We analyze orbital solutions for 48 massive multiple-star systems in the Cygnus OB2 association, 23 of which are newly presented here, to find that the observed distribution of orbital periods is ...approximately uniform in log P for P < 45 days, but it is not scale-free. We identify six stars, all supergiants, that exhibit aperiodic velocity variations of ~30 km ssup -1 attributed to atmospheric fluctuations.
•Little extant climate change communication research examines the impact of imagery.•Perceived authenticity and credibility importantly influenced image evaluations.•Familiar climate images were ...easily understood but also attracted cynicism.•Images of ‘solutions’ produced positive affective responses and less polarization.•Images of ‘impacts’ produced greater intentions towards personal behavioral change.
Imagery plays a central role in climate change communication. But whereas research on the verbal communication of climate change has proliferated, far fewer studies have focused on visual communication. Correspondingly, relatively little is known about how to effectively engage the public using the visual medium. The current research is the first mixed methods, cross-national investigation of public perceptions of climate images, with a focus on photographic climate change imagery. Four structured discussion groups in the UK and Germany (N=32) and an international survey with an embedded experiment in the UK, Germany and the US (N=3014) were conducted to examine how different types of climate change imagery were evaluated. The qualitative research pointed to the importance of the perceived authenticity and credibility of the human subjects in climate images, as well as widespread negativity towards images depicting protests and demonstrations. Images of climate ‘solutions’ produced positive emotional responses in the survey and were less polarizing for climate change skeptics, but they were also the least motivating of action. Familiar climate images (such as a polar bear on melting ice) were easily understood in the survey (and evaluated positively as a consequence) but viewed with cynicism in discussion groups. We present a detailed discussion of these and other key findings in this paper and describe a novel application of the data through an online image library for practitioners which accompanies the research (www.climatevisuals.org).
Primary biliary cholangitis (PBC) is a chronic, progressive autoimmune liver disease that mainly affects middle‐aged women. Obeticholic acid (OCA), which was recently approved by the Food and Drug ...Administration for PBC treatment, has demonstrated positive effects on biochemical markers of liver function. Our objective was to evaluate the long‐term clinical impact and cost‐effectiveness of OCA as a second‐line treatment for PBC in combination with ursodeoxycholic acid (UDCA) in adults with an inadequate response to UDCA. We developed a mathematical model to simulate the lifetime course of PBC patients treated with OCA+UDCA versus UDCA alone. Efficacy data were derived from the phase 3 PBC OCA International Study of Efficacy trial, and the natural history of PBC was informed by published clinical studies. Model outcomes were validated using the PBC Global Study. We found that in comparison with UDCA, OCA+UDCA could decrease the 15‐year cumulative incidences of decompensated cirrhosis from 12.2% to 4.5%, hepatocellular carcinoma from 9.1% to 4.0%, liver transplants from 4.5% to 1.2%, and liver‐related deaths from 16.2% to 5.7% and increase 15‐year transplant‐free survival from 61.1% to 72.9%. The lifetime cost of PBC treatment would increase from $63,000 to $902,000 (1,330% increment). The discounted quality‐adjusted life years with UDCA and OCA+UDCA were 10.74 and 11.78, respectively, and the corresponding costs were $142,300 and $633,900, resulting in an incremental cost‐effectiveness ratio of $473,400/quality‐adjusted life year gained. The results were most sensitive to the cost of OCA. Conclusion: OCA is a promising new therapy to substantially improve the long‐term outcomes of PBC patients, but at its current annual price of $69,350, it is not cost‐effective using a willingness‐to‐pay threshold of $100,000/quality‐adjusted life year; pricing below $18,450/year is needed to make OCA cost‐effective. (Hepatology 2017;65:920‐928).
Abstract
Purpose
Cancer research on sexual and gender minority (SGM) populations is gaining momentum. The purpose of this systematic review was to examine what is currently known in the research ...literature regarding patient-reported health outcomes after cancer treatment among SGM populations.
