Extensive measurements of CO
2
fugacity in the North Pacific surface ocean and overlying atmosphere during the years 1985–1989 are synthesized and interpreted to yield a basin‐wide estimate of ΔfCO
2
.... The observations, taken from February through early September, suggest that the subtropical and subarctic North Pacific is a small sink for atmospheric CO
2
(0.07 to 0.2 Gton C (half year)
−1
for the region north of 15°N). Objective analysis techniques are used to estimate uncertainty fields resulting from constructing basin‐wide contours of oceanic fCO
2
on the basis of individual cruise transects. The uncertainties are significant and imply that future sampling programs need to recognize that estimating oceanic uptake of anthropogenic CO
2
from ship‐transect observations of oceanic fCO
2
alone will require very extensive sampling.
This thesis analyzes direct observations and model output of surface ocean fCO$\sb2$ in the North Pacific. Direct observations of fCO$\sb2$ indicate that the North Pacific serves as a small net sink ...for atmospheric CO$\sb2$ during spring through summer seasons. Objective analysis techniques indicate that uncertainties in the $\rm \Delta fCO\sb2$ field are significant (integrated basin-wide uncertainty = $\pm$14 $\mu$atm). Direct observations of sea surface temperature, salinity, phosphate and derived geostrophic currents are analyzed along with fCO$\sb2$ observations to establish which processes are most important in North Pacific surface carbon cycle dynamics. A simple model is used to estimate the relative influences of gas exchange, temperature changes, salinity changes, and nutrient uptake surface fCO$\sb2$. Large-scale and small-scale fCO$\sb2$ fields in the western subtropics are influenced primarily by geostrophic advection. In the eastern subtropics, biological uptake of surface nutrients is of leading order importance in the small-scale (geographic) fCO$\sb2$ signal. Seasonal fCO$\sb2$ cycles in the eastern subtropics are determined primarily by seasonal sea surface temperature changes. Biological activity and thermodynamics are of equal importance in subarctic North Pacific carbon cycling. Direct fCO$\sb2$ observations are compared with output from the 'HAMOCC3-with-plankton' model. The model reproduces the observed fCO$\sb2$ trends in the subtropics. There are significant inconsistencies between modeled and observed fCO$\sb2$ in the frontal and subarctic North Pacific. These inconsistencies appear to be due primarily to inadequate resolution of the Kuroshio Current, insufficient subarctic wintertime mixing, and insufficient riverine influence. Discrepancies between modeled and observed PO$\sb4$ and Chl a fields suggest that although subtropical fCO$\sb2$ fields are adequately modeled, the biological component of the carbon model may be insufficiently represented to model possible climate-scale feedback mechanisms. Experimental sampling strategies for the North Pacific and the global ocean are explored using objective analysis. The addition of two new transects in the North Pacific would reduce the basin-wide uncertainties by only 1-2 $\mu$atm, regardless of the orientation of the transects. Objectively mapped uncertainties for the WOCE transects indicate that a doubling of the WOCE transects could reduce uncertainties in estimated global $\rm \Delta fCO\sb2$ by 30%.
This article describes evidence suggesting that science curiosity counteracts politically biased information processing. This finding is in tension with two bodies of research. The first casts doubt ...on the existence of “curiosity” as a measurable disposition. The other suggests that individual differences in cognition related to science comprehension—of which science curiosity, if it exists, would presumably be one—do not mitigate politically biased information processing but instead aggravate it. The article describes the scale‐development strategy employed to overcome the problems associated with measuring science curiosity. It also reports data, observational and experimental, showing that science curiosity promotes open‐minded engagement with information that is contrary to individuals’ political predispositions. We conclude by identifying a series of concrete research questions posed by these results.
The benefits and burdens of patient advocacy Fuld Nasso, Shelley; Porter, Laura Diane; McNiff Landrum, Kristen K.
