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Few surveys have focused on physician moral distress, burnout, and professional fulfilment. We assessed physician wellness and coping during the COVID-19 pandemic.Cross-sectional survey using four validated instruments.Sixty-two sites in Canada and the United States.Attending physicians (adult, pediatric; intensivist, nonintensivist) who worked in North American ICUs.None.We analysed 431 questionnaires (43.3% response rate) from 25 states and eight provinces. Respondents were predominantly male (229 [55.6%]) and in practice for 11.8 ± 9.8 years. Compared with prepandemic, respondents reported significant intrapandemic increases in days worked/mo, ICU bed occupancy, and self-reported moral distress (240 [56.9%]) and burnout (259 [63.8%]). Of the 10 top-ranked items that incited moral distress, most pertained to regulatory/organizational ( n = 6) or local/institutional ( n = 2) issues or both ( n = 2). Average moral distress (95.6 ± 66.9), professional fulfilment (6.5 ± 2.1), and burnout scores (3.6 ± 2.0) were moderate with 227 physicians (54.6%) meeting burnout criteria. A significant dose-response existed between COVID-19 patient volume and moral distress scores. Physicians who worked more days/mo and more scheduled in-house nightshifts, especially combined with more unscheduled in-house nightshifts, experienced significantly more moral distress. One in five physicians used at least one maladaptive coping strategy. We identified four coping profiles (active/social, avoidant, mixed/ambivalent, infrequent) that were associated with significant differences across all wellness measures.Despite moderate intrapandemic moral distress and burnout, physicians experienced moderate professional fulfilment. However, one in five physicians used at least one maladaptive coping strategy. We highlight potentially modifiable factors at individual, institutional, and regulatory levels to enhance physician wellness.

Background: Fluid and vasopressor management in septic shock remains controversial. In this randomized controlled trial, we evaluated the efficacy of dynamic measures (stroke volume change during passive leg raise) to guide resuscitation and improve patient outcome. Research Question: Will resuscitation guided by dynamic assessments of fluid responsiveness in patients with septic shock improve patient outcomes? Study Design and Methods: Prospective, multicenter, randomized clinical trial at 13 hospitals in the United States and United Kingdom. Patients presented to Emergency Rooms with sepsis associated hypotension and anticipated Intensive Care Unit (ICU) admission. Intervention arm patients were assessed for fluid responsiveness before clinically driven fluid bolus or increase in vasopressors. The protocol included reassessment and therapy as indicated by the PLR result. The control arm received Usual Care. Primary clinical outcome was positive fluid balance at 72 hours or ICU discharge, whichever occurred first. Results: In modified-ITT (mITT) analysis including 83 Intervention and 41 Usual Care eligible patients, fluid balance at 72 hours or ICU discharge was significantly lower (-1.37L favoring Intervention arm, 0.65 ± 2.85L Intervention arm vs. 2.02 ± 3.44L Usual Care arm, p=0.021. Fewer patients required renal replacement therapy (5.1% vs 17.5%, p=0.04) or mechanical ventilation (17.7% vs 34.1%, p=0.04) in the Intervention arm compared to Usual Care. In the allrandomized Intent to Treat (ITT) population (102 Intervention, 48 Usual Care) there were no significant differences in safety signals. Interpretation: Physiologically informed fluid and vasopressor resuscitation using passive leg raise-induced stroke volume change to guide management of septic shock is safe and demonstrated lower net fluid balance and reductions in the risk of renal and respiratory failure. Dynamic assessments to guide fluid administration may improve outcomes for septic shock patients compared with Usual Care. Trial Registration clinicaltrials.gov identifier: NCT02837731

We use data from an Internet-based survey and estimate the benefits of an oyster consumption safety policy with the contingent valuation method. In addition to providing a context-specific estimate of willingness-to-pay for oyster safety, we consider an important issue in the contingent valuation mortality risk reduction literature. A number of studies find that willingness-to-pay for mortality risk reduction is not sensitive to the scope of the risk change. We present the scope test as a difference in the number of lives saved by the program, instead of small changes in risk, and find that referendum votes are responsive to scope. A third feature of this article is that we identify those at-risk respondents who would most benefit from the policy and decompose willingness-to-pay into use values and altruistic nonuse values. We find that willingness-to-pay per life saved ranges from $3.95 million to $7.69 million for the private good of lives saved when the respondent is at risk (i.e., use values). Willingness-to-pay per life saved including both use and altruistic nonuse values ranges from $6.89 million to $12.87 million.