Methods
In March 2021, a medical librarian conducted a systematic keyword search on PubMed, Embase, Scopus, Web of Science, PsycINFO,
ClinicalTrials.gov
, and the Cochrane Central Register of Controlled Trials. The primary inclusion criterion was assessment of at least one physical, psychosocial, emotional, or functional patient-reported health outcome related to the impacts of cancer diagnosis and/or treatment. Articles that met inclusion criteria were reviewed in their entirety, charted in a Word Table, and assessed for quality. Quality considerations included study design, sampling approach, diversity of sample, measures used, and analytic procedures. Studies were synthesized based on type of cancer study participants experienced.
Results
Sixty-four studies were included in the final analysis: most were quantitative, secondary analyses or cross-sectional studies with convenience samples, and focused on people with a history of breast or prostate cancer. Differences between sexual minority men and women in terms of coping and resilience were noted. Few studies reported on experiences of transgender persons and none reported on experiences of intersex persons.
Conclusions
A growing literature describes the patient-reported health outcomes of SGM people with a history of cancer. This study summarizes important between-group differences among SGM and heterosexual, cisgender counterparts that are critical for clinicians to consider when providing care.
Implications for cancer survivors
Sexual orientation and gender identity are relevant to cancer survivors’ health outcomes. Subgroups of SGM people have differential experiences and outcomes related to cancer and its impacts.
Wildfire smoke contributes substantially to the global disease burden and is a major cause of air pollution in the US states of Oregon and Washington. Climate change is expected to bring more ...wildfires to this region. Social media is a popular platform for health promotion and a need exists for effective communication about smoke risks and mitigation measures to educate citizens and safeguard public health.
Using a sample of 1,287 Tweets from 2022, we aimed to analyze temporal Tweeting patterns in relation to potential smoke exposure and evaluate and compare institutions' use of social media communication best practices which include (i) encouraging adoption of smoke-protective actions; (ii) leveraging numeric, verbal, and Air Quality Index risk information; and (iii) promoting community-building. Tweets were characterized using keyword searches and the Linguistic Inquiry and Word Count (LIWC) software. Descriptive and inferential statistics were carried out.
44% of Tweets in our sample were authored between January-August 2022, prior to peak wildfire smoke levels, whereas 54% of Tweets were authored during the two-month peak in smoke (September-October). Institutional accounts used Twitter (or X) to encourage the adoption of smoke-related protective actions (82% of Tweets), more than they used it to disseminate wildfire smoke risk information (25%) or promote community-building (47%). Only 10% of Tweets discussed populations vulnerable to wildfire smoke health effects, and 14% mentioned smoke mitigation measures. Tweets from Washington-based accounts used significantly more verbal and numeric risk information to discuss wildfire smoke than Oregon-based accounts (p = 0.042 and p = 0.003, respectively); however, Tweets from Oregon-based accounts on average contained a higher percentage of words associated with community-building language (p < 0.001).
This research provides practical recommendations for public health practitioners and researchers communicating wildfire smoke risks on social media. As exposures to wildfire smoke rise due to climate change, reducing the environmental disease burden requires health officials to leverage popular communication platforms, distribute necessary health-related messaging rapidly, and get the message right. Timely, evidence-based, and theory-driven messaging is critical for educating and empowering individuals to make informed decisions about protecting themselves from harmful exposures. Thus, proactive and sustained communications about wildfire smoke should be prioritized even during wildfire "off-seasons."
