Showing papers by "RAND Corporation published in 2011"

The answer is 17 years, what is the question: understanding time lags in translational research:

Abstract: This study aimed to review the literature describing and quantifying time lags in the health research translation process. Papers were included in the review if they quantified time lags in the development of health interventions. The study identified 23 papers. Few were comparable as different studies use different measures, of different things, at different time points. We concluded that the current state of knowledge of time lags is of limited use to those responsible for R&D and knowledge transfer who face difficulties in knowing what they should or can do to reduce time lags. This effectively ‘blindfolds’ investment decisions and risks wasting effort. The study concludes that understanding lags first requires agreeing models, definitions and measures, which can be applied in practice. A second task would be to develop a process by which to gather these data.

Are Micro and Macro Labor Supply Elasticities Consistent? A Review of Evidence on the Intensive and Extensive Margins

Abstract: We evaluate whether state-of-the-art macro models featuring indivisible labor are consistent with modern quasi-experimental micro evidence by synthesizing evidence on both the intensive and extensive margins. We find that micro estimates are consistent with macro estimates of the steady-state (Hicksian) elasticities relevant for cross-country comparisons on both the extensive and intensive margins. However, micro estimates of intertemporal substitution (Frisch) elasticities are an order of magnitude smaller than the values needed to explain business cycle fluctuations in aggregate hours by preferences. The key puzzle to be resolved is why micro and macro estimates of the Frisch extensive margin elasticity are so different.

A Systematic Review of Barriers to Medication Adherence in the Elderly: Looking Beyond Cost and Regimen Complexity

Abstract: Background Medication nonadherence is a common problem among the elderly. Objective To conduct a systematic review of the published literature describing potential nonfinancial barriers to medication adherence among the elderly. Methods The PubMed and PsychINFO databases were searched for articles published in English between January 1998 and January 2010 that (1) described “predictors,” “facilitators,” or “determinants” of medication adherence or that (2) examined the “relationship” between a specific barrier and adherence for elderly patients (ie, ≥65 years of age) in the United States. A manual search of the reference lists of identified articles and the authors' files and recent review articles was conducted. The search included articles that (1) reviewed specific barriers to medication adherence and did not solely describe nonmodifiable predictors of adherence (eg, demographics, marital status), (2) were not interventions designed to address adherence, (3) defined adherence or compliance and specified its method of measurement, and (4) involved US participants only. Nonsystematic reviews were excluded, as were studies that focused specifically on people who were homeless or substance abusers, or patients with psychotic disorders, tuberculosis, or HIV infection, because of the unique circumstances that surround medication adherence for each of these populations. Results Nine studies met inclusion criteria for this review. Four studies used pharmacy records or claims data to assess adherence, 2 studies used pill count or electronic monitoring, and 3 studies used other methods to assess adherence. Substantial heterogeneity existed among the populations studied as well as among the measures of adherence, barriers addressed, and significant findings. Some potential barriers (ie, factors associated with nonadherence) were identified from the studies, including patient-related factors such as disease-related knowledge, health literacy, and cognitive function; drug-related factors such as adverse effects and polypharmacy; and other factors including the patient-provider relationship and various logistical barriers to obtaining medications. None of the reviewed studies examined primary nonadherence or nonpersistence. Conclusion Medication nonadherence in the elderly is not well described in the literature, despite being a major cause of morbidity, and thus it is difficult to draw a systematic conclusion on potential barriers based on the current literature. Future research should focus on standardizing medication adherence measurements among the elderly to gain a better understanding of this important issue.

Efficacy and Comparative Effectiveness of Atypical Antipsychotic Medications for Off-Label Uses in Adults: A Systematic Review and Meta-Analysis