The gut microbiome regulates a number of homeostatic mechanisms in the healthy host including immune function and gut barrier protection. Loss of normal gut microbial structure and function has been associated with diseases as diverse as Clostridioides difficile infection, asthma, and epilepsy. Recent evidence has also demonstrated a link between the gut microbiome and sepsis. In this review, we focus on three key areas of the interaction between the gut microbiome and sepsis. First, prior to sepsis onset, gut microbiome alteration increases sepsis susceptibility through several mechanisms, including (a) allowing for expansion of pathogenic intestinal bacteria, (b) priming the immune system for a robust pro-inflammatory response, and (c) decreasing production of beneficial microbial products such as short-chain fatty acids. Second, once sepsis is established, gut microbiome disruption worsens and increases susceptibility to end-organ dysfunction. Third, there is limited evidence that microbiome-based therapeutics, including probiotics and selective digestive decontamination, may decrease sepsis risk and improve sepsis outcomes in select patient populations, but concerns about safety have limited uptake. Case reports of a different microbiome-based therapy, fecal microbiota transplantation, have shown correlation with gut microbial structure restoration and decreased inflammatory response, but these results require further validation. While much of the evidence linking the gut microbiome and sepsis has been established in pre-clinical studies, clinical evidence is lacking in many areas. To address this, we outline a potential research agenda for further investigating the interaction between the gut microbiome and sepsis.

Customized unicompartmental knee arthroplasty (C-UKA) utilizes implants manufactured on an individual patient basis, derived from pre-operative computed tomography images in an effort to more closely approximate the natural anatomy of the knee. The outcomes from 349 medial and lateral fixed-bearing C-UKA were reviewed. Implant survivorship analysis was conducted via retrospective chart review, and follow-up analysis was conducted via a single postoperative phone call or email. The rate of follow-up was 69% (242 knees). The average age at surgery was 71.1 years and the average body mass index was 28.8 kg/m2. Seven revision arthroplasties (2.1%) had knowingly been performed at an average of 1.9 years postoperatively (range: 0.1–3.9 years), resulting in an implant survivorship of 97.9% at an average follow-up of 4.2 years (range: 0.1–8.7) and 97.9% at an average of 4.8 years (range: 2.0–8.7) when knees with less than two years of follow-up were excluded. The reasons for revision were implant loosening (one knee), infection (two knees), progression of osteoarthritis (two knees), and unknown reasons (two knees). The average KOOS, JR. interval score was 84 (SD: 14.4). Of those able to be contacted for follow-up analysis, 67% were “very satisfied,” 26% were “satisfied,” 4% were “neutral,” 2% were “dissatisfied,” and 1% were “very dissatisfied.” When asked if the knee felt “natural,” 60% responded with “always,” 35% responded with “sometimes,” and 5% responded with “never.” After analyzing a large cohort of C-UKA, we found favorable rates of survivorship, satisfaction, and patient-reported functional outcomes.

Diet influences, and is influenced by, a wide range of socioeconomic, cultural, geographic, and genetic variables. Here we survey a matrix of such interactions as well as their connection to a variety of health outcomes, in a cohort of 689 diverse adults employed at Emory University and enrolled in the Center for Health Discovery and Well-Being (CHDWB) study. Principal component analysis (PCA) of the Block Food Frequency Questionnaire revealed seven PC cumulatively explaining 25.8% and each individually at least 2% of the proportional consumption of 110 food items. PC1 is strongly correlated with the Healthy Eating Index-2015 measure, and accordingly healthier scores associate with multiple measures of physical and mental health. It, as well as PC2 (likely a measure of food expense) and PC3 (carbohydrate versus protein consumption) show significant geographic structure across the Atlanta metropolitan area, correlating with race and ethnicity, income level, age and sex. Notably, a polygenic score for body mass index (BMI) consisting of 281 SNPs explains 2.8% of the variance in PC5, which is as strong as its association with BMI itself. PC5 appears to differentiate participants with respect to conscious eating behavior related to the choice of diet or comfort foods. Our analysis adds to the growing literature on factor analysis of socio-demographic influences on nutrition and health.

SummaryWe report preliminary data from a cohort of adults admitted to COVID-designated intensive care units from March 6 through April 17, 2020 across an academic healthcare system. Among 217 critically ill patients, mortality for those who required mechanical ventilation was 29.7% (49/165), with 8.5% (14/165) of patients still on the ventilator at the time of this report. Overall mortality to date in this critically ill cohort is 25.8% (56/217), and 40.1% (87/217) patients have survived to hospital discharge. Despite multiple reports of mortality rates exceeding 50% among critically ill adults with COVID-19, particularly among those requiring mechanical ventilation, our early experience indicates that many patients survive their critical illness.

Trial registrationClinicalTrials.gov: NCT03509350. Registered on 26 April 2018.

Fluid and vasopressor management in septic shock remains controversial. In this randomized controlled trial, we evaluated the efficacy of dynamic measures (stroke volume change during passive leg raise) to guide resuscitation and improve patient outcome.Will resuscitation that is guided by dynamic assessments of fluid responsiveness in patients with septic shock improve patient outcomes?We conducted a prospective, multicenter, randomized clinical trial at 13 hospitals in the United States and United Kingdom. Patients presented to EDs with sepsis that was associated hypotension and anticipated ICU admission. Intervention arm patients were assessed for fluid responsiveness before clinically driven fluid bolus or increase in vasopressors occurred. The protocol included reassessment and therapy as indicated by the passive leg raise result. The control arm received usual care. The primary clinical outcome was positive fluid balance at 72 hours or ICU discharge, whichever occurred first.In modified intent-to-treat analysis that included 83 intervention and 41 usual care eligible patients, fluid balance at 72 hours or ICU discharge was significantly lower (-1.37 L favoring the intervention arm; 0.65 ± 2.85 L intervention arm vs 2.02 ± 3.44 L usual care arm; P = .021. Fewer patients required renal replacement therapy (5.1% vs 17.5%; P = .04) or mechanical ventilation (17.7% vs 34.1%; P = .04) in the intervention arm compared with usual care. In the all-randomized intent-to-treat population (102 intervention, 48 usual care), there were no significant differences in safety signals.Physiologically informed fluid and vasopressor resuscitation with the use of the passive leg raise-induced stroke volume change to guide management of septic shock is safe and demonstrated lower net fluid balance and reductions in the risk of renal and respiratory failure. Dynamic assessments to guide fluid administration may improve outcomes for patients with septic shock compared with usual care.NCT02837731.

Recent seminal studies have revealed that laboratory mice differ from adult humans with regard to the frequency, number, and distribution of memory T cells. Because our data show that memory T cells are more susceptible to sepsis-induced death than naive T cells, in this study we developed a model in which mice possess a memory T cell compartment more similar to that of adult humans, to better study immune responses during sepsis in the more physiologically relevant context of high frequencies of memory T cells. Using this model, we found that CD44(hi) memory T cells significantly upregulated the coinhibitory molecule 2B4 during sepsis, and 2B4(+) memory T cells coexpressed markers of both activation and exhaustion. Genetic deficiency in 2B4 resulted in decreased mortality during sepsis. Mechanistically, this decreased mortality was associated with reduced caspase-3/7(+) apoptotic T cells in 2B4(–/–) relative to WT, septic hosts. These results were corroborated by analysis of PBMCs isolated from human patients with sepsis, which showed increased frequencies of caspase-3/7(+) apoptotic cells among 2B4(+) relative to 2B4(–) T cells. Thus, 2B4 plays a critical role in sepsis-induced apoptosis in both murine memory T cells and those isolated from human patients with sepsis.

The Centers for Medicare and Medicaid Services requires hospitals to report compliance with a sepsis treatment bundle as part of its Inpatient Quality Reporting Program. We used recently released data from this program to characterize national performance on the sepsis measure, known as SEP-1.Cross-sectional study of United States hospitals participating in the Centers for Medicare and Medicaid Services Hospital Inpatient Quality Reporting Program linked to Centers for Medicare and Medicaid Services' Healthcare Cost Reporting Information System.General, short-stay, acute-care hospitals in the United States.We examined the hospital factors associated with reporting SEP-1 data, the hospital factors associated with performance on the SEP-1 measure, and the relationship between SEP-1 performance and performance on other quality measures related to time-sensitive medical conditions. A total of 3,283 hospitals were eligible for the analysis, of which 2,851 (86.8%) reported SEP-1 performance data. SEP-1 reporting was more common in larger, nonprofit hospitals. The most common reason for nonreporting was an inadequate case volume. Among hospitals reporting SEP-1 performance data, overall bundle compliance was generally low, but it varied widely across hospitals (mean and SD: 48.9% ± 19.4%). Compared with hospitals with worse SEP-1 performance, hospitals with better SEP-1 performance tended to be smaller, for-profit, nonteaching, and with intermediate-sized ICUs. Better hospital performance on SEP-1 was associated with higher rates of timely head CT interpretation for stroke patients (rho = 0.16; p0.001), more frequent aspirin administration for patients with chest pain or heart attacks (rho = 0.24; p0.001) and shorter median time to electrocardiogram for patients with chest pain (rho = -0.12; p0.001).The majority of eligible hospitals reported SEP-1 data, and overall bundle compliance was highly variable. SEP-1 performance was associated with structural hospital characteristics and performance on other measures of hospital quality, providing preliminary support for SEP-1 performance as a marker of timely hospital sepsis care.