Journal of clinical oncology,
10/2021, Letnik:
39, Številka:
28_suppl
Journal Article
Recenzirano
Abstract only
204
Background: Patient advocates share their time and experience to improve cancer research, care, and support. Advocacy can be rewarding and empowering, and survivors and caregivers ...express a variety of reasons for engaging in advocacy. Yet, advocacy can also come with mental and emotional costs. Challenges include the grief of losing friends to cancer, the related “survivors’ guilt”, and the burden of repeatedly reliving their experience. The National Coalition for Cancer Survivorship (NCCS) conducted a survey to better understand the experience of patient advocates, and actions that organizations can take to recognize and support advocates. Methods: NCCS convened two focus groups with 10 advocates (the “working group”) to understand factors that contribute to advocates feeling rewarded or burned out from advocacy. We reviewed the transcripts to identify themes and reviewed the literature. We developed a survey and included a validated, non-proprietary, single-item burnout measure used for health care professionals. We built the survey online and tested with select working group members. We disseminated the survey to NCCS’ advocacy network, and working group members shared with their networks. Results: As of June 1, we received 176 responses, with the survey will open for another week. The initial data show that the vast majority of respondents find their advocacy work rewarding (97%), empowering (93%), and a positive impact on their lives (96%). At the same time, 29.5% of respondents indicated they have symptoms of burnout, including emotional and physical exhaustion. Respondents report that their advocacy work results in exhaustion (50.7%), sadness (41.1%), and anxiousness (28.7%). More than a third (36.7%) said that grief makes it hard to maintain their work as advocates. A majority manage the demands of their advocacy work by practicing self-care (66.6%) and using coping strategies (62.5%). Advocates shared the specific practices and strategies they used. Less than half (42.5%) said they set boundaries between their advocacy work and their personal life. The final analysis of the survey data will be complete by the end of June 2021. Conclusions: The phrase, “Nothing about us, without us,” has guided the inclusion of patient and caregiver voices in the design of research, care delivery, research grant review, quality measurement, and other aspects of cancer care and cancer research. Yet organizations that ask for the mental and emotional labor of advocates, including patient organizations, researchers, health care professionals, government institutions, and pharmaceutical companies, should understand the costs to advocates and how to best support them. As one respondent said, “Perhaps organizations could set the stage for this work by openly validating the toll that cancer itself takes, and acknowledge that advocacy takes energy and commitment, which may not always be possible to sustain in the face of ongoing treatment or other life complications.”
Background
Graduate admissions in psychology continue to be a popular and competitive venture, with the demand for new graduate student opportunities exceeding the annual supply.
Objective
Our ...present work was a partial replication and extension of Appleby and Appleby (2006). We added closed- and open-ended questions regarding social media to gauge how graduate admissions committees utilize social media to evaluate applicants.
Method
We asked U.S. graduate admissions directors to answer six open-ended questions and then rate the frequency and fatality/harmfulness of 17 potential applicant errors. From the population of 467 graduate admissions directors, 56 provided complete responses (12.0% response rate).
Results
We examine the closed-ended quantitative results presenting descriptive data and combining the frequency and fatality scales into a scatterplot; outcomes from the open-ended qualitative results provide rich and nuanced advice about graduate admissions errors.
Conclusion
Poorly written application materials are to be avoided (obviously), but the evidence-informed advice offered here is much more nuanced and complex.
Teaching Implications
Mentors and faculty advisors can use information from this study to provide data-informed advice to students interested in improving their chances for admission to graduate programs in psychology, offering specific tips on the most harmful/fatal mistakes to avoid.