Abstract: Context Atypical antipsychotic medications are commonly used for off-label conditions such as agitation in dementia, anxiety, and obsessive-compulsive disorder. Objective To perform a systematic review on the efficacy and safety of atypical antipsychotic medications for use in conditions lacking approval for labeling and marketing by the US Food and Drug Administration. Data Sources and Study Selection Relevant studies published in the English language were identified by searches of 6 databases (PubMed, EMBASE, CINAHL, PsycInfo, Cochrane DARE, and CENTRAL) from inception through May 2011. Controlled trials comparing an atypical antipsychotic medication (risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone, asenapine, iloperidone, or paliperidone) with placebo, another atypical antipsychotic medication, or other pharmacotherapy for adult off-label conditions were included. Observational studies with sample sizes of greater than 1000 patients were included to assess adverse events. Data Extraction Independent article review and study quality assessment by 2 investigators. Data Synthesis Of 12 228 citations identified, 162 contributed data to the efficacy review. Among 14 placebo-controlled trials of elderly patients with dementia reporting a total global outcome score that includes symptoms such as psychosis, mood alterations, and aggression, small but statistically significant effects sizes ranging from 0.12 and 0.20 were observed for aripiprazole, olanzapine, and risperidone. For generalized anxiety disorder, a pooled analysis of 3 trials showed that quetiapine was associated with a 26% greater likelihood of a favorable response (defined as at least 50% improvement on the Hamilton Anxiety Scale) compared with placebo. For obsessive-compulsive disorder, risperidone was associated with a 3.9-fold greater likelihood of a favorable response (defined as a 25% improvement on the Yale-Brown Obsessive Compulsive Scale) compared with placebo. In elderly patients, adverse events included an increased risk of death (number needed to harm [NNH] = 87), stroke (NNH = 53 for risperidone), extrapyramidal symptoms (NNH = 10 for olanzapine; NNH = 20 for risperidone), and urinary tract symptoms (NNH range = 16-36). In nonelderly adults, adverse events included weight gain (particularly with olanzapine), fatigue, sedation, akathisia (for aripiprazole), and extrapyramidal symptoms. Conclusions Benefits and harms vary among atypical antipsychotic medications for off-label use. For global behavioral symptom scores associated with dementia in elderly patients, small but statistically significant benefits were observed for aripiprazole, olanzapine, and risperidone. Quetiapine was associated with benefits in the treatment of generalized anxiety disorder, and risperidone was associated with benefits in the treatment of obsessive-compulsive disorder; however, adverse events were common.

Depression and Medication Adherence in the Treatment of Chronic Diseases in the United States: A Meta-Analysis

Abstract: Objective To conduct a meta-analysis of the association between depression and medication adherence among patients with chronic diseases. Poor medication adherence may result in worse outcomes and higher costs than if patients fully adhere to their medication regimens.

Association between Intraoperative Blood Transfusion and Mortality and Morbidity in Patients Undergoing Noncardiac Surgery

Abstract: Background: The impact of intraoperative erythrocyte transfusiononoutcomesofanemicpatientsundergoingnoncardiacsurgeryhasnotbeenwellcharacterized.Theobjective of this study was to examine the association between blood transfusion and mortality and morbidity in patients with severeanemia(hematocritlessthan30%)whoareexposedto one or two units of erythrocytes intraoperatively. Methods: Thiswasaretrospectiveanalysisoftheassociationof blood transfusion and 30-day mortality and 30-day morbidity in 10,100 patients undergoing general, vascular, or orthopedic surgery. We estimated separate multivariate logistic regression models for 30-day mortality and for 30-day complications. Results: Intraoperative blood transfusion was associated with an increased risk of death (odds ratio [OR], 1.29; 95% CI, 1.03–1.62). Patients receiving an intraoperative transfusion were more likely to have pulmonary, septic, wound, or thromboembolic complications, compared with patients not receiving an intraoperative transfusion. Compared with patients who were not transfused, patients receiving one or two units of erythrocytes were more likely to have pulmonary complications (OR, 1.76; 95% CI, 1.48–2.09), sepsis (OR, 1.43; 95% CI, 1.21–1.68), thromboembolic complications (OR, 1.77; 95% CI, 1.32–2.38), and wound complications (OR, 1.87; 95% CI, 1.47–2.37). Conclusions: Intraoperative blood transfusion is associated with a higher risk of mortality and morbidity in surgical patients with severe anemia. It is unknown whether this association is due to the adverse effects of blood transfusion or is, instead, the result of increased blood loss in the patients receiving blood.

The protective effect of marriage for survival: a review and update.

Abstract: The theory that marriage has protective effects for survival has itself lived for more than 100 years since Durkheim’s groundbreaking study of suicide (Durkheim 1951 [1897]). Investigations of differences in this protective effect by gender, by age, and in contrast to different unmarried statuses, however, have yielded inconsistent conclusions. These investigations typically either use data in which marital status and other covariates are observed in cross-sectional surveys up to 10 years before mortality exposure, or use data from panel surveys with much smaller sample sizes. Their conclusions are usually not based on formal statistical tests of contrasts between men and women or between never-married, divorced/separated, and widowed statuses. Using large-scale pooled panel survey data linked to death registrations and earnings histories for U.S. men and women aged 25 and older, and with appropriate contrast tests, we find a consistent survival advantage for married over unmarried men and women, and an additional survival “premium” for married men. We find little evidence of mortality differences between never-married, divorced/separated, and widowed statuses.

Content analysis of gender roles in media: Where are we now and where should we go?

