We present constraints on an astrophysical population of neutrino sources imposed by recent data from the IceCube neutrino observatory. By using the IceCube point source search method to model the ...detection of sources, our detection criterion is more sensitive than using the observation of high-energy neutrino multiplets for source identification. We frame the problem as a Bayesian hierarchical model to connect the high-level population parameters to the IceCube data, allowing us to consistently account for all relevant sources of uncertainty in our model assumptions. Our results show that sources with a local density of n0 ≳ 10−7 Mpc−3 and luminosity L ≲ 1043 erg s−1 are the most likely candidates, but that populations of rare sources with n0 ≃ 10−9 Mpc−3 and L ≃ 1045 erg s−1 can still be consistent with the IceCube observations. We demonstrate that these conclusions are strongly dependent on the source evolution considered, for which we consider a wide range of models. In doing so, we present realistic, model-independent constraints on the population parameters that reflect our current state of knowledge from astrophysical neutrino observations. We also use our framework to investigate constraints in the case of possible source detections and future instrument upgrades. Our approach is flexible and can be used to model specific source cases and extended to include multimessenger information.
While Chile recently decriminalized abortion in cases of rape, lethal fetal anomaly, and to save a woman's life, most abortions are still criminalized. We assessed medical and midwifery school ...faculty and students' views on punishing and reporting people involved in unlawful abortion, and their understanding of their obligation to protect patient confidentiality and to report unlawful abortions.
We interviewed 30 medical and midwifery school clinician faculty from seven public, private, secular and Catholic-affiliated universities, all located in the metropolitan region of Santiago, Chile. Medical (n = 239) and midwifery (n = 79) students at these same seven universities completed an online survey. We coded faculty interview transcripts, and analyzed codes related to maintaining patient confidentiality and reporting unlawful abortion. We summarized student views related to reporting and imprisoning people involved in unlawful abortion, and used general estimating equation (GEE) models to identify the factors associated with support for criminalization.
Faculty and students generally did not support reporting or imprisoning anyone involved in an unlawful abortion and believed that protecting patient information takes precedence over reporting. Yet, faculty described pressures to report in the public sector and several cases where they or their colleagues were involved in reports. Most students somewhat/strongly agreed (78%) that patient information concerning an unlawful abortion should be kept confidential; 35% strongly/somewhat agreed that a clinician involved in an unlawful surgical abortion should be imprisoned, and 18% agreed that the woman involved should be imprisoned, with students from secular universities being significantly less likely to support reporting and punishing people involved in unlawful abortion, than students from Catholic universities.
There is a need to clarify clinicians' ethical obligations in abortion care, in particular in Catholic universities, so that they can ensure that their patients have access to high quality confidential health care services.
•Laws around maintaining confidentiality and reporting unlawful abortions conflict.•Most clinical faculty and students support protecting patient confidentiality.•Clinicians perceive pressure to report unlawful abortions in the public sector.•Public sector bureaucracy and fragmented relationships with patients facilitate reporting.•Respondents support protecting patient information over reporting abortions.
IMPORTANCE: In the US, access to medication abortion using history-based (no-test) eligibility assessment, including through telehealth and mailing of mifepristone, has grown rapidly. Additional ...evidence on the effectiveness and safety of these models is needed. OBJECTIVE: To evaluate whether medication abortion with no-test eligibility assessment and mailing of medications is as effective as in-person care with ultrasonography and safe overall. DESIGN, SETTING, AND PARTICIPANTS: Prospective, observational study with noninferiority analysis. Sites included 4 abortion-providing organizations in Colorado, Illinois, Maryland, Minnesota, Virginia, and Washington from May 2021 to March 2023. Eligible patients were seeking medication abortion up to and including 70 days’ gestation, spoke English or Spanish, and were aged 15 years or older. EXPOSURE: Study groups reflected the model of care selected by the patient and clinicians and included: (1) no-test (telehealth) eligibility assessment and mailing of medications (no-test + mail) (n = 228); (2) no-test eligibility assessment and pickup of medications (no-test + pickup) (n = 119); or (3) in-person with ultrasonography (n = 238). MAIN OUTCOMES AND MEASURES: Effectiveness, defined as a complete abortion without the need for repeating the mifepristone and misoprostol regimen or a follow-up procedure, and safety, defined as an abortion-related serious adverse event, including overnight hospital admission, surgery, or blood transfusion. Outcomes were derived from patient surveys and medical records. Primary analysis focused on the comparison of the no-test + mail group with the in-person with ultrasonography group. RESULTS: The mean age of the participants (N = 585) was 27.3 years; most identified as non-Hispanic White (48.6%) or non-Hispanic Black (28.1%). Median (IQR) gestational duration was 45 days (39-53) and comparable between study groups (P = .30). Outcome data were available for 91.8% of participants. Overall effectiveness was 94.4% (95% CI, 90.7%-99.2%) in the no-test + mail group and 93.3% (95% CI, 88.3%-98.2%) in the in-person with ultrasonography group in adjusted models (adjusted risk difference, 1.2 95% CI, −4.1 to 6.4), meeting the prespecified 5% noninferiority margin. Serious adverse events included overnight hospitalization (n = 4), blood transfusion (n = 2), and emergency surgery (n = 1) and were reported by 1.1% (95% CI, 0.4%-2.4%) of participants, with 3 in the no-test + mail group, 3 in the in-person with ultrasonography group, and none in the no-test + pickup group. CONCLUSIONS AND RELEVANCE: This prospective, observational study found that medication abortion obtained following no-test telehealth screening and mailing of medications was associated with similar rates of complete abortion compared with in-person care with ultrasonography and met prespecified criteria for noninferiority, with a low prevalence of adverse events.
