Nevin Manimala

Health Aff (Millwood). 2023 Nov;42(11):1507-1516. doi: 10.1377/hlthaff.2023.00478.

ABSTRACT

Since 1965, the US federal government has incentivized physicians to practice in high-need areas of the country through the designation of Health Professional Shortage Areas (HPSAs). Despite its being in place for more than half a century and directing more than a billion dollars annually, there is limited evidence of the HPSA program’s effectiveness at reducing geographic disparities in access to care and health outcomes. Using a generalized difference-in-differences design with matching, we found no statistically significant changes in mortality or physician density from 1970 to 2018 after a county-level HPSA designation. As a result, we found that 73 percent of counties designated as HPSAs remained physician shortage areas for at least ten years after their inclusion in the program. Fundamental improvements to the program’s design and incentive structure may be necessary for it to achieve its intended results.

PMID:37931191 | DOI:10.1377/hlthaff.2023.00478

Health Aff (Millwood). 2023 Nov;42(11):1551-1558. doi: 10.1377/hlthaff.2023.00399.

ABSTRACT

Using data from the Centers for Disease Control and Prevention’s Web-based Injury Statistics Query and Reporting System, we analyzed trends in firearm suicide across the life course, comparing age-related trends over time (2015-20 versus 1999-2014) and stratified by differences in state firearm policy environments. Overall, we found stable trends in firearm suicide rates across the life course, although with higher overall rates across all age groups in 2015-20 versus in 1999-2014. Ages 14-16 was the only age group with an accelerating life-course trend in firearm suicide rates in 2015-20 versus in 1999-2014. The state policy environment was associated with significant differences in firearm suicide, with an average of 4.62 more deaths per 100,000 people per year in states with less- versus more-strict environments. This was in contrast to nonfirearm suicides, for which we observed no consistent differences between states. The largest overall differences in firearm suicide between states occurred in adulthood through middle age. These findings can inform further research on health care-based approaches to reducing firearm suicide, such as health care screening for firearm ownership, screening for suicide risk among firearm owners, and motivational interviewing to promote safe firearm storage.

PMID:37931189 | DOI:10.1377/hlthaff.2023.00399

Annu Rev Public Health. 2023 Nov 6. doi: 10.1146/annurev-statistics-040522-093748. Online ahead of print.

ABSTRACT

This review is devoted to recent developments in the statistical analysis of spherical data, strongly motivated by applications in cosmology. We start from a brief discussion of cosmological questions and motivations, arguing that most cosmological observables are spherical random fields. Then, we introduce some mathematical background on spherical random fields, including spectral representations and the construction of needlet and wavelet frames. We then focus on some specific issues, including tools and algorithms for map reconstruction (i.e., separating the different physical components that contribute to the observed field), geometric tools for testing the assumptions of Gaussianity and isotropy, and multiple testing methods to detect contamination in the field due to point sources. Although these tools are introduced in the cosmological context, they can be applied to other situations dealing with spherical data. Finally, we discuss more recent and challenging issues, such as the analysis of polarization data, which can be viewed as realizations of random fields taking values in spin fiber bundles. Expected final online publication date for the Annual Review of Statistics and Its Application, Volume 11 is March 2024. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

PMID:37931184 | DOI:10.1146/annurev-statistics-040522-093748

Annu Rev Public Health. 2023 Nov 6. doi: 10.1146/annurev-publhealth-060222-014438. Online ahead of print.

ABSTRACT

The promise of adaptation and adaptive designs in implementation science has been hindered by the lack of clarity and precision in defining what it means to adapt, especially regarding the distinction between adaptive study designs and adaptive implementation strategies. To ensure a common language for science and practice, authors reviewed the implementation science literature and found that the term adaptive was used to describe interventions, implementation strategies, and trial designs. To provide clarity and offer recommendations for reporting and strengthening study design, we propose a taxonomy that describes fixed versus adaptive implementation strategies and implementation trial designs. To improve impact, (a) future implementation studies should prespecify implementation strategy core functions that in turn can be taught to and replicated by health system/community partners, (b) funders should support exploratory studies that refine and specify implementation strategies, and (c) investigators should systematically address design requirements and ethical considerations (e.g., randomization, blinding/masking) with health system/community partners. Expected final online publication date for the Annual Review of Public Health, Volume 45 is April 2024. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

PMID:37931183 | DOI:10.1146/annurev-publhealth-060222-014438

Int J Pharm Pract. 2023 Nov 1:riad060. doi: 10.1093/ijpp/riad060. Online ahead of print.

ABSTRACT

OBJECTIVES: A National Recruitment Scheme (NRS) for Pharmacy trainees was introduced in England and Wales in 2017, standardising recruitment processes on behalf of employers and with the aim of reducing bias for candidates applying to training posts within the National Health Service (NHS). This research attempted to identify whether the introduction of the NRS had an impact on the recruitment of Black, Asian, or other Minority Ethnic applicants into the most sought-after posts within the Scheme (hospital posts).

