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A 2005–2015 analysis of the accuracy of valuations of 293 common surgical procedures showed substantial absolute discrepancies in operative times estimated by the Relative Value Scale Update Committee (RUC) and times recorded in a surgical registry, but the RUC did not systematically over- or underestimate times.

OBJECTIVES/GOALS: Our research has three main aims: 1. Measure attitudes toward a SARS-CoV-2 vaccine among BIPOC. 2. Assess the effectiveness of race-conscious public health messages in changing attitudes toward a SARS-CoV-2 vaccine. 3. Test the efficacy of financial incentives to increase uptake of a SARS-CoV-2 vaccine. METHODS/STUDY POPULATION: We surveyed 784 unvaccinated residents of L.A. County. To recruit participants, we collaborated with Qualtrics. The survey randomized participants to one of three public health messages, as well as one of two financial compensation schemes. Twenty-five participants completed semi-structured interviews via Zoom or telephone. Interviews were audio recorded, translated into English if needed, and transcribed. The inductive, semi-structured interview guide focused on three domains: i) concerns and distrust toward a COVID vaccine, ii) policy interventions and/or government action related to a COVID vaccine, iii) non-pharmacological policy interventions related to the COVID-19 pandemic. Major emergent themes were identified and analyzed using Watkins (2012) team analysis of qualitative data steps. RESULTS/ANTICIPATED RESULTS: Many BIPOC remain vaccine hesitant: 2/3 of the survey respondents stated that they did not intend to or were not sure if they planned to get vaccinated. Follow-up interviews show that fear of vaccine side effects, bodily autonomy in choosing to get vaccinated are major concerns. However, public health measures like masking and physical distancing remain preferred safety methods for BIPOC residents. Misinformation and overcommunication in public health messaging concerning vaccine eligibility may be a major barrier to vaccine uptake among BIPOC. DISCUSSION/SIGNIFICANCE: Real world financial compensation mechanisms need to provide large enough compensation to avoid a crowding out of altruistic vaccination motivations and to effectively incentivize increased vaccine uptake. Additionally, short race-conscious public health messages were ineffective at improving vaccine attitudes.

Introduction Previous research has found that the percentage of US adults with diabetes achieving a glycated hemoglobin (HbA1c) target of <7.0% with currently available treatments has been fairly constant from 2003 to 2010, remaining at just over 50% [ 1 ]. The objective of this study was to compare the most recent data (2011–2014) with earlier data to track progress on HbA1c target achievement, for both the general target of <7.0% and inferred individualized targets based on age and the presence of complications. Methods Data from 2677 adults with self-reported diabetes from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2014 were examined to determine the percentage of adults who achieved HbA1c targets of <7% and an individualized target based on age and comorbidities. National estimates are reported by using weights that account for the complex sampling design of the NHANES. Results The percentage of people with diabetes and HbA1c <7.0% slightly declined from 52.2% (95% CI 48.7–55.7%) to 50.9% (95% CI 47.2–54.7%) between the two most recent waves of data. Achievement of individualized targets declined from 69.8% (95% CI 66.5–73.0%) to 63.8% (95% CI 60.1–67.5%). The percentage with HbA1c >9.0% increased from 12.6% (95% CI 10.5–14.8%) to 15.5% (95% CI 12.9–18.2%). Achievement of individualized targets varied by age group and presence of comorbidities, but exhibited similar trends as general target achievement. Conclusions Despite the development of many new medications to treat diabetes during the past decade, the proportion of patients achieving glycemic control targets has not improved. Funding Intarcia Therapeutics.