Restrictions on the availability of medication abortion are a barrier to accessing early abortion. People seeking medication abortion may be interested in obtaining the medications through ...alternative models. The purpose of this study was to explore patient perspectives on obtaining abortion medications in advance of pregnancy or over the counter (OTC).
Between October 2017 and August 2018, we conducted 30 in-depth interviews with abortion patients who indicated support for alternative models. We recruited patients from 10 abortion clinics in states with a range of policy environments. We analyzed interviews using inductive and deductive iterative techniques.
Participants identified logistical benefits of these alternative models, including eliminating travel to a clinic and multiple appointments, and increased privacy around decision-making. Participants were interested in advance provision for its convenience and the sense of preparedness that would come with having the pills available at home, yet some had concerns about the pills being found or stolen. Privacy was the key factor considered for OTC access, including both the privacy benefits of avoiding a clinic and the concern of having one's privacy compromised within the community if purchasing the medications in public.
People who have previously had a medication abortion are interested in alternative methods of provision for reasons concerning convenience, privacy, and avoiding burdens related to hostile policy environments, such as long travel distances to clinics and multiple appointments. Concerns around these models were primarily safety concerns for young people. Further research is needed to evaluate the safety, effectiveness, acceptability, and feasibility of these alternative models of providing medication abortion.
ICU-acquired paresis (ICUAP) is common in survivors of critical illness. There is significant associated morbidity, including prolonged time on the ventilator and longer hospital stay. However, it is ...unclear whether ICUAP is independently associated with mortality, as sicker patients are more prone and existing studies have not adjusted for this.
To test the hypothesis that ICUAP is independently associated with increased mortality. Secondarily, to determine if handgrip dynamometry is a concise measure of global strength and is independently associated with mortality.
A prospective multicenter cohort study was conducted in intensive care units (ICU) of five academic medical centers. Adults requiring at least 5 days of mechanical ventilation without evidence of preexisting neuromuscular disease were followed until awakening and were then examined for strength.
We measured global strength and handgrip dynamometry. The primary outcome was in-hospital mortality and secondary outcomes were hospital and ICU-free days, ICU readmission, and recurrent respiratory failure. Subjects with ICUAP (average MRC score of < 4) had longer hospital stays and required mechanical ventilation longer. Handgrip strength was lower in subjects with ICUAP and had good test performance for diagnosing ICUAP. After adjustment for severity of illness, ICUAP was independently associated with hospital mortality (odds ratio OR, 7.8; 95% confidence interval CI, 2.4-25.3; P = 0.001). Separately, handgrip strength was independently associated with hospital mortality (OR, 4.5; 95% CI, 1.5-13.6; P = 0.007).
ICUAP is independently associated with increased hospital mortality. Handgrip strength is also independently associated with poor hospital outcome and may serve as a simple test to identify ICUAP. Clinical trial registered with www.clinicaltrials.gov (NCT00106665).
The cosmic neutrino flux recently discovered by IceCube will be instrumental in probing the highest-energy astrophysical processes. Nevertheless, the origin of these neutrinos is still unknown. While ...it would be more straightforward to identify a transient, or galactic source, class, finding a population of distant, continuous sources is challenging. We introduce a source-type classification technique that incorporates all available information from catalogs of source candidates. We show that IceCube-Gen2 can statistically establish the origin of cosmic neutrinos, even for the most challenging source populations–starburst galaxies, AGN, or galaxy clusters–if neutrino track directions can be reconstructed with a precision ∼0.3°. We further show that the source catalog out to ∼100 Mpc can be sufficient for the most challenging source types, allowing for more straightforward source surveys. We also characterize the role of detector properties, namely angular resolution, size, and veto power in order to understand the effects of IceCube-Gen2’s design specifics.