METHODS: An observational study was undertaken. Anonymised pharmacist trainee recruitment data between the cohort intakes of 2015-16 and 2020-21 was obtained from the pharmacy regulator the General Pharmaceutical Council and a comparison of proportional representations of ethnicities was undertaken, to ascertain whether a greater proportion of applicants from minority backgrounds attained the most sought-after posts in the NHS after the NRS was introduced. A robust generalised linear model was then used to analyse the data using binomial as the variance function and logit as a link function, where the proportion of hospital recruitment was an outcome with a two-way interaction between intervention and ethnicity after adjusting for overall proportion.

KEY FINDINGS: The statistical analysis of 18 283 pharmacy trainees in total, of whom 4446 were in hospital, shows a significant overall impact of intervention, with a significant positive change in the proportions of Asian-Pakistani applicants (P-value < 0.001) and Black-African applicants (P-value < 0.001) recruited to hospital posts.

CONCLUSIONS: Since the introduction of the NRS there has been a statistically significant impact on the correlation between the overall number of Black, Asian or other Minority Ethnic applicants and their proportion in hospital. That is, not only is the makeup of the hospital cohort increasingly reflecting the diversity of the overall cohort, but also a larger percentage of each ethnic cohort is attaining hospital training places.

PMID:37931152 | DOI:10.1093/ijpp/riad060

Proc Natl Acad Sci U S A. 2023 Nov 14;120(46):e2300327120. doi: 10.1073/pnas.2300327120. Epub 2023 Nov 6.

ABSTRACT

The past several years have witnessed increased calls for community violence interventions (CVIs) that address firearm violence while centering local expertise and avoiding the criminal legal system. Currently, little evidence exists on CVI effectiveness at the individual level. This study presents an evaluation of the impact of a street outreach-based CVI [Chicago CRED (Create Real Economic Destiny)] on participant involvement in violence. We used a quasiexperimental design with a treatment sample of 324 men recruited by outreach staff from 2016 to 2021 and a balanced comparison sample of 2,500 men from a network of individuals arrested in CRED’s service areas. We conducted a Bayesian survival analysis to evaluate CRED’s effect on individual violence-related outcomes on three levels of treatment: All enrolled participants, a subsample that made it through the initial phase, and those who completed programming. The intervention had a strong favorable effect on the probability of arrest for a violent crime for those completing the program: After 24 mo, CRED alumni experienced an 11.3 percentage point increase in survival rates of arrest for a violent crime relative to their comparisons (or, stated differently, a 73.4% reduction in violent crime arrests). The other two treatment levels experienced nontrivial declines in arrests but did not reach statistical significance. No statistically significant reduction in victimization risk was detected for any of the treatment levels. Results demonstrate that completion of violence intervention programming reduces the likelihood of criminal legal involvement for participants, despite the numerous systemic and environmental factors that impede personal success.

PMID:37931107 | DOI:10.1073/pnas.2300327120

Proc Natl Acad Sci U S A. 2023 Nov 14;120(46):e2314092120. doi: 10.1073/pnas.2314092120. Epub 2023 Nov 6.

ABSTRACT

Recently, graph neural network (GNN)-based algorithms were proposed to solve a variety of combinatorial optimization problems [M. J. Schuetz, J. K. Brubaker, H. G. Katzgraber, Nat. Mach. Intell.4, 367-377 (2022)]. GNN was tested in particular on randomly generated instances of these problems. The publication [M. J. Schuetz, J. K. Brubaker, H. G. Katzgraber, Nat. Mach. Intell.4, 367-377 (2022)] stirred a debate whether the GNN-based method was adequately benchmarked against best prior methods. In particular, critical commentaries [M. C. Angelini, F. Ricci-Tersenghi, Nat. Mach. Intell.5, 29-31 (2023)] and [S. Boettcher, Nat. Mach. Intell.5, 24-25 (2023)] point out that a simple greedy algorithm performs better than the GNN. We do not intend to discuss the merits of arguments and counterarguments in these papers. Rather, in this note, we establish a fundamental limitation for running GNN on random instances considered in these references, for a broad range of choices of GNN architecture. Specifically, these barriers hold when the depth of GNN does not scale with graph size (we note that depth 2 was used in experiments in [M. J. Schuetz, J. K. Brubaker, H. G. Katzgraber, Nat. Mach. Intell.4, 367-377 (2022)]), and importantly, these barriers hold regardless of any other parameters of GNN architecture. These limitations arise from the presence of the overlap gap property (OGP) phase transition, which is a barrier for many algorithms, including importantly local algorithms, of which GNN is an example. At the same time, some algorithms known prior to the introduction of GNN provide best results for these problems up to the OGP phase transition. This leaves very little space for GNN to outperform the known algorithms, and based on this, we side with the conclusions made in [M. C. Angelini, F. Ricci-Tersenghi, Nat. Mach. Intell.5, 29-31 (2023)] and [S. Boettcher, Nat. Mach. Intell.5, 24-25 (2023)].