We find ourselves in an era of unprecedented growth in the development and use of so-called “orphan” drugs to treat rare diseases, which are poised to represent more than one-fifth of pharmaceutical ...expenditures by 2022. This widespread use has been facilitated by legislative and regulatory incentives in both the United States and abroad, yet US payers and health systems have not yet made a concerted effort to understand whether and how rare diseases require special considerations on their part and how to adapt traditional methods of health technology assessment and economic evaluation to accommodate these situations. In this article, we explore the general ethical dilemmas that rare diseases present, steps taken by health technology assessment bodies worldwide to define the level of rarity that would necessitate special measures and the modifications to their assessment and valuation processes needed, and the contextual components for rare-disease evaluation that lie outside of the assessment framework as a guide to US decision makers on constructing a formal and relevant process stateside.
•This article is an overview of the societal, ethical, and coverage/reimbursement landscape for consideration of novel treatments for rare diseases and highlights the following:•Confirms the ethical struggle and tradeoffs associated with making special arrangements to consider the value of new treatments for rare diseases and the high degree of variation in how payer and health technology assessment organizations deploy such arrangements;•Adds a discussion of the contextual elements necessary for developing rare-disease policy, highlighting those that fall outside the traditional boundaries of economic assessment and evidence synthesis;•Documents the current gaps in US payer understanding of these issues and outlines the steps necessary to create an internationally harmonious approach to rare-disease policy.•Confirms the ethical struggle and tradeoffs associated with making special arrangements to consider the value of new treatments for rare diseases and the high degree of variation in how payer and health technology assessment organizations deploy such arrangements;•Adds a discussion of the contextual elements necessary for developing rare-disease policy, highlighting those that fall outside the traditional boundaries of economic assessment and evidence synthesis;•Documents the current gaps in US payer understanding of these issues and outlines the steps necessary to create an internationally harmonious approach to rare-disease policy.
•Insights for communication to improve coping with climate change are provided.•Communication principles are suggested for the climate change coping context.•Climate change will have diverse impacts ...on peoples’ stress and coping responses.•Individual resilience is linked to ecosystem and community resilience.
Climate change poses a major threat to human well-being and will be the root cause of a variety of stressors in coming decades. Psychologists have an important role to play in developing interventions and communication strategies to help people understand and cope with climate change impacts. Through a review of the literature, we identify three guiding insights for strategies to promote adaptive coping and resilience to climate change stress. First, it is unlikely that one single “correct” or “best” way of communicating about adaptive coping with climate change exists, but there are established best practices communicators can follow. Second, in implementing these best practices, practitioners must attend to the impact of variability in the nature of different kinds of stress caused by climate change, as well as individual differences in how people chronically respond to stressors. Third, because individuals, communities, and ecosystems are interconnected, work on adaptive coping to climate change must address individual coping in the context of community and ecosystem resilience. These insights from psychological science can be leveraged to promote human flourishing despite increasing stressors posed by climate change.
International Ocean Discovery Program Expedition 352 to the Bonin forearc drilled the sequence of volcanic rocks erupted in the immediate aftermath of subduction initiation along the western margin ...of the Pacific Plate. Pristine volcanic glasses collected during this expedition were analyzed for major and trace elements, halogens, sulfur, and H and O isotopes with goals of characterizing the fluids and melts of subducted materials that were involved in generating the nascent upper plate crust. Incompatible trace element compositions of the oldest lavas (forearc basalts FAB) are similar to those of the most depleted mid‐ocean ridge basalts globally. Most FAB were generated by decompression melting during seafloor spreading in a near‐trench, supra‐subduction zone environment with only minor involvement of diverse and generally dilute water‐rich fluids from the subducting plate. Boninite series glasses are enriched in incompatible trace elements mobilized from the subducting plate, but strongly depleted in other elements, such as the middle‐heavy rare‐earth elements. These traits are attributed to generation of boninites largely by flux melting involving water‐rich melts first derived from the leading edge of subducted basaltic crust and then from both subducted crust and sediment. These melts were generated at low pressures as the shallow, embryonic slab extracted heat from hot asthenosphere near the trench. The progressive depletion of the mantle source for the FAB‐through‐boninite sequence suggests that the asthenospheric mantle remained trapped above the nascent subducting plate for the first several million years of subduction beneath the Philippine Sea Plate.