Background Although current performance measures define low-density-lipoprotein cholesterol (LDL-C) levels <100 mg/dL in patients with cardiovascular disease (CVD) as good quality, they provide a ...snapshot and do not address whether treatment intensification was performed to manage elevated LDL-C levels. Methods We determined the proportion of patients with CVD (n = 22,888) with LDL-C <100 mg/dL and the proportion with uncontrolled LDL-C levels (≥100 mg/dL) who received treatment intensification within the 45-day follow-up in a Veterans Affairs Network. We evaluated facility, provider, and patient correlates of treatment intensification. Results Low-density-lipoprotein cholesterol levels were at goal in 16,350 (71.4%) patients. An additional 2,093 (one third of those eligible for treatment intensification) received treatment intensification. Controlling for clustering between facilities and patient's illness severity: history of diabetes (odds ratio OR 1.15, 95% CI 1.01-1.32), hypertension (OR 1.19, 95% CI 1.01-1.42), good medication adherence (OR 2.20, 95% CI 1.91-2.54), and a higher number of lipid panels (OR 1.20, 95% CI 1.14-1.27) were associated with treatment intensification. Patients older than 75 years (OR 0.65, 95% CI 0.56-0.75) and women (OR 0.66, 95% CI 0.43-1.00) were less likely to receive treatment intensification. Teaching status of the facility, physician or specialist primary care provider, and patient's race were not associated with treatment intensification. Conclusions Only one third of the CVD patients with elevated LDL-C received treatment intensification. Diabetic and hypertensive patients were more likely to receive treatment intensification, whereas, older patients, female patients, and patients with poor medication adherence were less likely to receive treatment intensification. Our findings highlight areas for quality improvement initiatives.
Objective: Studies provide conflicting results about the impact of comorbid conditions on the quality of chronic illness care. We assessed the effect of comorbidity type (concordant, discordant, or ...both) on the receipt of guideline-recommended care among patients with diabetes. Research Design: Patients were assigned to 1 of 4 condition groups: diabetes-concordant (hypertension, ischemic heart disease, hyperlipidemia), and/or diabetes-discordant (arthritis, depression, chronic obstructive pulmonary disease) conditions, or neither. We evaluated hemoglobin A1c, blood pressure, and low-density lipoprotein cholesterol readings at index and measured overall good quality of diabetes care, including a 6-month follow-up interval. We assessed the effect of condition group on overall good quality of care with logistic regression and generalized ordered logistic regression. Results: We assigned 35,872 patients to the diabetes comorbid condition groups, ranging from 2.0% in the discordant-only group to 58.0% in the concordant-only group. Patients with both types of conditions were more likely than those with no comorbidities to receive overall good quality for glycemic odds ratio (OR), 2.13; 95% confidence interval (CI), 1.86-2.41, blood pressure (OR, 1.62; 95% CI, 1.40-1.84), and low-density lipoprotein cholesterol (OR, 3.57; 95% CI, 3.08-4.05) control within 6 months of an index visit. They were also more likely to receive overall good quality for all 3 quality measures combined (OR, 2.17; 95% CI, 1.96-2.39). Conclusions: Patients with the greatest clinical complexity were more likely than less complex patients to receive high quality diabetes care, suggesting that increased complexity does not necessarily predispose chronically ill patients to receiving poorer care. However, caution should be used in treating certain patient groups, such as the elderly, for whom adherence to multiple condition-specific guidelines may lack benefit or cause harm.
Background The aim of this analysis was to identify the proportion of coronary heart disease (CHD) patients achieving guideline-recommended low-density lipoprotein cholesterol (LDL-C) and ...non–high-density lipoprotein cholesterol (non–HDL-C) goals and to identify correlates of dual goal attainment. Methods We analyzed patient, provider, and facility characteristics for 21,801 CHD patients in one Veterans Affairs Hospitals Network. Results Low-density lipoprotein cholesterol goal attainment was 80%, but optional LDL-C goal attainment was 41%. Of patients with triglycerides ≥200 mg/dL, 51% attained both LDL-C and non–HDL-C goals. Correlates of higher dual goal attainment included older age (65-74 years: odds ratio OR 1.47, 95% CI 1.28-1.69), diabetes (OR 1.33, 95% CI 1.16-1.53), obesity (OR 1.25, 95% CI 1.04-1.50), a higher number of primary care visits (OR 1.04, 95% CI 1.04-1.05), and mild increase in illness severity of patients in provider's panel (OR 1.20, 95% CI 1.0008-1.46), whereas African American patients were less likely to achieve dual lipid goals (OR 0.63, 95% CI 0.48-0.82). Receipt of care from physician (vs nonphysician) or specialist (vs primary care) provider, number of patients in provider's panel, and percentage of patients in provider's panel with diagnosis of hyperlipidemia were not associated with dual goal attainment. Conclusions A large proportion of CHD patients attained LDL-C goal, but optional LDL-C goal attainment was low. Patients with elevated triglycerides had poor attainment of dual LDL-C and non–HDL-C goals, suggesting a treatment gap. Factors associated with dual goal attainment may identify interventions needed to improve future guideline adherence.
