Influence network linkages across implementation strategy conditions in a randomized controlled trial of two strategies for scaling up evidence-based practices in public youth-serving systems.

BackgroundGiven the importance of influence networks in the implementation of evidence-based practices and interventions, it is unclear whether such networks continue to operate as sources of information and advice when they are segmented and disrupted by randomization to different implementation strategy conditions. The present study examines the linkages across implementation strategy conditions of social influence networks of leaders of youth-serving systems in 12 California counties participating in a randomized controlled trial of community development teams (CDTs) to scale up use of an evidence-based practice.MethodsSemi-structured interviews were conducted with 38 directors, assistant directors, and program managers of county probation, mental health, and child welfare departments. A web-based survey collected additional quantitative data on information and advice networks of study participants. A mixed-methods approach to data analysis was used to create a sociometric data set (n = 176) to examine linkages between treatment and standard conditions.ResultsOf those network members who were affiliated with a county (n = 137), only 6 (4.4%) were directly connected to a member of the opposite implementation strategy condition; 19 (13.9%) were connected by two steps or fewer to a member of the opposite implementation strategy condition; 64 (46.7%) were connected by three or fewer steps to a member of the opposite implementation strategy condition. Most of the indirect steps between individuals who were in different implementation strategy conditions were connections involving a third non-county organizational entity that had an important role in the trial in keeping the implementation strategy conditions separate. When these entities were excluded, the CDT network exhibited fewer components and significantly higher betweenness centralization than did the standard condition network.ConclusionAlthough the integrity of the RCT in this instance was not compromised by study participant influence networks, RCT designs should consider how influence networks may extend beyond boundaries established by the randomization process in implementation studies.Trial registrationNCT00880126

Extragalactic Radio Sources and the WMAP Cold Spot

We detect a dip of 20-45% in the surface brightness and number counts of NVSS sources smoothed to a few degrees at the location of the WMAP cold spot. The dip has structure on scales of approximately 1-10 degrees. Together with independent all-sky wavelet analyses, our results suggest that the dip in extragalactic brightness and number counts and the WMAP cold spot are physically related, i.e., that the coincidence is neither a statistical anomaly nor a WMAP foreground correction problem. If the cold spot does originate from structures at modest redshifts, as we suggest, then there is no remaining need for non-Gaussian processes at the last scattering surface of the CMB to explain the cold spot. The late integrated Sachs-Wolfe effect, already seen statistically for NVSS source counts, can now be seen to operate on a single region. To create the magnitude and angular size of the WMAP cold spot requires a ~140 Mpc radius completely empty void at z<=1 along this line of sight. This is far outside the current expectations of the concordance cosmology, and adds to the anomalies seen in the CMB.Comment: revised version, ApJ, in pres

Effect of Artificial Pitch Damping on the Longitudinal and Rolling Stability of Aircraft with Negative Static Margins

A preliminary theoretical investigation has been made of the short-period longitudinal and steady-rolling (inertia coupling) stability of a hypersonic glider configuration for center-of-gravity locations rear-ward of the airplane neutral point. Such center-of-gravity positions for subsonic flight would improve performance by reducing supersonic and hypersonic static margins and trim drag. Results are presented of stability calculations and a simulator study for a velocity of 700 ft/sec and an altitude of 401,000 feet. With no augmentation, the airplane was rapidly divergent and was considered unsatisfactory in the simulator study. When a pitch damper was employed as a stability augmenter, the short-period mode became overdamped, and the airplane was easily controlled on the simulator. A steady-rolling analysis showed that the airplane can be made free of rolling divergence for all roll rates with an appropriate damper gain

In-Situ measurement of hydride corrosion of uranium using X-ray and neutron scattering techniques

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Quality Assessment of a Collaborative Approach for Decreasing Drug-Related Morbidity and Achieving Therapeutic Goals

