtained from the AURA3 trial. In this study, overall survival data were immature and the results for QoL and symptom domains were not clinically meaningful. In addition, median progression-free survival (PFS) was six months longer for osimertinib than for chemotherapy. However, to date, no study has demonstrated that PFS reliably predicts longer survival or better QoL.
Our HTA suggested that, unless proven, PFS should not be used as a valid surrogate outcome for decision making in public health. For example, the results of the AURA3 trial showed that osimertinib has an effect on the surrogate outcome of PFS in patients with EGFR T790M-positive advanced NSCLC that has progressed after first-line EGFR-TKI therapy, but not on the clinically relevant outcomes of overall survival and QoL. Furthermore, currently available evidence has failed to prove that PFS reliably predicts outcomes that are clinically relevant. Despite this, osimertinib has been given marketing authorization and is widely recommended in clinical guidelines.
Greater psychosocial risk in childhood and adolescence predicts poorer cardiometabolic outcomes in adulthood. We assessed whether the timing of psychosocial risk from infancy through adolescence predicts cardiometabolic outcomes in young adulthood. Young adults and their mothers participated in a longitudinal study beginning in infancy in Santiago, Chile (N = 1040). At infancy, 5 years, 10 years, and adolescence, mothers reported on depressive symptoms, stressful experiences, support for child development in the home, father absence, parental education, and socioeconomic status (SES) to create a psychosocial risk composite at each time point. Young adults (52.1% female; 21–27 years) provided fasting serum samples and participated in anthropometric and blood pressure (BP) assessments, including a dual-energy X-ray absorptiometry (DXA) scan for measuring body fat. Greater infant psychosocial risk was associated with a greater young adult metabolic syndrome score (β = 0.07, 95% confidence intervals (CI): 0.01 to 0.13, p = 0.02), a higher body mass index and waist circumference composite (β = 0.08, 95% CI: 0.03 to 0.13, p = 0.002), and a higher body fat (DXA) composite (β = 0.07, 95% CI: 0.01 to 0.12, p = 0.02). No psychosocial risk measure from any time point was associated with BP. Infant psychosocial risk predicted cardiometabolic outcomes in young adulthood better than psychosocial risk at 5 years, 10 years, or adolescence, mean of psychosocial risk from infancy through adolescence, and maximum of psychosocial risk at any one time. Consistent with the Developmental Origins of Health and Disease model, findings suggest that infancy is a sensitive period for psychosocial risk leading to poorer cardiometabolic outcomes in young adulthood.
In the absence of direct evidence from randomized controlled trials (RCTs), real-world evidence (RWE) can play an important role in healthcare decision making. As part of a health technology assessment, we assessed the comparative risk of tuberculosis (TB) associated with using infliximab and etanercept in patients with rheumatoid arthritis.
We performed a systematic literature search using the PubMed database to identify relevant meta-analyses.
We located two relevant meta-analyses: one based on RCTs and one based on observational studies. Evidence from seven RCTs on infliximab (2,686 patients; 12 TB events) and two RCTs on etanercept (663 patients; 2 TB events) suggested no significant differences in the risk of TB between the two treatments, compared with placebo. In contrast, evidence from ten observational studies that directly compared the two treatments (443,941 patients; 253 TB events) indicated a significantly higher risk of TB with infliximab than with etanercept.
Although RWE is prone to confounding and bias, in this case it had the advantage of providing direct comparisons with larger sample sizes and longer follow up than evidence from RCTs. As a result, RWE was used to inform decision making on the risk of TB with infliximab and etanercept in patients with rheumatoid arthritis.