During the COVID-19 vaccination rollout from March 2021- December 2022, the Centers for Disease Control and Prevention funded 110 primary and 1051 subrecipient partners at the national, state, local, ...and community-based level to improve COVID-19 vaccination access, confidence, demand, delivery, and equity in the United States. The partners implemented evidence-based strategies among racial and ethnic minority populations, rural populations, older adults, people with disabilities, people with chronic illness, people experiencing homelessness, and other groups disproportionately impacted by COVID-19. CDC also expanded existing partnerships with healthcare professional societies and other core public health partners, as well as developed innovative partnerships with organizations new to vaccination, including museums and libraries. Partners brought COVID-19 vaccine education into farm fields, local fairs, churches, community centers, barber and beauty shops, and, when possible, partnered with local healthcare providers to administer COVID-19 vaccines. Inclusive, hyper-localized outreach through partnerships with community-based organizations, faith-based organizations, vaccination providers, and local health departments was critical to increasing COVID-19 vaccine access and building a broad network of trusted messengers that promoted vaccine confidence. Data from monthly and quarterly REDCap reports and monthly partner calls showed that through these partnerships, more than 295,000 community-level spokespersons were trained as trusted messengers and more than 2.1 million COVID-19 vaccinations were administered at new or existing vaccination sites. More than 535,035 healthcare personnel were reached through outreach strategies. Quality improvement interventions were implemented in healthcare systems, long-term care settings, and community health centers resulting in changes to the clinical workflow to incorporate COVID-19 vaccine assessments, recommendations, and administration or referrals into routine office visits. Funded partners' activities improved COVID-19 vaccine access and addressed community concerns among racial and ethnic minority groups, as well as among people with barriers to vaccination due to chronic illness or disability, older age, lower income, or other factors.
Objectives
To develop an algorithm to identify individuals with limited life expectancy and examine the effect of limited life expectancy on glycemic control and treatment intensification in ...individuals with diabetes mellitus.
Design
Individuals with diabetes mellitus and coexisting congestive heart failure, chronic obstructive pulmonary disease, dementia, end‐stage liver disease, and/or primary or metastatic cancer with limited life expectancy were identified. To validate the algorithm, 5‐year mortality was assessed in individuals identified as having limited life expectancy. Rates of meeting performance measures for glycemic control between individuals with and without limited life expectancy were compared. In individuals with uncontrolled glycosylated hemoglobin (HbA1c) levels, the effect of limited life expectancy on treatment intensification within 90 days was examined.
Setting
One hundred ten Department of Veterans Affairs facilities; October 2006 to September 2007.
Participants
Eight hundred eighty‐eight thousand six hundred twenty‐eight individuals with diabetes mellitus.
Measurements
HbA1c; treatment intensification within 90 days of index HbA1c reading.
Results
Twenty‐nine thousand sixteen (3%) participants had limited life expectancy. Adjusting for age, 5‐year mortality was five times as high in participants with limited life expectancy than in those without. Participants with limited life expectancy had poorer glycemic control than those without (glycemic control: 77.1% vs 78.1%; odds ratio (OR) = 0.84, 95% confidence interval (CI) = 0.81–0.86) and less‐frequent treatment intensification (treatment intensification: 20.9% vs 28.6%; OR = 0.71, 95% CI = 0.67–0.76), even after controlling for patient‐level characteristics.
Conclusion
Participants with limited life expectancy were less likely than those without to have controlled HbA1c levels and to receive treatment intensification, suggesting that providers treat these individuals less aggressively. Quality measurement and performance‐based reimbursement systems should acknowledge the different needs of this population.
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