Background Collaboration between physicians and pharmacists is one approach to address drug-related morbidity and achieve therapeutic goals. A collaborative practice of pharmaceutical care has been used in the Fairview Clinics System of Minneapolis-St Paul since 1999. Methods The quality of therapeutic determinations made by pharmacists within this collaborative practice of pharmaceutical care was studied by a 12-member panel of physicians and pharmacists who used randomly selected patient records. This was a quality improvement and care process validation component of a study evaluating the effects of drug therapy management in patients receiving prepaid medical assistance. An implicit review process was used to evaluate the clinical credibility of therapeutic determinations made by pharmaceutical care practitioners. Results A total of 5780 drug therapy problems were resolved for 2524 patients receiving pharmaceutical care. The rate of therapeutic goals achieved increased from 74% at the time of patients\u27 initial pharmaceutical care encounters to 89% at patients\u27 latest encounters. In this quality assessment analysis panel members performed a total of 4779 evaluations of clinical decisions. Panelists indicated agreement with the evaluations in 94.2% of cases, expressed a neutral opinion in 3.6% of cases, and disagreed in 2.2% of cases. Intraclass correlation coefficients ranged from 0.73 to 0.85. Conclusions The decisions made by pharmaceutical care practitioners working in collaboration with physicians to provide drug therapy management services are clinically credible based on the evaluations and comments of a peer review panel. This study provides information on the quality of care provided by pharmacists when collaborating with physicians to provide drug therapy management services

Associations between Modifiable Health-Risk Behaviors and Personality Types

Objectives: The first objective for this study was to explore if characteristics of personality type (using the Preferred Communication Style Questionnaire) are associated with the following modifiable health-risk behaviors: smoking, exercise, alcohol consumption, nutrition, sleep, depression-related stress, anxiety-related stress, healthcare professional usage, and self-discipline. The second objective for this study was to explore if characteristics of personality type are associated with (1) the quality of patient-physician relationships, (2) patient-physician communication, and (3) preferred method for receiving information. Methods: Data were collected from 10,500 adult individuals residing in the United States via an on-line, self-administered survey coordinated by Qualtrics Panels from March 14-30, 2016. Chi-square analysis was used for making comparisons between categories of personality types and items related to health-risk behaviors. Statistical significance was set at p \u3c 0.05. However, chi-square analysis with large sample sizes (e.g. 10,500 in this study) readily yields statistical significance. Practical significance was set at four or more percentage points above or below the overall mean. Results: Regarding objective 1, personality type was associated with all nine health-risk behaviors studied. Personality types within the Experiencer temperament (17% of the U.S. population) accounted for 46% of the undesirable scores we computed for health-risk behaviors. The Idealist temperament (17% of population) accounted for 32% of the undesirable scores. Conceptualizers (10% of population) accounted for 17% of the undesirable scores and Traditionalists (46% of population) accounted for 5% of the undesirable scores. Regarding objective 2, the findings showed that personality type was associated with (1) the importance people place on the patient-physician relationship, (2) which characteristics of that relationship are most desirable, (3) desire for more communication with their physician, and (4) the preferred method for receiving information. Discussion and Conclusions: Precision medicine has been proposed as a way to create a new taxonomy of disease that uses individual specific data to develop accurate diagnosis, targeted treatment, and improved health outcomes. Based on the findings of this study, we propose that inclusion of personality type is an important component of these efforts so that the health care system can conform more to the individual patient in order to increase engagement and adherence, reduce errors, minimize ineffective treatment and waste, and can be cost effective

Handling qualities of a wide-body transport airplane utilizing Pitch Active Control Systems (PACS) for relaxed static stability application

Piloted simulation studies have been conducted to evaluate the effectiveness of two pitch active control systems (PACS) on the flying qualities of a wide-body transport airplane when operating at negative static margins. These two pitch active control systems consisted of a simple 'near-term' PACS and a more complex 'advanced' PACS. Eight different flight conditions, representing the entire flight envelope, were evaluated with emphasis on the cruise flight conditions. These studies were made utilizing the Langley Visual/Motion Simulator (VMS) which has six degrees of freedom. The simulation tests indicated that (1) the flying qualities of the baseline aircraft (PACS off) for the cruise and other high-speed flight conditions were unacceptable at center-of-gravity positions aft of the neutral static stability point; (2) within the linear static stability flight envelope, the near-term PACS provided acceptable flying qualities for static stabilty margins to -3 percent; and (3) with the advanced PACS operative, the flying qualities were demonstrated to be good (satisfactory to very acceptable) for static stabilty margins to -20 percent

Diversity Synthesis of Complex Pyridines Yields a Probe of a Neurotrophic Signaling Pathway