Deaths are frequently under-estimated during emergencies, times when accurate mortality estimates are crucial for emergency response. This study estimates excess all-cause, pneumonia and influenza mortality during the coronavirus disease 2019 (COVID-19) pandemic using the 11 September 2020 release of weekly mortality data from the United States (U.S.) Mortality Surveillance System (MSS) from 27 September 2015 to 9 May 2020, using semiparametric and conventional time-series models in 13 states with high reported COVID-19 deaths and apparently complete mortality data: California, Colorado, Connecticut, Florida, Illinois, Indiana, Louisiana, Massachusetts, Michigan, New Jersey, New York, Pennsylvania and Washington. We estimated greater excess mortality than official COVID-19 mortality in the U.S. (excess mortality 95% confidence interval (CI) 100 013–127 501 vs. 78 834 COVID-19 deaths) and 9 states: California (excess mortality 95% CI 3338–6344) vs. 2849 COVID-19 deaths); Connecticut (excess mortality 95% CI 3095–3952) vs. 2932 COVID-19 deaths); Illinois (95% CI 4646–6111) vs. 3525 COVID-19 deaths); Louisiana (excess mortality 95% CI 2341–3183 vs. 2267 COVID-19 deaths); Massachusetts (95% CI 5562–7201 vs. 5050 COVID-19 deaths); New Jersey (95% CI 13 170–16 058 vs. 10 465 COVID-19 deaths); New York (95% CI 32 538–39 960 vs. 26 584 COVID-19 deaths); and Pennsylvania (95% CI 5125–6560 vs. 3793 COVID-19 deaths). Conventional model results were consistent with semiparametric results but less precise. Significant excess pneumonia deaths were also found for all locations and we estimated hundreds of excess influenza deaths in New York. We find that official COVID-19 mortality substantially understates actual mortality, excess deaths cannot be explained entirely by official COVID-19 death counts. Mortality reporting lags appeared to worsen during the pandemic, when timeliness in surveillance systems was most crucial for improving pandemic response.
Over the past three decades, research efforts and interventions have been implemented across the United States to increase the persistence of underrepresented minority (URM) students in science, technology, engineering, and math (STEM). This Element systematically compares STEM interventions that offer resources and opportunities related to mentorship, research, and more. We organize the findings of this literature into a multi-phase framework of STEM integration and identity development. We propose four distinct phases of STEM integration: Phase 1: High School; Phase 2: Summer before College; Phase 3: First Year of College; and Phase 4: Second Year of College through Graduation. We combine tenets of theories about social identity, stereotypes and bias, and the five-factor operationalization of identity formation to describe each phase of STEM integration. Findings indicate the importance of exploration through exposure to STEM material, mentorship, and diverse STEM communities. We generalize lessons from STEM interventions to URM students across institutions.
The concept of the Anthropocene has highlighted the significant global impact of human activities on ecological systems on a geological scale (Crutzen 2002). This concept has come to significantly influence a scientific and political agenda orientated towards documenting and denouncing multiple negative anthropogenic factors that have led to global change. Nevertheless, not all large-scale environmental transformations by human societies have been intrinsically destructive. Many indigenous communities in the Neotropics, Palearctic, sub-Saharan Africa, North America, Indo-Malaya and Australasia have radically – albeit often constructively – modified the physical and biotic conditions of the ecological systems that they inhabit (Ellis 2015). It is necessary to revise the assumption that human actions always degrade the environment, through a reconceptualization that we have previously called ‘anthropogenesis’ (Rivera-Núñez et al. 2020). Instead of the naïve portrayal of the ‘good Anthropocene’ (Hamilton 2015, Fremaux & Barry 2019), anthropogenesis seeks to enrich the biodiversity debate with the historical human expressions of constructed environments that the conservation-focused ‘Edenic sciences’ and the ‘pristine syndrome’ (Robbins & Moore 2013) tend to ignore, or ‘Anthropo-not-see’ (de la Cadena 2019). The objective of this comment paper is to urge the academic community, grassroots organizations and governments to employ a concept of ‘palimpsest’ (from the Ancient Greek for ‘again scraped’, implying that something is scraped clear ready to be used again) in the reconceptualization of biodiversity conservation from a historical perspective that implements research and policy agendas that incorporate the human propensity for environmental construction in a deeper and more inclusive manner.