To determine whether glutamine (GLN)-supplemented parenteral nutrition (PN) improves clinical outcomes in surgical intensive care unit (SICU) patients.GLN requirements may increase with critical illness. GLN-supplemented PN may improve clinical outcomes in SICU patients.A parallel-group, multicenter, double-blind, randomized, controlled clinical trial in 150 adults after gastrointestinal, vascular, or cardiac surgery requiring PN and SICU care. Patients were without significant renal or hepatic failure or shock at entry. All received isonitrogenous, isocaloric PN [1.5 g/kg/d amino acids (AAs) and energy at 1.3× estimated basal energy expenditure]. Controls (n = 75) received standard GLN-free PN (STD-PN); the GLN group (n = 75) received PN containing alanyl-GLN dipeptide (0.5 g/kg/d), proportionally replacing AA in PN (GLN-PN). Enteral nutrition (EN) was advanced and PN weaned as indicated. Hospital mortality and infections were primary endpoints.Baseline characteristics, days on study PN and daily macronutrient intakes via PN and EN, were similar between groups. There were 11 hospital deaths (14.7%) in the GLN-PN group and 13 deaths in the STD-PN group (17.3%; difference, -2.6%; 95% confidence interval, -14.6% to 9.3%; P = 0.66). The 6-month cumulative mortality was 31.4% in the GLN-PN group and 29.7% in the STD-PN group (P = 0.88). Incident bloodstream infection rate was 9.6 and 8.4 per 1000 hospital days in the GLN-PN and STD-PN groups, respectively (P = 0.73). Other clinical outcomes and adverse events were similar.PN supplemented with GLN dipeptide was safe, but did not alter clinical outcomes among SICU patients.

The current definition of sepsis is life-threatening, acute organ dysfunction secondary to a dysregulated host response to infection. Criteria to operationalize this definition can be judged by six domains of usefulness (reliability, content, construct and criterion validity, measurement burden, and timeliness). The relative importance of these six domains depends on the intended purpose for the criteria (clinical care, basic and clinical research, surveillance, or quality improvement [QI] and audit). For example, criteria for clinical care should have high content and construct validity, timeliness, and low measurement burden to facilitate prompt care. Criteria for surveillance or QI/audit place greater emphasis on reliability across individuals and sites and lower emphasis on timeliness. Criteria for clinical trials require timeliness to ensure prompt enrollment and reasonable reliability but can tolerate high measurement burden. Basic research also tolerates high measurement burden and may not need stability over time. In an illustrative case study, we compared examples of criteria designed for clinical care, surveillance and QI/audit among 396,241 patients admitted to 12 academic and community hospitals in an integrated health system. Case rates differed four-fold and mortality three-fold. Predictably, clinical care criteria, which emphasized timeliness and low burden and therefore used vital signs and routine laboratory tests, had the greater case identification with lowest mortality. QI/audit criteria, which emphasized reliability and criterion validity, used discharge information and had the lowest case identification with highest mortality. Using this framework to identify the purpose and apply domains of usefulness can help with the evaluation of existing sepsis diagnostic criteria and provide a roadmap for future work.

Although sepsis was described more than 2,000 years ago, and clinicians still struggle to define it, there is no “gold standard,” and multiple competing approaches and terms exist. Challenges include the ever-changing knowledge base that informs our understanding of sepsis, competing views on which aspects of any potential definition are most important, and the tendency of most potential criteria to be distributed in at-risk populations in such a way as to hinder separation into discrete sets of patients. We propose that the development and evaluation of any definition or diagnostic criteria should follow four steps: 1) define the epistemologic underpinning, 2) agree on all relevant terms used to frame the exercise, 3) state the intended purpose for any proposed set of criteria, and 4) adopt a scientific approach to inform on their usefulness with regard to the intended purpose. Usefulness can be measured across six domains: 1) reliability (stability of criteria during retesting, between raters, over time, and across settings), 2) content validity (similar to face validity), 3) construct validity (whether criteria measure what they purport to measure), 4) criterion validity (how new criteria fare compared to standards), 5) measurement burden (cost, safety, and complexity), and 6) timeliness (whether criteria are available concurrent with care decisions). The relative importance of these domains of usefulness depends on the intended purpose, of which there are four broad categories: 1) clinical care, 2) research, 3) surveillance, and 4) quality improvement and audit. This proposed methodologic framework is intended to aid understanding of the strengths and weaknesses of different approaches, provide a mechanism for explaining differences in epidemiologic estimates generated by different approaches, and guide the development of future definitions and diagnostic criteria.

Introduction: Over 7 million Americans are current or former prisoners. Blacks are imprisoned at rates 4 to 10 times greater than Whites. While personal incarceration history is associated with greater all-cause mortality and incident cardiovascular disease (CVD), the impact of high neighborhood rates of incarceration on CVD risk in non-incarcerated individuals is unknown. Hypothesis: High neighborhood incarceration rate, defined as the upper quartile, is associated with poor individual CVD risk profile. Methods: A total of 1368 subjects from the Atlanta area (mean age 49 ± 10 years, 62% female [n=850], 41% Black [n=560]) were recruited from two community cohorts. Zip codes were used to link neighborhood incarceration and crime rates to individual pooled risk scores (ASCVD), risk factors for CVD including hypertension, dyslipidemia and impaired fasting glucose (IFG), and biomarkers including high-sensitivity C-reactive protein (hsCRP) and the homeostatic model assessment for insulin resistance (HOMA-IR). Results: High neighborhood incarceration rate was associated with high ASCVD risk score (OR=1.41, 95% CI=1.02, 1.95), hypertension (OR=1.48, 95% CI=1.05, 2.07) and dyslipidemia (OR=1.45, 95% CI=1.04, 2.04), after controlling for relevant demographic, socioeconomic and behavioral covariates. Tests for interaction with race were significant: Black individuals living in areas with high incarceration rates were more likely to have hypertension (OR=1.63, 95% CI=1.03, 2.58), dyslipidemia (OR=1.80, 95% CI=1.15, 2.83), IFG (OR=1.77, 95% CI=1.04, 3.03), and elevated HOMA-IR (OR=2.04, 95% CI=1.20, 3.47); Whites were more likely to have an elevated hsCRP (OR=1.81, 95% CI=1.02, 3.22). Conclusions: In conclusion, high neighborhood incarceration rate is associated with a worse CVD risk profile; this effect was more pronounced in Blacks. Neighborhood exposure to increased incarceration rates, particularly in Black communities, represents an additional health disparity that warrants further investigation.

The Center for Health Discovery and Wellbeing (CHDWB) is an academic program designed to evaluate the efficacy of clinical self-knowledge and health partner counseling for development and maintenance of healthy behaviors. This paper reports on the change in health profiles for over 90 traits, measured in 382 participants over three visits in the 12 months following enrolment. Significant changes in the desired direction of improved health are observed for many traits related to cardiovascular health, including BMI, blood pressure, cholesterol, and arterial stiffness, as well as for summary measures of physical and mental health. The changes are most notable for individuals in the upper quartile of baseline risk, many of whom showed a positive correlated response across clinical categories. By contrast, individuals who start with more healthy profiles do not generally show significant improvements and only a modest impact of targeting specific health attributes was observed. Overall, the CHDWB model shows promise as an effective intervention particularly for individuals at high risk for cardiovascular disease.

Fluid resuscitation with colloids is an established second line therapy for septic patients. Evidence of relative efficacy outcomes is tempered by considerations of the relative costs of the individual fluids. An assessment of recent large clinical trials was performed, resulting in a ranking in the efficacy of these therapies. Probabilities for mortality and the need for renal replacement therapy (RRT) were derived and used to inform a decision analysis model comparing the effect of crystalloid, albumin and hydroxyethyl starch solutions in severe septic patients followed from hospital admission to 90 days in intensive care. The US payer perspective was used. Model inputs for costs and efficacy were derived from the peer-reviewed literature, assuming that that all fluid preparations are bio-equivalent within each class of these therapies. Probabilities for mortality and the need for renal replacement therapy (RRT) data were synthesized using a Bayesian meta-analysis. Relative to crystalloid therapy, 0.21 life years were gained with albumin and 0.85 life years were lost with hydroxyethyl starch. One-way sensitivity analysis showed that the model’s outcomes were sensitive to the cost of RRT but not to the costs of the actual fluids or any other costs. We conclude that albumin may be the most cost-effective treatment in these patients when the total medical costs and iatrogenic morbidities involved in treating sepsis with fluids are considered. These results should assist and inform decision making in the choice of these drugs.

Objectives: To develop hypotheses of patient and surrogate’s rationale for decision-making. Design: We pursued a qualitative study of patients with acute respiratory distress syndrome or sepsis and their surrogates. Fourteen patients and 28 surrogates were given semistructured interviews while in the ICU and again 30 days later. The interviews focused on goal outcomes for the ICU stay and why a patient or surrogate would want a specific intervention (e.g., intubation and cardiopulmonary resuscitation). Setting: ICU of tertiary care academic hospital. Patients: Fourteen acute respiratory distress syndrome or sepsis patients and 28 of their surrogates. Interventions: None. Measurements and Main Results: Interviews were analyzed using grounded theory and the constant comparative method on NVivo 10.0 (QSR International, Melbourne, Australia). We identified the following four typologies of decision-making rationale: 1) “Timers”—determined decisions based on the length of time on life support; 2) “Natural Livers”—rejected interventions using a “machine”; 3) “Deferrers”—relied on physician for decision-making and prognosis; and 4) “Believers”—relied on a higher power for guidance. Conclusions: Our hypothesized typologies need validation in a prospective observational trial. If validated, they may allow for better clinician communication.

Structure-activity relationship (SAR) efforts around our initial lead compound 1 led to the identification of potent P2X(7) receptor antagonists with improved pharmacokinetic profiles. These compounds were potent and selective at the P2X(7) receptor in both human and rodent. Compound (entry 31) exhibited oral efficacy in the rat MIA and CCI pain models.

The various methods of dispute resolution can be intimidating to the untested and daunting to even those who have experienced them. Yet no matter the method selected, the parties own the process and the result. It is therefore incumbent upon the parties to not only understand the various methods of dispute resolution, but they must also be prepared to manage the selected process to conclusion. This article reviews the various methods of dispute resolution and provides tools that parties can use to manage the selected process to an end result. While not a guarantee of success, these tools sufficiently increase the likelihood of making the selected method of dispute resolution an efficient and cost-effective process.

This paper describes a new learning tool called the "Student Insight Panel," which was recently launched in undergraduate consumer behavior classes. By administering a series of online surveys of relevant consumer behavior topics to students, the primary goal of Student Insight is to increase their involvement and interest in the course topics. To do so, professors utilizing Student Insight analyze the survey data and present the findings to students in conjunction with more traditional teaching techniques, such as lectures and discussion. This is done in real time, and therefore topics can be covered that are so current they are not covered in textbooks. Initial assessment of the Student Insight Panel indicates that it enhances students' interest in consumer behavior topics as well as their ability to learn the material.

This study introduces marketing educators to the Madeline Hunter Direct Instruction Model (HDIM) as an approach to significantly and substantially improve student learning through course-embedded assessment.The effectiveness of the method is illustrated in three different marketing courses taught by three different marketing professors. The results demonstrate double-digit improvement in student achievement. Examples of application exercises are provided. The HDIM offers a viable tool for use in an environment in which marketing faculties are increasingly required to demonstrate course-embedded assessment as part of annual review, promotion, and tenure processes.

A web-based contingent behavior analysis was developed to quantify the effect of both negative and positive information treatments and post harvest processes on demand for oysters. Results from a panel model indicate that consumers of raw and cooked oysters behave differently after news of an oyster-related human mortality. While cooked oyster consumers take precautionary measures against risk, raw oyster consumers exhibit optimistic bias and increase their consumption level. Further, by varying the source of a counter-information treatment, we find that source credibility impacts behavior. Oyster consumers, and in particular, raw oyster consumers, are most responsive to information provided by a not-for-profit, nongovernmental organization. Finally, post harvest processing of oysters has no impact on demand.

A highly efficient one-pot, three-component microwave-assisted procedure has been developed for the preparation of 1-(para-substituted-aryl)-4-(2-acetoxyethyl)piperazines and 1-(para-substituted-aryl)-4-(2-acetoxyethyl)piperidines. Microwave-accelerated heating of electron-deficient aryl halides and potassium acetate with either 1,4-diazabicyclo[2.2.2]octane (DABCO) or quinuclidine at 180 °C for 120 min provided the title products in good yields and with general substrate scope. Similarly, subjection of potassium pthalimide instead of potassium acetate to the same conditions provided good yields of 1-arylpiperazines and 1-arylpiperidines containing a 2-phthalimidoethyl substituent at the C-4 position.

Tax relief from a sales tax holiday depends on lower final prices for the eligible goods. In this article, prices are compared for ten goods across several retail locations before, during, and after the 2001 Florida sales tax holiday period. The comparison is also extended to the same items in a metropolitan statistical area just outside of Florida. The exploratory data indicate that before-tax prices are slightly higher in Florida retail establishments during the sales tax holiday, but it is not clear whether these prices reflect less generous markdowns by Florida managers or pricing decisions for much larger regions. Whichever the case, the tax policy forces consumers to speculate on non-holiday prices and choose items where the final price is, in fact, lower during the holiday.

This paper investigates consumer expectations about the potential success of a proposed brand extension. Initial expectation of success without attribute-specific information forms the foundation of the consumer’s evaluation of the extension. We demonstrate that expectation of success, confidence in the expectation, and likelihood of extension trial vary according to the degree of perceived fit between the core brand and the extension. Principal component analysis reveals that bases of similarity used in assessing category fit can be characterized as manufacturing company features and situational features. Additionally, results show that considerations other than degree of fit influence the formation of initial expectations.

1,4-Dicyclooctatetraenyl-1,3-butadiyne and p-, m-, and o-di(cyclooctatetraenylethynyl)benzene (1−4, respectively) and their dipotassium salts (12-−42-) in THF-d8 have been synthesized and studied b...

Outcomes-based education has been recommended as a method of assessment for continuous improvement by educational institutions and accreditation associations, including AACSB. While many recognize that OBE may have the greatest impact at the course level, faculty have been given few examples of implementing OBE in their courses. The purpose of this article is to illustrate implementation of OBE at the course level using a practitioner-oriented measurement instrument. The SOCO (Sales Orientation/Customer Orientation) scale is administered in a Professional Selling class. Rationale is given as to the scale selection, method of analysis, and using the results for course improvement initiatives.

Many universities are faced with demands to upgrade MBA programs at the same time that available resources to do so are declining. The authors argue that information provided through assessments of customer (i.e., student) satisfaction with current program features should play an important role in resource allocation decisions. An exploratory study of primarily non-traditional MBA students was conducted to investigate the influence of satisfaction with a program's core academic curriculum and program infrastructure on overall program satisfaction and likelihood of recommending the program to a prospective student. For the sample studied, the authors find that program infrastructure is a more important predictor, and that the influence of core curriculum is moderated by student GPA. Results are discussed and implications for MBA program quality enhancement efforts are offered.

The free energies of activation for bond shift in fluoro-, chloro-, bromo- and iodocyclooctatetraene in THF- d 8 were determined by 13 C NMR spectroscopy to be 12.7, 15.0, 15.4 and 16.1 kcal/mol, respectively, at 298 K. Analysis of HF/6-31G*-optimized geometries and natural atomic charges for the ground state and ring inversion transition state for cyclooctatetraene (COT) and its monofluoro and monochloro derivatives indicates that the bond shift transition state for COT-F is stabilized (relative to COT) by electrostatic interactions between the fluorine and the flanking hydrogens, whereas those of the larger halogens are destabilized by steric interactions with the vicinal CH groups. © 1997 Elsevier Science Ltd.

The combination and joint estimation of revealed and stated preference (RP/SP) data approach to examining consumer preferences to relevant policy-based measures typically fail to account for heterogeneity in the data by considering behavior of the average individual. However, in policy-based analyses, where the research is often driven by understanding how different individuals react to different or similar scenarios, a preferred approach would be to analyze preferences of homogenous population subgroups. We accomplish this by developing a split-sample RP/SP analysis that examines whether homogenous subgroups of the population, based on individual health and behavioral characteristics, respond differently to health-risk information and new food safety technology. The ongoing efforts by the U.S. Food and Drug Administration (FDA) to reduce illness and death associated with consuming raw Gulf of Mexico oysters provide an ideal platform for the analysis as the health risks only relate to a very specific consumer subgroup. Results from split-sample demand models indicate that educational information treatments cause vulnerable at-risk consumers to reduce their oyster demand, implying that a more structured approach to disseminating the brochures to the at-risk population could have the desired result of reducing annual illness levels. Also, findings across all subgroups provide strong empirical evidence that the new FDA policy requiring processing technology to be used in oyster production will have a detrimental effect on the oyster industry. Key Words: Food safety technology; health-risk information; homogenous subgroups; revealed preference; stated preference

A natural experiment setting is exploited to develop a unique dataset of oyster consumer actual and anticipated behavior immediately prior to and following the BP Deepwater Horizon oil spill. Using data from a repeat sample of oyster consumers, a pre and post-spill revealed and stated preference model allows both a short and longer-term response to the spill to be investigated. Findings indicate that, as expected, the BP spill had a negative impact on oyster demand in terms of short-run actual behavior, although spill effects show signs of dissipating several months following the spill. However, by accounting for unobserved heterogeneity in the sample, findings further indicate that short and longer-term spill responses differ across consumer groups. For the larger consumer groups, the negative spill effects continue over the longer-term horizon, while other groups are either non-responsive or increase consumption following news of the spill. Key Words: Consumer behavior, BP oil spill, revealed and stated preference, latent class analysis