Recognizing the value of including complex pyridines in small-molecule screening collections, we developed a previously unexplored [2 + 2 + 2]-cycloaddition of silyl-tethered diynes with nitriles. The tether provides high regioselectivity, while the solvent THF allows catalytic CpCo(CO)2 to be used without exogenous irradiation. One of the resulting bicyclic and monocyclic (desilylated) pyridines was identified as an inhibitor of neuregulin-induced neurite outgrowth (EC50 = 0.30 µM) in a screen that probes a pathway likely to be involved in breast cancers and schizophrenia.Chemistry and Chemical Biolog

Use of the Jung/Myers Model of Personality Types to Identify and Engage with Individuals at Greatest Risk of Experiencing Depression and Anxiety

Depression is the leading cause of ill health and disability worldwide. Objectives were (1) to determine the strength of the association between personality type with depression and anxiety using the Preferred Communication Style Questionnaire (PCSQ©) and the Four-Item Patient Health Questionnaire for Depression and Anxiety (PHQ-4) and (2) evaluate the extent to which severity of depression and anxiety is associated with personality type. Data were collected via a self-administered online survey of 10,500. Chi-square analysis compared personality types and depression and anxiety. Practical significance was determined by calculating the percentage-from-expected score based on established statistics reflecting each personality type’s percentage in the US population. Personality type was strongly associated with both depression and anxiety with certain types at significantly greater risk than others. Findings can improve the research and clinical community’s understanding of the specific risk factors and triggers for depression and anxiety, and result in more efficacious, tailored treatment options

Financial Hardship from Purchasing Prescription Drugs Among Older Adults in the United States Before, During, and After the Medicare Part D “Donut Hole”: Findings from 1998, 2001, 2015, and 2021

BACKGROUND: Cost-related nonadherence compromises successful and effective management of chronic disease. The Medicare Modernization Act of 2003 (MMA) and Patient Protection and Affordable Care Act of 2010 (ACA) aimed to increase the affordability of outpatient prescription drugs for older adults (older than age 64 years). The Medicare Part D prescription drug insurance coverage gap (“donut hole”) created by the MMA was fully closed in 2020 by the ACA. OBJECTIVES: To (1) describe prescription drug coverage and financial hardship from purchasing prescription drugs among older American adults for 2021, (2) compare these results with findings from data collected before the MMA and during the progressive elimination of the Medicare Part D coverage gap, and (3) compute the likelihood for financial hardship from purchasing prescription drugs using variables for year, prescription drug insurance coverage, health-related information, and demographics. METHODS: Data were obtained from 4 nationally distributed, crosssectional surveys of older adults to track coverage for and financial hardship from purchasing prescription drugs. Surveys in 1998 and 2001 were mailed to national random samples of US seniors. Of 2,434 deliverable surveys, 700 (29%) provided useable data. Data were collected in 2015 and 2021 via online surveys sent to samples of US adults. Of 27,694 usable responses, 4,445 were from older adults. Descriptive statistics and logistic regression analyses described relationships among financial hardship and demographics, diagnoses, and daily prescription drug use. RESULTS: Five percent of older adults lacked prescription drug coverage in 2021, continuing a downward trend from 32% in 1998, 29% in 2001, and 9% in 2015. Contrastingly, 20% of older adults reported financial hardship from prescription drug purchases in 2021, bending an upward trend from 19% in 1998, 31% in 2001, and 36% in 2015. Financial hardship from purchasing prescription drugs was more likely to be reported by older adults lacking prescription drug insurance, taking multiple medications daily, and having a low annual household income across all survey years. The latter 2 of these 3 factors were still predictive of financial hardship from purchasing prescription drugs among older adults with prescription drug insurance. CONCLUSIONS: Financial hardship from purchasing prescription drugs is still experienced by many older adults after the full implementation of the MMA and ACA. Lacking prescription drug coverage, taking more than 5 prescription drugs daily, and a low annual household income may increase the likelihood of experiencing this financial hardship. Pharmacists can be a resource for older adults making choices about their prescription drug coverages and purchases. DISCLOSURES: Funding was provided by the American Association of Colleges of Pharmacy New Investigator Program, the University of Minnesota Grant-in-Aid of Research Program, the Peters Endowment for Pharmacy Practice Innovation, the Chapman University Research Program, and the University Minnesota Research Program. Plain language summary Almost all older adults in the United States have prescription drug insurance, but many still cannot afford them. This is most true for those who take many daily prescriptions, do not have prescription insurance, and have a low income