Medication abortion is safe and effective, but restrictions still limit patients from accessing this method. Alternative models of medication abortion provision, namely advance provision, ...over-the-counter (OTC), and online, could help improve access to care for some, although there is limited evidence about abortion patients’ interest in these models.
Between 2017 and 2019, we administered a cross-sectional survey to abortion patients at 45 clinics across 15 U.S. states to explore their interest in and support for advance provision, OTC, and online abortion access. We assessed relationships between sociodemographic characteristics and interest in and support for each model using bivariate logistic regressions and present perceived advantages and disadvantages of each model, as described by a subset of participants.
Among 1,965 people enrolled, 1,759 (90%) initiated the survey. Interest in and support for advance provision was highest (72% and 82%, respectively), followed by OTC (63% and 72%) and online access (57% and 70%). In bivariate analyses, non-Hispanic Black and Asian/Pacific Islander respondents expressed lower interest and support for the online model and Alaska Native/Native American respondents expressed higher interest in an OTC model, as compared with white respondents. Among 439 participants naming advantages and disadvantages of each model, the most common advantages included convenience and having the abortion earlier. The most common disadvantages were not seeing a provider first and possibly taking pills incorrectly.
Although most abortion patients expressed interest in and support for alternative models of medication abortion provision, variation in support across race/ethnicity highlights a need to ensure that abortion care service models meet the needs and preferences of all patients, particularly people from historically underserved populations.
ObjectiveTo assess Chilean medical and midwifery students’ attitudes and willingness to become trained to provide abortion care, shortly after abortion was decriminalised in 2017.DesignWe fielded a ...cross-sectional, web-based survey of medical and midwifery students. We used generalised estimating equations to assess differences by type of university and degree sought.SettingWe recruited students from a combination of seven secular, religiously-affiliated, public and private universities that offer midwifery or medical degrees with a specialisation in obstetrics and gynaecology, located in Santiago, Chile.ParticipantsStudents seeking medical or midwifery degrees at one of seven universities were eligible to participate. We distributed the survey link to medical and midwifery students at these seven universities; 459 eligible students opened the survey link and 377 students completed the survey.Primary and secondary outcomesIntentions to become trained to provide abortion services was our primary outcome of interest. Secondary outcomes included moral views and concerns about abortion provision.ResultsMost students intend to become trained to provide abortion services (69%), 20% reported that they will not provide an abortion under any circumstance, half (50%) had one or more concern about abortion provision and 16% agreed/strongly agreed that providing abortions is morally wrong. Most believed that their university should train medical and midwifery students to provide abortion services (70%–79%). Secular university students reported higher intentions to provide abortion services (beta 0.47, 95% CI: 0.31 to 0.63), more favourable views (beta 0.52, CI: 0.32 to 0.72) and were less likley to report concerns about abortion provision (adjusted OR 0.47, CI: 0.23 to 0.95) than students from religious universities.ConclusionMedical and midwifery students are interested in becoming trained to provide abortion services and believe their university should provide this training. Integrating high-quality training in abortion care into medical and midwifery programmes will be critical to ensuring that women receive timely, non-judgemental and quality abortion care.
Microtargeting for conservation Metcalf, Alexander L.; Phelan, Conor N.; Pallai, Cassandra ...
Conservation biology,
October 2019, Letnik:
33, Številka:
5
Journal Article
Recenzirano
Odprti dostop
Widespread human action and behavior change is needed to achieve many conservation goals. Doing so at the requisite scale and pace will require the efficient delivery of outreach campaigns. ...Conservation gains will be greatest when efforts are directed toward places of high conservation value (or need) and tailored to critical actors. Recent strategic conservation planning has relied primarily on spatial assessments of biophysical attributes, largely ignoring the human dimensions. Elsewhere, marketers, political campaigns, and others use microtargeting—predictive analytics of big data—to identify people most likely to respond positively to particular messages or interventions. Conservationists have not yet widely capitalized on these techniques. To investigate the effectiveness of microtargeting to improve conservation, we developed a propensity model to predict restoration behavior among 203,645 private landowners in a 5,200,000 ha study area in the Chesapeake Bay Watershed (U.S.A.). To isolate the additional value microtargeting may offer beyond geospatial prioritization, we analyzed a new high‐resolution land‐cover data set and cadastral data to identify private owners of riparian areas needing restoration. Subsequently, we developed and evaluated a restoration propensity model based on a database of landowners who had conducted restoration in the past and those who had not (n = 4978). Model validation in a parallel database (n = 4989) showed owners with the highest scorers for propensity to conduct restoration (i.e., top decile) were over twice as likely as average landowners to have conducted restoration (135%). These results demonstrate that microtargeting techniques can dramatically increase the efficiency and efficacy of conservation programs, above and beyond the advances offered by biophysical prioritizations alone, as well as facilitate more robust research of many social–ecological systems.