Traditional revealed and stated preference (RP/SP) models consider a typical individual’s behavioral responses to various policy-based information treatments. For some costbenefit applications in which resource managers are concerned with responses from a representative individual, this is sufficient. However, as behavioral responses to information treatments can vary across respondents, we develop a latent class analysis to examine unobserved homogenous subgroup responses to health-risk information treatments. Results from a probabilistic model indicate that homogenous classes of consumers respond differently to the health-risk information treatments. This suggests that future policy-based research could benefit from examining potential heterogeneity in individuals’ responses to risk information treatments in order to fully understand the efficacy of treatments on behavior. Key Words: Food safety technology; health-risk information; latent class analysis; revealed preference; stated preference

In this paper we use data from an internet-based survey and estimate the benefits of an oyster consumption safety policy with the contingent valuation method. In addition to providing a context specific estimate of willingness-to-pay for oyster safety, we consider two unresolved issues in the contingent valuation health risk literature. First, a number of studies in the mortality risk reduction literature find that willingness-to-pay is not sensitive to the scope of the risk change. We present the scope test as a difference in the number of lives saved by the program, instead of small changes in risk, and that referendum votes are responsive to scope. Second, we identify those at risk respondents who would actually benefit from the policy and decompose willingness-to-pay into personal mortality risk reduction values and altruistic willingness-to-pay. We find that respondents are sensitive to the scope of the policy and most at-risk respondents are willing to pay even more. We find that willingness-to-pay per life saved is $1.28 million for the pure private good of own-risk reduction. Willingness-to-per per life saved including private values and public, altruistic nonuse values is $5.92 million. Altruistic values are the major component of willingness-to-pay. Key Words: contingent valuation, scope test, altruism, seafood safety, health risk, oyster

Initial rate studies of the oxygenation (60-70° C) of 2,6-dimethylpyrrole (DMP), in nitrobenzene, reveal that this reaction is second order overall and first order in both DMP and O 2 . The presence of an equimolar concentration (based on DMP) of the phenolic antioxidant BHT does not inhibit the initial rate of DMP oxygenation. With dodecane or toluene, as solvent, DMP oxygenation (70- 120° C) is approximately first order in both DMP and O 2 . DMP oxygenation in dodecane in the presence of 1 or 3 equiv of BHT results in an approximate 52% reduction in the rate of DMP oxygenation

Despite recent advances in critical care and ventilator management, acute lung injury and acute respiratory distress syndrome continue to cause significant morbidity and mortality. Granulocyte-macrophage colony stimulating factor may be beneficial for patients with acute respiratory distress syndrome.To determine whether intravenous infusion of granulocyte-macrophage colony stimulating factor would improve clinical outcomes for patients with acute lung injury/acute respiratory distress syndrome.A randomized, double-blind, placebo-controlled clinical trial of human recombinant granulocyte-macrophage colony stimulating factor vs. placebo. The primary outcome was days alive and breathing without mechanical ventilatory support within the first 28 days after randomization. Secondary outcomes included mortality and organ failure-free days.Medical and surgical intensive care units at three academic medical centers.One hundred thirty individuals with acute lung injury of at least 3 days duration were enrolled, out of a planned cohort of 200 subjects.Patients were randomized to receive human recombinant granulocyte-macrophage colony stimulating factor (64 subjects, 250 μg/M) or placebo (66 subjects) by intravenous infusion daily for 14 days. Patients received mechanical ventilation using a lung-protective protocol.There was no difference in ventilator-free days between groups (10.7 ± 10.3 days placebo vs. 10.8 ± 10.5 days granulocyte-macrophage colony stimulating factor, p = .82). Differences in 28-day mortality (23% in placebo vs. 17% in patients receiving granulocyte-macrophage colony stimulating factor (p = .31) and organ failure-free days (12.8 ± 11.3 days placebo vs. 15.7 ± 11.9 days granulocyte-macrophage colony stimulating factor, p = .16) were not statistically significant. There were similar numbers of serious adverse events in each group.In a randomized phase II trial, granulocyte-macrophage colony stimulating factor treatment did not increase the number of ventilator-free days in patients with acute lung injury/acute respiratory distress syndrome. A larger trial would be required to determine whether treatment with granulocyte-macrophage colony stimulating factor might alter important clinical outcomes, such as mortality or multiorgan failure. (ClinicalTrials.gov number, NCT00201409 [ClinicalTrials.gov]).

Novel P2X(7) antagonists were developed using a purine scaffold. These compounds were potent and selective at the P2X(7) receptor in human and rodent as well as efficacious in rodent pain models. Compound 15a was identified to have oral potency in several pain models in rodent similar to naproxen, gabapentin and pregabalin. Structure-activity relationship (SAR) development and results of pain models are presented.