Feeding back about eco-feedback: How do consumers use and respond to energy monitors?

To date, a multitude of studies have examined the empirical effect of feedback on energy consumption yet very few have examined how feedback might work and the processes it involves. Moreover, it remains to be seen if the theoretical claims made concerning how feedback works can be substantiated using empirical data. To start to address this knowledge gap, the present research used qualitative data analysis to examine how consumers use and respond to energy monitors. The findings suggest feedback may increase both the physical and conscious visibility of consumption as well as knowledge about consumption. Accordingly, support was evident for the theoretical assertions that feedback transforms energy from invisible to visible, prompts motivated users to learn about their energy habits, and helps address information deficits about energy usage. We conclude by evaluating the feasibility of feedback to substantially reduce consumption and discuss ways in which feedback could be improved to aid its effectiveness in the long term before discussing the implication our findings may have for government policy

The question of energy reduction: The problem(s) with feedback

With smart metering initiatives gaining increasing global popularity, the present paper seeks to challenge the increasingly entrenched view that providing householders with feedback about their energy usage, via an in-home-display, will lead them to substantially reduce their energy consumption. Specifically, we draw on existing quantitative and qualitative evidence to outline three key problems with feedback, namely: (a) the limited evidence of efficacy, (b) the need for user engagement, and (c) the potential for unintended consequences. We conclude by noting that, in their current form, existing in-home-displays may not induce the desired energy-reduction response anticipated by smart metering initiatives. Instead, if smart metering is to effectively reduce energy consumption there is a clear need to develop and test innovative new feedback devices that have been designed with user engagement in mind

Going the extra green mile: When others' actions fall short of their responsibility

The present research examined whether the environmental responsibility and actions attributed to large scale organizations, such as the government, can influence people's environmental efforts. In particular, we examined whether people increase or decrease their willingness to enact energy conservation behaviors (ECB) when there is a shortfall between others' actions and their responsibility. In Studies 1 and 2 we found that willingness to enact ECB was positively correlated with judgements about each of the organizations' eco-responsibility but not their eco-actions. Interestingly, each of the organizations' actions were perceived as falling short of their responsibility and this shortfall was positively associated with willingness to enact ECB. In Study 3, we found that manipulating respondents perceptions of government shortfall increased participants' willingness to enact ECB. Overall our findings provide support for social compensation theory as when others actions fall short of their responsibility people are prepared to “go the extra green mile”

Outcomes of Patients Lost to Follow-up in African Antiretroviral Therapy Programs: Individual Patient Data Meta-analysis.

BACKGROUND: Low retention on combination antiretroviral therapy (cART) has emerged as a threat to the Joint United Nations Programme on human immunodeficiency virus (HIV)/AIDS (UNAIDS) 90-90-90 targets. We examined outcomes of patients who started cART but were subsequently lost to follow-up (LTFU) in African treatment programs. METHODS: This was a systematic review and individual patient data meta-analysis of studies that traced patients who were LTFU. Outcomes were analyzed using cumulative incidence functions and proportional hazards models for the competing risks of (i) death, (ii) alive but stopped cART, (iii) silent transfer to other clinics, and (iv) retention on cART. RESULTS: Nine studies contributed data on 7377 patients who started cART and were subsequently LTFU in sub-Saharan Africa. The median CD4 count at the start of cART was 129 cells/μL. At 4 years after the last clinic visit, 21.8% (95% confidence interval [CI], 20.8%-22.7%) were known to have died, 22.6% (95% CI, 21.6%-23.6%) were alive but had stopped cART, 14.8% (95% CI, 14.0%-15.6%) had transferred to another clinic, 9.2% (95% CI, 8.5%-9.8%) were retained on cART, and 31.6% (95% CI, 30.6%-32.7%) could not been found. Mortality was associated with male sex, more advanced disease, and shorter cART duration; stopping cART with less advanced disease andlonger cART duration; and silent transfer with female sex and less advanced disease. CONCLUSIONS: Mortality in patients LTFU must be considered for unbiased assessments of program outcomes and UNAIDS targets in sub-Saharan Africa. Immediate start of cART and early tracing of patients LTFU should be priorities

Promoting Physical Activity with Hard-to-Reach Women: An Iterative and Participatory Research Study

