The Politics and Policy of Small City Downtown Development

Many theories on successful small city development and revitalization efforts hinge on three major areas; Policies and programs, quality of life, and strong coalitions between government, non-profit groups, local business, and residents. This dissertation examines the affects that government policies and programs (e.g., Main Street programs, zoning laws, etc.) have on the success of small city development and revitalization efforts. Using original survey data from a sample of key small city policy makers across the United States, this dissertation explores how perceptions of small city downtowns are influenced by government efforts to improve them. Regression analysis is employed to determine these relationships. Perceptions of the overall quality of life are also addressed. The dissertation concludes that mixed-use zoning, programs such as Main Street USA, cooperation among key stakeholders, and the perceptions of quality of life in a given area have a highly significant impact on the success of downtowns. The implications found here can aid cities striving to improve their downtowns and the quality of life for the people who live there

Randomized, active-controlled, comparative phase 3 efficacy and safety equivalence trial of Ovaleap® (recombinant human follicle-stimulating hormone) in infertile women using assisted reproduction technology (ART)

Background: Pharmacokinetic studies with XM17 (Ovaleap®), a recombinant human follicle-stimulating hormone (r-hFSH, follitropin alfa), have demonstrated good safety and tolerability in healthy women whose endogenous FSH levels were down-regulated with a long agonist protocol. In these studies, Ovaleap® pharmacokinetics were dose-proportional and bioequivalent to the reference follitropin alfa product (Gonal-f®). The objective of the present study is to determine whether Ovaleap® is equivalent to Gonal-f® with respect to the number of oocytes retrieved in infertile but ovulatory women undergoing assisted reproductive technology (ART) therapy. Methods: This multinational, multicenter, randomized (1:1), active-controlled, assessor-blind, comparative study included infertile normally gonadotrophic women 18 to 37 years old with a body mass index of 18 to 29 kg/m2 and regular menstrual cycles of 21 to 35 days undergoing ART therapy. During a 5-day fixed-dose phase, women received 150 IU/day of Ovaleap® (n = 153) or Gonal-f® (n = 146), followed by an up to 15-day dose-adaptation phase during which doses could be adjusted every 3 to 5 days, up to a maximum of 450 IU/day. Ovaleap® was to be deemed equivalent to Gonal-f® if the two-sided 0.95 confidence interval (CI) for the difference in the number of oocytes retrieved fell within the equivalence range of ±3 oocytes. Results: Similar numbers of oocytes were retrieved in the 2 treatment groups. The mean ± SD number of oocytes retrieved was 12.2 ± 6.7 in the Ovaleap® group and 12.1 ± 6.7 in the Gonal-f® group (intent-to-treat [ITT] population). Regression analysis estimated a mean difference of 0.03 oocytes between the treatment groups (95 % CI: −0.76-0.82), which was well within the prespecified equivalence range of ±3 oocytes. Ovaleap® and Gonal-f® showed favorable and comparable safety profiles, with no unexpected safety findings. Conclusions: Ovaleap® has shown the same efficacy and safety as Gonal-f® for stimulation of follicular development in infertile women (up to 37 years of age) who are undergoing ART therapy. Trial Registration EudraCT: 2009-017674-20. Current controlled trials: ISRCTN74772901. Date of trial registration: 19 March 2010

Evaluability Assessment of “Growing Healthy Communities,” a Mini-grant Program to Improve Access to Healthy Foods and Places for Physical Activity

Mini-grants have been used to stimulate multisector collaboration in support of public health initiatives by funding non-traditional partners, such as economic development organizations. Such mini-grants have the potential to increase access to healthy foods and places for physical activity through built environment change, especially in small and rural towns in the United States. Although a promising practice, few mini-grant evaluations have been done. Therefore, our purpose was to conduct an Evaluability Assessment (EA), which is a process that can help promising programs that lack evidence advance toward full-scale evaluation. Specifically, we conducted an Evaluability Assessment of a statewide mini-grant program, called “Growing Healthy Communities” (GHC), to determine if this program was ready for evaluation and identify any changes needed for future implementation and evaluation that could also inform similar programs

Changes in Cardiovascular Health in the United States, 2003–2011

Background Cardiovascular disease is the leading cause of death in the United States, making improving cardiovascular health a key population health goal. As part of efforts to achieve this, the American Heart Association has developed the first comprehensive cardiovascular health index (CVHI). Our objective was to investigate the changes in CVHI in US states from 2003 to 2011. Methods and Results CVHI was examined using Behavioral Risk Factor Surveillance System data between 2003 and 2011 (odd‐numbered years). Total CVHI decreased from 3.73±0.01 in 2003 to 3.65±0.01 in 2009. The majority of states (88%) experienced a decline in CVHI and an increase in the prevalence of “poor” CVHI between 2003 and 2009. Among CVHI components, the highest prevalence of “ideal” was observed for blood glucose followed by smoking, whereas the lowest prevalence of “ideal” was observed for physical activity and diet. Between 2003 and 2009, prevalence of “ideal” smoking and diet status increased, while “ideal” prevalence of blood pressure, cholesterol, blood glucose, body mass index, and physical activity status decreased. We observed statistically significant differences between 2009 and 2011, outside the scope of the 2003–2009 trend, which we hypothesize are partially attributable to differences in sample demographic characteristics related to changes in Behavioral Risk Factor Surveillance System methodology. Conclusions Overall, CVHI decreased, most likely due to decreases in “ideal” blood pressure, body mass index, and cholesterol status, which may stem from low prevalence of “ideal” physical activity and diet status. These findings can be used to inform state‐specific strategies and targets to improve cardiovascular health

Polypharmacy and Multimorbidity Among Medicaid Enrollees: A Multistate Analysis

The purpose of this study is to explore the associations between polypharmacy and multimorbidity using conventional and novel measures of polypharmacy. In this cross-sectional study, data on fee-for-service (FFS) Medicaid enrollees with at least 1 chronic condition and aged 18–64 years (N = 38,329) were derived from the 2010 Medicaid Analytic eXtract (MAX) files of Maryland and West Virginia. Polypharmacy, by the authors\u27 novel definition, was determined as simultaneous use of ≥5 drugs for a consecutive period of 60 days. Multimorbidity was defined as having ≥2 chronic conditions based on the US Department of Health and Human Services framework. The association between multimorbidity and polypharmacy was examined with chi-square tests and logistic regression. Polypharmacy prevalence was estimated at 50.9% using the novel definition, as compared to 16.7% and 64.9% for the 2 commonly used conventional measures, respectively. For all 3 definitions, individuals with multimorbidity were more likely to have polypharmacy than those without multimorbidity (P \u3c 0.001). The authors also consistently found, using all definitions, that those who were older, female, white, and eligible for Medicaid because of cash assistance were more likely to have polypharmacy (all P \u3c 0.001). Polypharmacy was highly prevalent and significantly associated with multimorbidity among Medicaid FFS enrollees irrespective of the definitions used. The new measure may provide a more comprehensive and accurate estimation of polypharmacy than the conventional measures. These findings suggest the need for a paradigm shift from disease-specific care to patient-centered collaborative care to manage patients with multimorbidity and polypharmacy

Exploring Health Insurance Status and Emergency Department Utilization

Emergency department (ED) use, by both insured and uninsured, leads to significant health care costs in the United States. While frequent ED use is often attributed to the uninsured, there is some evidence that insured populations also report utilizing the ED when otherwise preventable or nonurgent. We conducted in-person surveys of patients visiting the ED at a large research hospital and examined the differences in their characteristics based on the health insurance status. While less than the uninsured, insured individuals still report barriers to access to care outside the ED that include lack of access to another health care facility and unavailability of a doctor’s office or clinic

Safety and efficacy of Ovaleap® (recombinant human follicle-stimulating hormone) for up to 3 cycles in infertile women using assisted reproductive technology: a phase 3 open-label follow-up to Main Study

Background: Ovaleap® (follitropin alfa), a recombinant human follicle-stimulating hormone intended for use in controlled ovarian stimulation in women undergoing assisted reproductive technologies (ART), showed therapeutic equivalence to Gonal-f® in a multinational, multicenter, randomized, controlled, assessor-blind phase 3 Main Study. The current study examined safety, including immunogenicity, and efficacy of Ovaleap® in an open-label, uncontrolled, follow-up treatment period of up to 2 additional treatment cycles in patients who did not become pregnant in the phase 3 Main Study. Methods: Patients with negative biochemical or clinical pregnancy in the phase 3 Main Study, regardless of treatment group (ie, Ovaleap® or Gonal-f®), were eligible to participate. Patients received Ovaleap® (Merckle Biotec GmbH, Ulm, Germany) for up to 2 additional cycles, administered using a reusable semi-automated pen device. The primary objective was the assessment of safety, including adverse events (AEs), ovarian hyperstimulation syndrome (OHSS), and anti-drug antibodies. Tolerability, patient satisfaction with the Ovaleap® pen device, and efficacy outcomes (as evaluated in the Main Study) were also assessed. Results: One hundred forty-seven patients were included in cycle 2, and 61 patients were included in cycle 3. In cycles 2 and 3, 10.9% (16/147) and 6.6% (4/61) of patients experienced treatment-emergent AEs (TEAEs), respectively. Three serious TEAEs (ie, appendicitis, OHSS, and borderline ovarian tumor) were reported and successfully resolved. The OHSS TEAE was the only OHSS reported in the study (0.7% [1/147]). Positive findings on anti-drug antibody assays in 6 serum samples did not show neutralizing activity or clinical relevance in biochemical pregnancy rate. No hypersensitivity reaction occurred. Most patients reported “very good”/“good” local tolerability. All patients were “very confident”/“confident” about dose accuracy and correctness of the injection. They all found use of the pen “very convenient”/“convenient” and were all “very satisfied”/“satisfied” with the pen device. Efficacy outcomes were consistent with the phase 3 Main Study. Conclusions: These findings further support the safety, including immunogenicity, and efficacy of Ovaleap® for stimulation of follicular development in infertile women undergoing ART. The findings support continued use of Ovaleap® for multiple cycles or a switch to Ovaleap® if pregnancy is initially not achieved with Gonal-f®. Trial registration: EudraCT number: 2009-017674-20. Current controlled trials register number: ISRCTN74772901