Plain Language Summary
The origin of crust created along the leading edge of the Philippine Sea Plate after the Pacific Plate began subducting beneath it about 52 million years ago was investigated by analyzing volcanic glasses recovered by drilling the Bonin forearc during International Ocean Discovery Program Expedition 352. The glasses have not been affected by alteration and thus preserve pristine compositions of the erupted lavas. Two deep water drill sites (U1440 and U1441) recovered basalts and rare andesites produced by crystal removal and crust assimilation. The compositions of the basalt glasses suggest that they were produced by depressurization of hot mantle during near‐trench seafloor spreading in the presence of minor amounts of water‐rich fluid from the newly subducting plate. Younger, more silica‐rich lavas termed “boninites” were recovered from two sites drilled in shallower water (U1439 and U1442). Boninite glass compositions demonstrate that these boninites were generated when shallow hot mantle was invaded by water‐rich melts derived first from the subducting basaltic crust and then this crust plus sediment.
Key Points
Forearc basalts formed in response to subduction initiation by melting of depleted mantle after minor inputs of variably saline fluids
Boninites were generated by melting residual mantle after fluxing by water rich melts from altered oceanic crust then crust and sediment
The subducting plate melted at exceedingly shallow depths beneath oceanic crust being generated by seafloor spreading
Adding mepolizumab to standard treatment with inhaled corticosteroids and controller medications could decrease asthma exacerbations and use of long-term oral steroids in patients with severe disease ...and increased eosinophils; however, mepolizumab is costly and its cost effectiveness is unknown.
To estimate the cost effectiveness of mepolizumab.
A Markov model was used to determine the incremental cost per quality-adjusted life year (QALY) gained for mepolizumab plus standard of care (SoC) and for SoC alone. The population, adults with severe eosinophilic asthma, was modeled for a lifetime time horizon. A responder scenario analysis was conducted to determine the cost effectiveness for a cohort able to achieve and maintain asthma control.
Over a lifetime treatment horizon, 23.96 exacerbations were averted per patient receiving mepolizumab plus SoC. Avoidance of exacerbations and decrease in long-term oral steroid use resulted in more than $18,000 in cost offsets among those receiving mepolizumab, but treatment costs increased by more than $600,000. Treatment with mepolizumab plus SoC vs SoC alone resulted in a cost-effectiveness estimate of $386,000 per QALY. To achieve cost effectiveness of approximately $150,000 per QALY, mepolizumab would require a more than 60% price discount. At current pricing, treating a responder cohort yielded cost-effectiveness estimates near $160,000 per QALY.
The estimated cost effectiveness of mepolizumab exceeds value thresholds. Achieving these thresholds would require significant discounts from the current list price. Alternatively, treatment limited to responders improves the cost effectiveness toward, but remains still slightly above, these thresholds. Payers interested in improving the efficiency of health care resources should consider negotiations of the mepolizumab price and ways to predict and assess the response to mepolizumab.
We probe the dynamics of dissociating CS_{2} molecules across the entire reaction pathway upon excitation. Photoelectron spectroscopy measurements using laboratory-generated femtosecond extreme ...ultraviolet pulses monitor the competing dissociation, internal conversion, and intersystem crossing dynamics. Dissociation occurs either in the initially excited singlet manifold or, via intersystem crossing, in the triplet manifold. Both product channels are monitored and show that, despite being more rapid, the singlet dissociation is the minor product and that triplet state products dominate the final yield. We explain this by a consideration of accurate potential energy curves for both the singlet and triplet states. We propose that rapid internal conversion stabilizes the singlet population dynamically, allowing for singlet-triplet relaxation via intersystem crossing and the efficient formation of spin-forbidden dissociation products on longer timescales. The study demonstrates the importance of measuring the full reaction pathway for defining accurate reaction mechanisms.
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