Lessons from Other Democracies: Ideas for Combatting Mistrust and Polarization in US Elections

Protections are baked into each stage of US election administration. Yet, there is a crisis of confidence in US elections. After falling to a record low following the 2020 elections, trust in US elections increased after the 2022 midterms. However, far too many Americans continue to harbor mistaken beliefs about the prevalence of widespread fraud and miscounted votes, as well as concerns about the ability of election officials to administer future elections fairly. Malign actors—both foreign and domestic—are taking advantage of and reinforcing these trends to serve their varied interests, including geopolitical advantage and monetary gain.Adopting best practices from other countries is an opportunity to buttress policies and procedures that make US elections free and fair and draw inspiration from others facing the same challenges. With its decentralized election system and state "laboratories of democracy", the United States is well suited for incremental, location-specific adaptation of new ideas

Verbal and visuospatial deficits in dementia with Lewy bodies

This is the publisher's version, also available electronically from http://www.neurology.org/content/65/8/1232.Objective: To investigate the cognitive decline in dementia with Lewy bodies (DLBs) and characterize the contribution of Lewy bodies (LBs) to cognitive impairment in the presence of concurrent Alzheimer disease (AD). Methods: Cognitive deficits and rates of progression attributable to DLB and AD neuropathology were investigated in three groups of participants from the longitudinal cohort of the Alzheimer Disease Research Center at Washington University with autopsy-confirmed diagnoses of pure DLB (n = 9), mixed DLB/AD (n = 57), and pure AD (n = 66). Factor analysis was used to recover latent constructs in a comprehensive psychometric test battery, analysis of variance was used to test group differences on the observed dimensions, and random effects models were used to test longitudinal rates of cognitive decline. Results: Patients with AD pathology performed worse on the verbal memory dimension. Patients with LB pathology performed worse on the visuospatial dimension. Combined pathology affected visuospatial performance but not verbal memory. The rate of cognitive decline in the DLB, DLB/AD combined, and the pure AD groups was equivalent. Conclusions: The comorbid presence of DLB and AD alters the cognitive presentation of visuospatial deficits in dementia but does not alter dementia progression. Both visuospatial and verbal abilities declined at similar rates across the three patient groups. DLB diagnosis may be improved, particularly when there is comorbid AD, by using domain-specific testing

An investigation of novel reactivity and bonding in rare earth metal complexes

xxvi, 247 leaves : ill. (some col.) ; 29 cm + 1 CD-ROMThe synthesis, structure and reactivity of organolanthanide complexes supported by a family of novel bis(phosphinimine)carbazole and bis(phosphinimine)pyrrole pincer ligands is presented. Through the systematic development of the ligand frameworks, rare earth metal species with unique structure and reactivity were encountered. A variety of complexes that exhibited unusual bonding modes were prepared and characterized by single-crystal X-ray diffraction and multinuclear NMR spectroscopy. Modulation of the ligand frameworks allowed for rational manipulation of the steric and electronic environment imparted to the metal. Incorporation of a variety of N-aryl rings (mesityl, phenyl, para-isopropylphenyl and 2-pyrimidine) and PR2 moieties (PPh2, PO2C2H4 and PMe2) into the ligand design led to rare earth complexes that revealed diverse reaction behaviour. In particular, C–H bond activation, sigmatropic alkyl migration and ring opening insertion reactivity were observed. Kinetic and deuterium labeling studies are discussed with respect to the unique reaction mechanisms encountered during the study of these highly reactive organometallic rare earth complexes

Reducing physician voiding cystourethrogram ordering in children with first febrile urinary tract infection: evaluation of a purposefully sequenced educational intervention

Background: Physicians often fail to implement clinical practice guidelines. Our aim was to evaluate whether a purposefully sequenced, multifaceted educational intervention would increase physician adherence to a guideline for voiding cystourethrogram (VCUG) use following first urinary tract infection (UTI) in young children.  Methods: Using a single centre, pretest-posttest design, we compared the proportion of guideline adherent VCUG orders and the VCUG ordering rate before and after three educational interventions (interactive lecture, clinical pathway, faxed reminder) selected and sequenced according to the PRECEDE (Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation) health promotion model.Results: One hundred and nine physicians ordered 219 VCUGs for 219 children. Following the interventions, there was an increase in the monthly proportion of adherent VCUGs ordered by pediatricians (analysis of variance (ANOVA) F(2,29) = 3.38, p = .048) and non-pediatricians (ANOVA F(2,28) = 14.71, p < .001). Also, pediatricians decreased their monthly VCUG ordering rate (linear trend incidence rate ratio 0.74, 95% confidence interval (CI) [0.54, 0.99]). Pediatricians were more likely to adhere with the guideline than were non-pediatricians (odds ratio 2.91, 95% CI [1.5, 5.5]).Conclusion: Exposure to purposefully sequenced educational interventions based on the PRECEDE model was associated with increased adherence to guideline recommendations.

The Impact of Spatial Heterogeneity in Land Use Practices and Aquifer Characteristics on Groundwater Conservation Policy Cost

Estimation of agricultural policy cost for a given level of groundwater conservation requires the establishment of an accurate baseline condition. This is especially critical when the benefits and cost of any conservation program are generally estimated relative to the status quo policy or baseline situation. An inaccurate baseline estimate will lead to poor estimates of potential water conservation savings and agricultural policy cost. Over a 60-year planning horizon per acre net present value is as much as 29.8% higher for a study area when aquifer characteristics are assumed to be homogenous and set to their average area value than when the heterogeneity in aquifer characteristics is explicitly modeled.Aquifer Modeling, Economics, Resource /Energy Economics and Policy,

Personality traits distinguishing dementia with Lewy bodies from Alzheimer disease

This is the publisher's version, also available electronically from http://www.neurology.org/content/68/22/1895.Objective: To identify personality traits that distinguish dementia with Lewy bodies (DLB) from Alzheimer disease (AD). Methods: We examined 290 participants enrolled in a longitudinal study (nondemented control = 34, DLB = 128, AD = 128) followed to autopsy. As part of the annual interview with the collateral source, the clinician asked about specific changes in personality, interests, and drives based on items from the Blessed Dementia Scale (BDS). Statistical analysis was performed using χ2 and Fisher exact tests. Factor analysis was performed to determine underlying structure and receiver operating characteristic curves assessed the ability for each of three derived factors to discriminate DLB from AD. Results: The sample was evaluated for a mean of 4.8 visits (range 1 to 14) with a mean age of 77.6 ± 9.9 years. The participants' cognitive status ranged from nondemented (Clinical Dementia Rating [CDR] 0) through all stages of dementia (CDR ≥ 0.5). Personality traits that distinguished DLB included diminished emotional responsiveness (p = 0.004), relinquishing hobbies (p = 0.01), growing apathy (p = 0.03), and purposeless hyperactivity (p = 0.003). Factor analyses of the BDS revealed a PASSIVE factor (diminished emotional responsiveness, relinquished hobbies, growing apathy, and purposeless hyperactivity) explaining 10.4% of variance and that DLB was more likely to manifest these personality traits than AD (p = 0.001). The PASSIVE factor discriminated DLB from AD (area under the curve = 0.61, 95% CI: 0.54 to 0.68, p = 0.006). Any change in personality is associated with the presence of visual hallucinations. Conclusions: Our results suggest that incorporating a brief, simple inventory of personality traits may improve the identification of individuals with dementia with Lewy bodies