Micro‐focalización para la Conservación
Resumen
Se necesitan acciones humanas diseminadas y un cambio en el comportamiento para lograr muchos objetivos de conservación. Que se logre esto a la escala y al ritmo requerido requerirá de la entrega eficiente de las campañas de participación. Las ganancias de la conservación serán mayores cuando los esfuerzos estén dirigidos hacia sitios con un alto valor (o necesidad) de conservación y estén personalizados para los actores más importantes. La reciente planeación estratégica de la conservación ha dependido principalmente de las evaluaciones espaciales de los atributos biofísicos, ignorando generalmente las dimensiones humanas. En otros ámbitos, los mercadólogos, las campañas políticas, así como otros, usan la micro‐focalización – el análisis predictivo de datos masivos – para identificar a las personas con mayor probabilidad de responder positivamente a mensajes o intervenciones particulares. Los conservacionistas todavía no han capitalizado extensamente estas técnicas. Desarrollamos un modelo de tendencia para predecir el comportamiento de restauración entre 203,645 terratenientes privados en un área de estudio de 5,200,000 ha en la cuenca de la Bahía de Chesapeake (E.U.A.) y así investigar la eficiencia de la micro‐focalización en el aumento de la conservación. Para aislar el valor adicional que puede ofrecer la micro‐focalización más allá de la priorización geoespacial, analizamos un nuevo conjunto de alta resolución de datos sobre la cobertura del suelo y datos catastrales para identificar a los terratenientes privados de áreas ribereñas que necesitan restauración. Después de esto, desarrollamos y evaluamos el modelo de tendencia a la restauración basado en una base de datos de terratenientes que han realizado restauraciones en el pasado y aquellos que no (n = 4,978). La validación del modelo en una base de datos paralela (n = 4,989) mostró que los terratenientes con los puntajes más altos para la tendencia a la restauración (es decir, el decil superior) tenían el doble de probabilidad de haber realizado acciones de conservación que el terrateniente promedio (135%). Estos resultados muestran que las técnicas de micro‐focalización pueden incrementar dramáticamente la eficiencia y la eficacia de los programas de conservación, más allá de los avances ofrecidos sólo por las priorizaciones biofísicas, así como facilitar la investigación más sólida sobre muchos sistemas socio‐ecológicos.
摘要
许多保护目标的实现都需要广泛的行动和行为转变, 要以必要的规模和速度完成这些转变, 则需要有效开展宣传活动。只有在开展工作时针对具有高保护价值 (或需求) 的地区和关键的实践者, 才能取得最大的保护成效。然而, 近期的战略保护规划主要依赖于对生物物理属性的空间尺度评估, 在很大程度上忽略了人类因素。而在如市场营销、政治活动和其它领域常用微目标的方法 (即大数据预测分析) 来识别最有可能对特定信息或干预措施作出积极响应的人群。这样的方法在保护实践者中尚未被广泛采用。为了研究微目标是否有助于保护, 我们开发了一个偏好模型来预测美国切萨皮克海湾流域 (Chesapeake Bay Watershed) 5,200,000公顷的研究区域内, 203,645名私有土地拥有者的生态恢复行为。为了确定在地理空间保护优先级划分之外, 微目标的方法可能提供的额外价值, 我们利用一套新的高精度土地覆盖数据集和地籍数据找出了需要恢复的河岸区域土地拥有者。接下来, 我们开发并评估了一个恢复偏好模型, 该模型是基于曾经进行过恢复的土地拥有者和没有进行过恢复的土地拥有者的数据库 (n = 4,978) 构建的。平行数据库 (n = 4,989) 的模型验证表明, 进行恢复的倾向性得分最高的土地拥有者 ( 前百分之十) 采取恢复行动的可能性是平均得分的土地拥有者的两倍多 (135%) 。这些结果表明, 微目标方法可以大大提高保护项目的效率和效能, 其意义超越单一的生物物理保护优先级划分, 且可以推动许多社会生态系统的有力研究。【翻译: 胡怡思; 审校: 聂永刚】
Article impact statement: Microtargeting boosts conservation impact by finding willing partners and individualizing behavior‐change interventions.