PMID:37931095 | DOI:10.1073/pnas.2314092120

Am J Speech Lang Pathol. 2023 Nov 6:1-11. doi: 10.1044/2023_AJSLP-23-00159. Online ahead of print.

ABSTRACT

OBJECTIVES: The aims of this study were to determine relationships between vocal effort and (a) acoustic correlates of vocal output and (b) supraglottic compression in individuals with primary muscle tension dysphonia (pMTD) and without voice disorders (controls) in the context of a vocal load challenge.

METHOD: Twenty-six individuals with pMTD and 35 vocally healthy controls participated in a 30-min vocal load challenge. The pre- and postload relationships among self-ratings of vocal effort, various acoustic voice measures, and supraglottic compression (mediolateral and anteroposterior) were tested with multiple regression models and post hoc Pearson’s correlations. Acoustic measures included cepstral peak prominence (CPP), low-to-high spectral ratio, difference in intensity between the first two harmonics, fundamental frequency, and sound pressure level (dB SPL).

RESULTS: Regression models for CPP and mediolateral compression were statistically significant. Vocal effort, diagnosis of pMTD, and vocal demand were each significant variables influencing CPP measures. CPP was lower in the pMTD group across stages. There was no statistical change in CPP following the vocal load challenge within either group, but both groups had an increase in vocal effort postload. Vocal effort and diagnosis influenced the mediolateral compression model. Mediolateral compression was higher in the pMTD group across stages and had a negative relationship with vocal effort, but it did not differ after vocal loading.

CONCLUSIONS: CPP and mediolateral supraglottic compression were influenced by vocal effort and diagnosis of pMTD. Increased vocal effort was associated with lower CPP, particularly after vocal load, and decreased mediolateral supraglottic compression in the pMTD group.

PMID:37931092 | DOI:10.1044/2023_AJSLP-23-00159

Am J Audiol. 2023 Nov 6:1-14. doi: 10.1044/2023_AJA-23-00169. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to determine the effectiveness of television (TV) streaming on hearing aid user performance and satisfaction in quiet and in noise.

METHOD: Twenty experienced hearing aid users were evaluated in quiet and in noise (5 dB SNR) under three hearing aid conditions: hearing aids, streaming with hearing aid microphones attenuated by 6 dB, and streaming with hearing aid microphones muted. The audiovisual Connected Speech Test served as the signal, and the ipsilateral competing message from the Synthetic Sentence Identification-Ipsilateral Competing Message (SSI-ICM) served as the noise. Measures of speech understanding, satisfaction with sound quality and clarity, and preference were obtained.

RESULTS: Speech understanding was significantly better in quiet than in noise, and streaming improved performance in noise when the hearing aid microphones were muted. Sound quality satisfaction was significantly better in quiet than in noise but was not impacted significantly by the hearing aid settings. Speech clarity satisfaction was significantly better in quiet than in noise, and streaming improved satisfaction in noise when the hearing aid microphones were muted. More participants preferred streaming with the microphones muted in quiet, in noise, and overall; however, results did not reach statistical significance.

CONCLUSIONS: Hearing aid users did not benefit from TV streaming with the microphones attenuated or muted when listening in quiet. TV streaming was more beneficial to hearing aid users when listening in noise with the microphones muted. Hearing aid users should be counseled on the impact of the hearing aid microphone settings when using a TV streamer, particularly in noise.

PMID:37931091 | DOI:10.1044/2023_AJA-23-00169

J Neurosci Nurs. 2023 Dec 1;55(6):228-234. doi: 10.1097/JNN.0000000000000730.

ABSTRACT

PURPOSE: This study evaluates the impact of pain belief on postoperative pain and analgesic consumption in patients undergoing spine surgery. METHODS: This descriptive and cross-sectional study was conducted on 71 patients undergoing spine surgery, who were admitted to the neurosurgery department of a university hospital between January 2021 and April 2022. Descriptive information form, Pain Beliefs Questionnaire, visual analog scale, pain evaluation form, and verbal category scale were used for data collection. RESULTS: Participant mean age was 53 years, and 40.8% underwent spinal disc surgery. A total of 60.2% of the participants experienced moderate postoperative pain, and severe pain was noted during the second postoperative hour, after rest and coughing, which decreased significantly during consecutive hours. Besides, 70.4% of the participants expressed that the level of pain decreased, 43.7% had pain as they expected, 69.0% had intermittent pain, and 53.5% experienced pain at the surgical site. The mean scores obtained from the Organic and Psychological Beliefs subscales of the Pain Beliefs Questionnaire were 4.25 and 4.21, respectively. There was a statistically significant relationship between the Psychological Beliefs and visual analog scale scores after coughing measured in the postoperative 24th and 36th hours. There was also a significant relationship between organic beliefs and working status. There was no statistically significant relationship between analgesic consumption and pain belief. CONCLUSION: Patients undergoing spine surgery experienced moderate pain and had a relatively high level of pain beliefs. Regular evaluation of pain levels and beliefs is required for effective pain management.

PMID:37931086 | DOI:10.1097/JNN.0000000000000730