Road Supply in Central London: Addition of an Ignored Social Cost

Studies examining the social cost of driving usually ignore the opportunity cost of having roads in place: the associated land rents. Especially for geographic regions where land is valuable, including the rent costs may even lead governments to close some roads. By using the London congestion charging zone case, a more general long-run social cost curve is calculated with the addition of the rents. Based on the optimal road usage concept, this study found that including the rents in the cost/benefit analysis significantly affects the results and can increase the social cost by up to 200% and decrease the optimal road usage by 40%

Internal Disinhibition Predicts Weight Regain Following Weight Loss and Weight Loss Maintenance

Objective: The disinhibition scale of the Eating Inventory predicts weight loss outcome; however, it may include multiple factors. The purpose of this study was to examine the factor structure of the disinhibition scale and determine how its factors independently relate to long-term weight loss outcomes. Research Methods and Procedures: Exploratory factor analysis of the disinhibition scale was conducted on 286 participants in a behavioral weight loss trial (TRIM), and confirmatory factor analysis was conducted on 3345 members of the National Weight Control Registry (NWCR), a registry of successful weight loss maintainers. Multivariate regressions were used to examine the relationships between the disinhibition scale factors and weight over time in both samples. Results: Using baseline data from TRIM, two factors were extracted from the disinhibition scale: 1) an internal factor that described eating in response to internal cues, such as feelings and thoughts; and 2) an external factor that described eating in response to external cues, such as social events. This factor structure was confirmed using confirmatory factor analysis in the NWCR. In TRIM, internal disinhibition significantly predicted weight loss at 6 months (p = 0.03) and marginally significantly predicted weight loss at 18 months (p = 0.06), with higher levels of internal disinhibition at baseline predicting less weight loss; external disinhibition did not predict weight loss at any time-point. In NWCR, internal disinhibition significantly predicted one-year weight change (p = 0.001), while external disinhibition did not. Discussion: These results suggest that it is the disinhibition of eating in response to internal cues that is associated with poorer long-term weight loss outcomes

Legal Ethics in the Digital Age

Ms. deMaine\u27s contribution to the seminar is: Legal Ethics in the Digital Agehttps://www.repository.law.indiana.edu/facbooks/1218/thumbnail.jp

Home grocery delivery improves the household food environments of behavioral weight loss participants: Results of an 8-week pilot study

<p>Abstract</p> <p>Background</p> <p>Household food availability is consistently linked to dietary intake; yet behavioral weight control treatment includes only minimal instruction on how to change the home environment to support dietary goals. This pilot study examined whether it is feasible to change the household food environments of behavioral weight loss participants through the use of a commercially available grocery home delivery service.</p> <p>Methods</p> <p>Overweight participants (N = 28; BMI = 31.7 ± 3.6 kg/m²; 89.3% women, 47.9 ± 9.5 years) were randomly assigned to 8-weeks of standard behavioral weight loss (SBT) or to SBT plus home food delivery (SBT+Home). SBT+Home participants were instructed to do their household grocery shopping via an online service affiliated with a regional supermarket chain and were reimbursed for delivery charges.</p> <p>Results</p> <p>Compared to SBT, SBT+Home produced significantly greater reductions in the total number of foods in the home (p = .01) and number of foods that were high in fat (p = .002). While the groups did not differ in 8-week weight losses, within SBT+Home there was a trend for the number of home deliveries to be associated with weight loss (p = .08). Participants reported that the home delivery service was easy to use and that it helped decrease impulse purchases and lead to healthier choices; however, few planned to continue using the service after the study.</p> <p>Conclusion</p> <p>Encouraging weight loss participants to use a commercially available online grocery ordering and home delivery service reduces the overall number of food items in the home and decreases access to high-fat food choices. More research is needed to determine whether this is a viable strategy to strengthen stimulus control and improve weight loss outcomes.</p

Redesigning inpatient care: testing the effectiveness of an Accountable Care Team model

BACKGROUND US healthcare underperforms on quality and safety metrics. Inpatient care constitutes an immense opportunity to intervene to improve care. OBJECTIVE Describe a model of inpatient care and measure its impact. DESIGN A quantitative assessment of the implementation of a new model of care. The graded implementation of the model allowed us to follow outcomes and measure their association with the dose of the implementation. SETTING AND PATIENTS Inpatient medical and surgical units in a large academic health center. INTERVENTION Eight interventions rooted in improving interprofessional collaboration (IPC), enabling data-driven decisions, and providing leadership were implemented. MEASUREMENTS Outcome data from August 2012 to December 2013 were analyzed using generalized linear mixed models for associations with the implementation of the model. Length of stay (LOS) index, case-mix index–adjusted variable direct costs (CMI-adjusted VDC), 30-day readmission rates, overall patient satisfaction scores, and provider satisfaction with the model were measured. RESULTS The implementation of the model was associated with decreases in LOS index (P < 0.0001) and CMI-adjusted VDC (P = 0.0006). We did not detect improvements in readmission rates or patient satisfaction scores. Most providers (95.8%, n = 92) agreed that the model had improved the quality and safety of the care delivered. CONCLUSIONS Creating an environment and framework in which IPC is fostered, performance data are transparently available, and leadership is provided may improve value on both medical and surgical units. These interventions appear to be well accepted by front-line staff. Readmission rates and patient satisfaction remain challenging

Untying a nanoscale knotted polymer structure to linear chains for efficient gene delivery in vitro and to the brain

The purpose of this study was to develop a platform transfection technology, for applications in the brain, which could transfect astrocytes without requiring cell specific functionalization and without the common cause of toxicity through high charge density. Here we show that a simple and scalable preparation technique can be used to produce a “knot” structured cationic polymer, where single growing chains can crosslink together via disulphide intramolecular crosslinks (internal cyclizations). This well-defined knot structure can thus “untie” under reducing conditions, showing a more favorable transfection profile for astrocytes compared to 25 kDa-PEI (48-fold), SuperFect® (39-fold) and Lipofectamine®2000 (18-fold) whilst maintaining neural cell viability at over 80% after four days of culture. The high transfection/lack of toxicity of this knot structured polymer in vitro, combined with its ability to mediate luciferase transgene expression in the adult rat brain, demonstrates its use as a platform transfection technology which should be investigated further for neurodegenerative disease therapies