This dissertation studies the effectiveness of public policies aimed at improving population health and narrowing health disparities. It is divided into three chapters. Chapter one provides new evidence on the health effects of cash transfers for people with disabilities. The chapter evaluates the U.S. Department of Veterans Affairs’ Disability Compensation program, one of the nation’s largest cash transfer programs. To accomplish this, a large administrative dataset is compiled by combining disability claims, medical records, and death records for over 800,000 veterans. The empirical strategy leverages the quasi-random assignment of disability claims to examining caseworkers and physicians, comparing veterans whose disability claims were assigned to examiners with varying levels of leniency. The results indicate that receiving $300 per month lowers five-year mortality by 0.8 percentage points, or 9.5% of the mean rate.The second chapter analyzes the prescribing behavior of nurse practitioners (NPs) and primary care physicians in states that allow NPs to prescribe medications independently. Inappropriate prescriptions are defined as drugs that are generally considered inappropriate for adults aged 65 years or older, according to the American Geriatrics Society’s Beers Criteria. The mean rates of inappropriate prescribing by NPs and primary care physicians are nearly the same. However, NPs are overrepresented among clinicians with the highest and lowest rates of inappropriate prescribing.The third chapter examines the adverse motivational effects of monetary incentives for vaccines. A survey experiment was conducted among 513 vaccine-hesitant adults between May and September 2021, priming half with the idea of monetary incentives for the COVID-19 vaccine. The findings show that monetary incentives discourage 14% of participants from getting vaccinated, a significant reduction since only one in four considered getting vaccinated at the outset. Participants in the primed group are more likely to believe that vaccines are unsafe and more likely to believe that people do not have a responsibility to get vaccinated, compared to participants in the control group.

To the Editor: Chan et al. (April 18 issue) 1 found discrepancies between survey-derived procedure times used by the Relative Value Scale Update Committee (RUC) of the American Medical Association and benchmark times in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) data set. A major confounder, however, was not explored: secondary procedures. Whereas the RUC’s estimates of procedure times are based on single procedures, NSQIP times often reflect multiple procedures performed during an operation. 2,3 Fair comparisons must consider these differences. We received permission from the NSQIP to analyze the effect of secondary procedures on procedure times, using . . .

Introduction: Several studies in radiology and medicine have evaluated the satisfaction of search error effect in chest radiography, abdominal radiography, osteoradiology, and patients with multiple trauma. No research to date exists evaluating the possible existence of the satisfaction of search error phenomenon during dental periapical radiograph interpretations.Purpose: The purpose of this study was to determine if there exists a satisfaction of search error effect when dental clinicians interpret periapical radiographs. The null hypothesis is that the detection accuracy will be the same or will improve for the detection of native lesions in the presence of an added abnormality. The alternative hypothesis is that there will be a decrease in detection accuracy for native lesions in the presence of an added abnormality.Materials and Methods: Six images were selected to be part of the present experiment. One of the six images served as the positive control and another image served as the negative control. Four images, each including a single subtle carious lesion, were selected to represent the experimental images. The single subtle carious lesion present within the four experimental radiographs served as the native pathology, and an abnormality such as a periapical radiolucency, resorption, inadequate non-ideal root canal obturation material, or recurrent carious lesion was artificially inserted into the image as the added pathology. Thus, the second set of images consisted of the same four images containing the native pathology including an added pathology that was inserted into the image using Adobe Photoshop CS6 (Adobe, Inc., San Jose, CA).Purposive sampling was obtained from 16 examiners that included residents from endodontics and periodontics, as well as alumni and faculty from the Saint Louis University Center for Advanced Dental Education. Each observer participated as a subject during two, time-separated sessions. Each session was separated by a minimum period of three months duration, in order to prevent memory bias. Before starting each interpretation session, the participants were given verbal instructions. Subjects were instructed to provide a location (by tooth number), identify and rate the presence of all suspected pathology using a Likert scale of 1-5: (1: Definitely normal, 2: Probably normal, 3: Possibly abnormal, 4: Probably abnormal, 5: Definitely abnormal). In the second session, the radiographs that were initially presented containing only the native lesion were presented again with the added abnormality, and vice versa. The observer’s reports and confidence ratings were recorded and analyzed. Ratings of 3-5 were considered as being positive for the presence of pathology.Results: A true satisfaction of search (SOS) error occurs when the presence of the native lesion is reported correctly without an added abnormality, but is not reported (missed) in the presence of an added abnormality. In our study, a true SOS error occurred in 13 of the 64 interpretation sets (20.31%). There was a total of 64 expected native lesions present within the 4 native images viewed by 16 observers. In the 4 four added images, there was a total of 64 expected added findings. In the images with containing only native lesions, the observers reported 30 of the 64 expected native lesions. In the images containing an artificially added abnormality, the observers reported 58 of the 64 expected added abnormalities and 25 of the 64 expected native lesions. Observers reported fewer native lesions in the presence of an added abnormality.Conclusion: The current investigation demonstrated the existence of the satisfaction of search effect during periapical radiographic interpretations. In 20.31% of interpretations, a true SOS error occurred. This study is clinically relevant because it can help clinicians in reducing false-negative errors made during radiographic interpretation, thus preventing misdiagnosis.

Although runoff from trafficked urban areas is recognized as a potentially significant pathway of micropollutants, runoff pollution remains poorly documented, except for relatively few historical pollutants such as some metals and hydrocarbons. Therefore, in this work, road and parking lot runoff from four sites with contrasting traffic levels were analyzed for a very broad spectrum of molecules and elements. A total of 128 pollutants and micropollutants were monitored, including inorganic (n = 41) and organic (n = 87) pollutants. Both the dissolved and particulate phases were considered. For a reduced number of samples, non-targeted screening by high-resolution mass spectrometry (HRMS) was carried out. For targeted screening, the contamination profiles were quite homogeneous, but the concentrations significantly differed between the different sites. Sites with the highest traffic density exhibited the highest concentrations for polycyclic aromatic hydrocarbons (PAHs), some traffic-related metals, alkylphenols and phthalates. Overall, for most micropollutants, the parking lot runoff exhibited the lowest concentrations, and the specificity of this site was confirmed by its HRMS fingerprint. Non-target screening allowed the sites to be discriminated based on the occurrence of specific compounds. Unlike the results of targeted screening, the HRMS intra-site variability was lower than its inter-site variability. Unknown substances were tentatively identified, either characteristic of each site or ubiquitous of all samples.

Background Heterogeneous respiratory system static compliance ( C RS ) values and levels of hypoxemia in patients with novel coronavirus disease (COVID-19) requiring mechanical ventilation have been reported in previous small-case series or studies conducted at a national level. Methods We designed a retrospective observational cohort study with rapid data gathering from the international COVID-19 Critical Care Consortium study to comprehensively describe C RS —calculated as: tidal volume/[airway plateau pressure-positive end-expiratory pressure (PEEP)]—and its association with ventilatory management and outcomes of COVID-19 patients on mechanical ventilation (MV), admitted to intensive care units (ICU) worldwide. Results We studied 745 patients from 22 countries, who required admission to the ICU and MV from January 14 to December 31, 2020, and presented at least one value of C RS within the first seven days of MV. Median (IQR) age was 62 (52–71), patients were predominantly males (68%) and from Europe/North and South America (88%). C RS , within 48 h from endotracheal intubation, was available in 649 patients and was neither associated with the duration from onset of symptoms to commencement of MV ( p  = 0.417) nor with PaO 2 /FiO 2 ( p  = 0.100). Females presented lower C RS than males (95% CI of C RS difference between females-males: − 11.8 to − 7.4 mL/cmH 2 O p  < 0.001), and although females presented higher body mass index (BMI), association of BMI with C RS was marginal ( p  = 0.139). Ventilatory management varied across C RS range, resulting in a significant association between C RS and driving pressure (estimated decrease − 0.31 cmH 2 O/L per mL/cmH 2 0 of C RS , 95% CI − 0.48 to − 0.14, p  < 0.001). Overall, 28-day ICU mortality, accounting for the competing risk of being discharged within the period, was 35.6% (SE 1.7). Cox proportional hazard analysis demonstrated that C RS (+ 10 mL/cm H 2 O) was only associated with being discharge from the ICU within 28 days (HR 1.14, 95% CI 1.02–1.28, p  = 0.018). Conclusions This multicentre report provides a comprehensive account of C RS in COVID-19 patients on MV. C RS measured within 48 h from commencement of MV has marginal predictive value for 28-day mortality, but was associated with being discharged from ICU within the same period. Trial documentation: Available at https://www.covid-critical.com/study . Trial registration : ACTRN12620000421932.

In the original publication [...]