Approximately half of all UK women are insufficiently physically active, with the lowest activity rates among ‘Hard-to-Reach’ or unreached women. In this article, Kathryn Brook, Dr Andy Pringle FRSPH, Dr Jackie Hargreaves and Dr Nicky Kime of Leeds Beckett University outline their research into developing methods to assess and meet the needs of ‘Hard-to-Reach’ women in needs-led and person-centred interventions

Exploring Halo Substructure with Giant Stars XI: The Tidal Tails of the Carina Dwarf Spheroidal and the Discovery of Magellanic Cloud Stars in the Carina Foreground

A new large-area Washington M,T_2+DDO51 filter survey of more than 10 deg^2 around the Carina dSph galaxy reveals a spectroscopically confirmed power law radial density "break" population of Carina giant stars extending several degrees beyond the central King profile. Magellan telescope MIKE spectroscopy establishes the existence of Carina stars to at least 4.5 times its central King limiting radius, r_lim and primarily along Carina's major axis. To keep these stars bound to the dSph would require a global Carina mass-to-light ratio of M/L > 6,300 M/L_sun. The MIKE velocities, supplemented with ~950 additional Carina field velocities from archived VLT+GIRAFFE spectra with r<=r_lim, demonstrate a nearly constant Carina velocity dispersion to just beyond r = r_lim, and both a rising velocity dispersion and a velocity shear at still larger radii. Together, the observational evidence suggests that the discovered extended Carina population represents tidal debris from the dSph. Of 65 giant candidates at large angular radii from the Carina center for which MIKE spectra have been obtained 94% are associated either with Carina or a second, newly discovered diffuse, but strongly radial velocity-coherent (velocity dispersion of 9.8 km s^-1), foreground halo system. The fifteen stars in this second, retrograde velocity population have (1) a mean metallicity ~1 dex higher than that of Carina, and (2) colors and magnitudes consistent with the red clump of the Large Magellanic Cloud (LMC). Additional spectroscopy of giant star candidates in fields linking Carina and the LMC shows a smooth velocity gradient between the LMC and the retrograde Carina moving group. We conclude that we have found Magellanic stars almost twice as far (22 deg) from the LMC center than previously known.Comment: ApJ, in pres

Experiences and lessons learned from the real-world implementation of an HIV recent infection testing algorithm in three routine service-delivery settings in Kenya and Zimbabwe.

INTRODUCTION: Testing for recent HIV infection can distinguish recently acquired infection from long-standing infections. Given current interest in the implementation of recent infection testing algorithms (RITA), we report our experiences in implementing a RITA in three pilot studies and highlight important issues to consider when conducting recency testing in routine settings. METHODS: We applied a RITA, incorporating a limited antigen (LAg) avidity assay, in different routine HIV service-delivery settings in 2018: antenatal care clinics in Siaya County, Kenya, HIV testing and counselling facilities in Nairobi, Kenya, and female sex workers clinics in Zimbabwe. Discussions were conducted with study coordinators, laboratory leads, and facility-based stakeholders to evaluate experiences and lessons learned in relation to implementing recency testing. RESULTS: In Siaya County 10/426 (2.3%) of women testing HIV positive were classified as recent, compared to 46/530 (8.7%) of women and men in Nairobi and 33/313 (10.5%) of female sex workers in Zimbabwe. Across the study setting, we observed differences in acceptance, transport and storage of dried blood spot (DBS) or venous blood samples. For example, the acceptance rate when testing venous blood was 11% lower than when using DBS. Integrating our study into existing services ensured a quick start of the study and kept the amount of additional resources required low. From a laboratory perspective, the LAg avidity assay was initially difficult to operationalise, but developing a network of laboratories and experts to work together helped to improve this. A challenge that was not overcome was the returning of RITA test results to clients. This was due to delays in laboratory testing, the need for multiple test results to satisfy the RITA, difficulties in aligning clinic visits, and participants opting not to return for test results. CONCLUSION: We completed three pilot studies using HIV recency testing based on a RITA in Kenya and Zimbabwe. The main lessons we learned were related to sample collection and handling, LAg avidity assay performance, integration into existing services and returning of test results to participants. Our real-world experience could provide helpful guidance to people currently working on the implementation of HIV recency testing in sub-Saharan Africa

The National Cancer Institute’s Community Networks Program Initiative to Reduce Cancer Health Disparities: Outcomes and Lessons Learned

We describe reach, partnerships, products, benefits, and lessons learned of the 25 Community Network Programs (CNPs) that applied community-based participatory research (CBPR) to reduce cancer health disparities

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown