To estimate effectiveness and acceptability of medication abortion with mifepristone dispensed by pharmacists.
We conducted a prospective cohort study at eight clinical sites and pharmacies in ...California and Washington State from July 2018 to March 2020. Pharmacists at participating pharmacies underwent a 1-hour training on medication abortion. We approached patients who had already been evaluated, counseled, and consented for medication abortion per standard of care. Patients interested in study participation gave consent, and the clinician electronically sent a prescription to the pharmacy for mifepristone 200 mg orally, followed 24-48 hours later by misoprostol 800 micrograms buccally. Participants were sent web-based surveys about their experience and outcomes on days 2 and 14 after enrollment and had routine follow-up with study sites. We extracted demographic and clinical data, including abortion outcome and adverse events, from medical records. We performed multivariable logistic regression to assess the association of pharmacy experience and other covariates with satisfaction.
We enrolled 266 participants and obtained clinical outcome information for 262 (98.5%), of whom two reported not taking either medication. Of the 260 participants with abortion outcome information, 252 (96.9%) and 237 (91.2%) completed day 2 and 14 surveys, respectively. Complete medication abortion (primary outcome) occurred for 243 participants (93.5%, 95% CI 89.7-96.1%). Four participants (1.5%, 95% CI 0.4-3.9%) had an adverse event, none of which was serious or related to pharmacist dispensing. In the day 2 survey, 91.3% (95% CI 87.1-94.4%) of participants reported satisfaction with the pharmacy experience. In the day 14 survey, 84.4% (95% CI 79.1-88.8%) reported satisfaction with the medication abortion experience. Those reporting being very satisfied with the pharmacy experience had higher odds of reporting overall satisfaction with medication abortion (adjusted odds ratio 2.96, 95% CI 1.38-6.32).
Pharmacist dispensing of mifepristone for medication abortion is effective and acceptable to patients, with a low prevalence of adverse events.
ClinicalTrials.gov, NCT03320057.
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.
CONTEXT: In 2017, Chile reformed its abortion law to allow the
procedure under limited circumstances. Exploring the views of Chilean medical
and midwifery faculty regarding abortion and the use of ...conscientious objection
(CO) at the time of reform can inform how these topics are being taught to the
country's future health care providers.
METHODS: Between March and September 2017, 30 medical and midwifery
school faculty from universities in Santiago, Chile were interviewed; 20 of the
faculty taught at secular universities and 10 taught at religiously affiliated
universities. Faculty perspectives on CO and abortion, the scope of CO, and
teaching about CO and abortion were analyzed using a grounded theory
approach.
RESULTS: Most faculty at secular and religiously affiliated
universities supported the rights of clinicians to refuse to provide abortion
care. Secular-university faculty generally thought that CO should be limited to
specific providers and rejected the idea of institutional CO, whereas
religious-university faculty strongly supported the use of CO by a broad range
of providers and at the institutional level. Only secular-university faculty
endorsed the idea that CO should be regulated so that it does not hinder access
to abortion care.
CONCLUSIONS: The broader support for CO in abortion among
religious-university faculty raises concerns about whether students are being
taught their ethical responsibility to put the needs of their patients above
their own. Future research should monitor whether Chile's CO regulations and
practices are guaranteeing people's access to abortion care.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK, VSZLJ
This book sheds light on the phenomenon of white rage, and maps out the uneasy relationship between white anxiety, religious fervour, American identity and perceived black racial progress.
Blagoevgrad, Bulgaria, has faced frequent water shortages during the past decade, but little effort has been made to encourage or implement water conservation among household water users. We employ ...the theory of planned behavior (TBP) as a theoretical framework in evaluating determinates of intention to implement a set of specific water conservation behaviors among Blagoevgrad residents. In addition to the TPB variables, we consider the effects of sociodemographics, environmental attitudes, information possession, and concern over future shortages on water conservation intention. The analysis is based on 728 questionnaires collected during the summer of 2003. The TPB variables all showed positive and significant correlation with water conservation intention. Self-perceived knowledge of climate change was also significantly related to intention. Environmental attitudes and concern over future shortages were significant but relatively weak determinants.
Objective: To evaluate and describe retention rates and weight loss in clients participating in a commercial weight loss program. Subjects: A total of 60 164 men and women ages 18-79 years who ...enrolled in the Jenny Craig Platinum program between May 2001 and May 2002. Methods: Retention rates, mean weight loss and percent weight loss were calculated on a weekly basis for the 52-week period following initial enrollment in the weight loss program. Clients were categorized based on final week of participation in the program (weeks 1-4, weeks 5-13, weeks 14-26, weeks 27-39 and weeks 40-52) and weight loss was calculated at final week. A subgroup of clients was identified based on attendance through 13, 26 and 52 weeks. Mean and percent weight loss was calculated for these subgroups of clients. Results: Of the 60 164 men and women who enrolled in the weight loss program, 73% were retained in the program after 4 weeks, 42% at 13 weeks, 22% at 26 weeks and 6.6% at 52 weeks. Clients who dropped out of the program during the first 4 weeks lost 1.1+/-1.6% (mean+/-s.d.) of their initial body weight, whereas clients who dropped out between 40 and 52 weeks lost 12.0+/-7.2%. Clients in the 13-week, 26-week and 52-week cohorts lost 8.3+/-3.3, 12.6+/-5.1 and 15.6+/-7.5% of their initial body weight, respectively. Conclusion: Weight loss was greater among clients who were retained in the program longer. The findings from this study suggest that a commercial weight loss program can be an effective weight loss tool for individuals who remain active in the program.
Neoplasms are thought to progress to cancer through genetic instability generating cellular diversity and clonal expansions driven by selection for mutations in cancer genes. Despite advances in the ...study of molecular biology of cancer genes, relatively little is known about evolutionary mechanisms that drive neoplastic progression. It is unknown, for example, which may be more predictive of future progression of a neoplasm: genetic homogenization of the neoplasm, possibly caused by a clonal expansion, or the accumulation of clonal diversity. Here, in a prospective study, we show that clonal diversity measures adapted from ecology and evolution can predict progression to adenocarcinoma in the premalignant condition known as Barrett's esophagus, even when controlling for established genetic risk factors, including lesions in TP53 (p53; ref. 6) and ploidy abnormalities. Progression to cancer through accumulation of clonal diversity, on which natural selection acts, may be a fundamental principle of neoplasia with important clinical implications.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
In August 2017, Chile lifted its complete ban on abortion by permitting abortion in three limited circumstances: 1) to save a woman's life, 2) lethal fetal anomaly, and 3) rape. The new law allows ...regulated use of conscientious objection (CO) in abortion care, including allowing institutions to register as objectors. This study assesses medical and midwifery students' support for CO, following legal reform.
From October 2017 to May 2018, we surveyed medical and midwifery students from seven universities located in Santiago, Chile. Universities included 4 secular (2 public and 2 private) and 3 private religiously-affiliated universities; all offering medical degrees with a specialization in obstetrics and gynecology (ob-gyn) and five offering midwifery degrees. We used generalized estimating equations (GEE) to identify characteristics associated with student support for CO, intentions to use CO to refuse to care for someone seeking abortion, and support for CO at the institutional level.
333 of the 413 eligible students who opened the survey, completed the questions on conscientious objection; 26% were seeking medical degrees with an ob-gyn specialty, 25% were seeking midwifery degrees, and 49% were seeking medical degrees and had not yet decided their specialty. While nearly all endorse requirements for conscientious objecting clinicians to inform (92%) and refer (91%) abortion-seeking patients, a minority (18%) would personally use conscientious objection to avoid caring for a patient seeking abortion (12% secular and 39% religious university students). About half of religious-university students (52%) and one-fifth of secular-university (20%) students support objections at the institutional level.
Most students support the regulated use of CO which preserves patients' access to abortion care. Religious-university student views on the use of conscientious objection in abortion care are discordant with those of their institutions which currently support institutional-level objections.
Ulcerative colitis, a chronic inflammatory disease of the colon, is associated with a high risk of colorectal carcinoma that is thought to develop through genomic instability. We considered that the ...rapid cell turnover and oxidative injury observed in ulcerative colitis might accelerate telomere shortening, thereby increasing the potential of chromosomal ends to fuse, resulting in cycles of chromatin bridge breakage and fusion and chromosomal instability associated with tumor cell progression. Here we have used quantitative fluorescence in situ hybridization to compare chromosomal aberrations and telomere shortening in non-dysplastic mucosa taken from individuals affected by ulcerative colitis, either with (UC progressors) or without (UC non-progressors) dysplasia or cancer. Losses, but not gains, of chromosomal arms and centromeres are highly correlated with telomere shortening. Chromosomal losses are greater and telomeres are shorter in biopsy samples from UC progressors than in those from UC non-progressors or control individuals without ulcerative colitis. A mechanistic link between telomere shortening and chromosomal instability is supported by a higher frequency of anaphase bridges-an intermediate in the breakage and fusion of chromatin bridges-in UC progressors than in UC non-progressors or control individuals. Our study shows that telomere length is correlated with chromosomal instability in a precursor of human cancer.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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