Factors Associated with Physical Activity Increases and Decreases Among a Sample of Appalachian Residents During the COVID-19 Pandemic: A Cross-Sectional Study

Introduction: Physical activity (PA) can prevent and reduce the deleterious physical and mental health effects of COVID-19 and associated lockdowns. Research conducted early in the pandemic demonstrates that a greater proportion of adults in the U.S. have decreased than increased PA, and the effects vary by sociodemographic factors. Ongoing evidence is important to identify patterns in PA changes during the pandemic. Purpose: This study aims to identify factors associated with increases and decreases in PA during the COVID-19 pandemic in a convenience sample of adults residing in Appalachia. Methods: Surveys were collected from a convenience sample of adults from eight counties in West Virginia from January to March 2021. Logistic regression analysis was used to identify sociodemographic, health, and rurality factors associated with (1) increased PA and (2) decreased PA during the pandemic, assessed retrospectively via self-report. Results: Analysis of 1,401 survey responses revealed that better self-rated health, lower body mass index, and higher income and education were associated with a greater likelihood of more time spent doing PA during the pandemic (p ≤ .05). Respondents with lower self-rated health, higher body mass index, lower income, and lower levels of education—plus females and those living in a more urban county—were more likely to spend less time doing PA during the pandemic (p ≤ .05). Implications: Analyses suggest that pre-pandemic disparities in PA by health, wealth, and education were exacerbated during the pandemic. These must be addressed before physical inactivity and ill health become endemic to the Appalachian Region

Percepção de estudantes de psicologia sobre a informática em sua formação profissional

Neste artigo analisa-se uma pesquisa de natureza qualitativa, cujo objetivo era explorar a percepção de 45 alunos de psicologia de diferentes universidades da cidade de Santiago do Chile, sobre a incorporação da informática como apoio para a aprendizagem em sua formação profissional. A informação foi coletada através de entrevistas semiestruturadas e analisou-se mediante o processo de codificação da Teoría Fundamentada. Os resultados mostram como categorias principais, o conhecimento da informática, a valoração da informática, e os fatores que obstaculizam o uso desta. Da codificação seletiva se desprende uma alta valoração da informática como ferramenta econômica e cômoda, mas também se observa uma alta reticência dos alunos diante de sua utilização no trabalho profissional tradicional do psicólogo. Encontraram-se fatores pessoais e institucionais nos que se baseia a valoração, a motivação e o nível de conhecimento dos estudantes diante do uso de ferramentas informáticas.This paper analyses a qualitative research aimed to exploring the perception of 45 psychology students from different universities in Santiago de Chile, about incorporating information systems to support learning in their professional training. Data were collected through semi structured interviews and their analysis was based on Grounded Theory's coding process. Results show that the major categories are computer knowledge, appreciation of computers and factors that hinder their use. From the selective coding a positive evaluation emerges of information systems as an economic and useful tool. However, there is also a high reluctance on the part of the students regarding the use of such tools in the psychologist' traditional professional work. Personal and organizational factors were found as bases for students' assessment, motivation and level of knowledge facing the use of these tools.En este artículo se analiza una investigación de naturaleza cualitativa, cuyo objetivo era explorar la percepción de 45 alumnos de psicología de diferentes universidades de la ciudad de Santiago de Chile, sobre la incorporación de la informática como apoyo para el aprendizaje en su formación profesional. La información se recolectó a través de entrevistas semiestructuradas y se analizó mediante el proceso de codificación de la Teoría Fundamentada. Los resultados muestran como categorías principales, el conocimiento de la informática, la valoración de la informática, y los factores que obstaculizan el uso de ésta. De la codificación selectiva se desprende una alta valoración de la informática como herramienta económica y cómoda, pero también se observa una alta reticencia de los alumnos frente a su utilización en el trabajo profesional tradicional del psicólogo. Se encontraron factores personales e institucionales en los cuales se fundamenta la valoración, la motivación y el nivel de conocimiento de los estudiantes frente al uso de herramientas informáticas