Abstract: This paper provides a commentary regarding the quantitative content analyses of gender roles in media published in the two special issues of Sex Roles (Rudy et al. 2010a, 2011). A few themes and some overarching lessons emerge from the wide variety of data presented. First, it is clear that women are under-represented across a range of media and settings. Second, when women are portrayed, it is often in a circumscribed and negative manner. Women are often sexualized—typically by showing them in scanty or provocative clothing. Women are also subordinated in various ways, as indicated by their facial expressions, body positions, and other factors. Finally, they are shown in traditionally feminine (i.e., stereotyped) roles. Women are portrayed as nonprofessionals, homemakers, wives or parents, and sexual gatekeepers. Although the studies generally support these conclusions, some interesting moderating factors are identified, such as race. It is suggested that next steps involve the development of theory and a body of empirical evidence regarding the effects of exposure to under-representation of women. Data concerning the effects of exposure to sexualized or stereotypical portrayals on young audiences is also lacking. Finally, content analyses of new media, including those created and distributed by users, are recommended as a next step. It is concluded that, while increasing the representation of women in media may be valuable, it is also critical that the manner in which they are portrayed be simultaneously considered to avoid increasing negative or stereotypical depictions that may be particularly harmful to viewers.

Where do poor women in developing countries give birth? A multi-country analysis of demographic and health survey data.

Abstract: BACKGROUND: In 2008 over 300000 women died during pregnancy or childbirth mostly in poor countries. While there are proven interventions to make childbirth safer there is uncertainty about the best way to deliver these at large scale. In particular there is currently a debate about whether maternal deaths are more likely to be prevented by delivering effective interventions through scaled up facilities or via community-based services. To inform this debate we examined delivery location and attendance and the reasons women report for giving birth at home. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a secondary analysis of maternal delivery data from Demographic and Health Surveys in 48 developing countries from 2003 to the present. We stratified reported delivery locations by wealth quintile for each country and created weighted regional summaries. For sub-Saharan Africa (SSA) where death rates are highest we conducted a subsample analysis of motivations for giving birth at home. In SSA South Asia and Southeast Asia more than 70% of all births in the lowest two wealth quintiles occurred at home. In SSA 54.1% of the richest women reported using public facilities compared with only 17.7% of the poorest women. Among home births in SSA 56% in the poorest quintile were unattended while 41% were attended by a traditional birth attendant (TBA); 40% in the wealthiest quintile were unattended while 33% were attended by a TBA. Seven per cent of the poorest women reported cost as a reason for not delivering in a facility while 27% reported lack of access as a reason. The most common reason given by both the poorest and richest women for not delivering in a facility was that it was deemed "not necessary" by a household decision maker. Among the poorest women "not necessary" was given as a reason by 68% of women whose births were unattended and by 66% of women whose births were attended. CONCLUSIONS: In developing countries most poor women deliver at home. This suggests that at least in the near term efforts to reduce maternal deaths should prioritize community-based interventions aimed at making home births safer.

The Effects of Lottery Prizes on Winners and Their Neighbors: Evidence from the Dutch Postcode Lottery

Abstract: Each week, the Dutch Postcode Lottery (PCL) randomly selects a postal code, and distributes cash and a new BMW to lottery participants in that code. We study the effects of these shocks on lottery winners and their neighbors. Consistent with the life-cycle hypothesis, the effects on winners' consumption are largely confined to cars and other durables. Consistent with the theory of in-kind transfers, the vast majority of BMW winners liquidate their BMWs. We do, however, detect substantial social effects of lottery winnings: PCL nonparticipants who live next door to winners have significantly higher levels of car consumption than other nonparticipants.

Help or Hindrance? The Effects of College Remediation on Academic and Labor Market Outcomes

Abstract: Providing remedial (also known as developmental) education is the primary way colleges cope with students who do not have the academic preparation needed to succeed in college-level courses. Remediation is widespread, with nearly one-third of entering freshmen taking remedial courses at an annual cost of at least $1 billion. Despite its prevalence, there is uncertainty surrounding its short- and longer-run effects. This paper presents new evidence on this question using longitudinal administrative data from Texas and a regression discontinuity research design. We find little indication that remediation improves academic or labor market outcomes.

Valuation of plug-in vehicle life-cycle air emissions and oil displacement benefits

Abstract: We assess the economic value of life-cycle air emissions and oil consumption from conventional vehicles, hybrid-electric vehicles (HEVs), plug-in hybrid-electric vehicles (PHEVs), and battery electric vehicles in the US. We find that plug-in vehicles may reduce or increase externality costs relative to grid-independent HEVs, depending largely on greenhouse gas and SO2 emissions produced during vehicle charging and battery manufacturing. However, even if future marginal damages from emissions of battery and electricity production drop dramatically, the damage reduction potential of plug-in vehicles remains small compared to ownership cost. As such, to offer a socially efficient approach to emissions and oil consumption reduction, lifetime cost of plug-in vehicles must be competitive with HEVs. Current subsidies intended to encourage sales of plug-in vehicles with large capacity battery packs exceed our externality estimates considerably, and taxes that optimally correct for externality damages would not close the gap in ownership cost. In contrast, HEVs and PHEVs with small battery packs reduce externality damages at low (or no) additional cost over their lifetime. Although large battery packs allow vehicles to travel longer distances using electricity instead of gasoline, large packs are more expensive, heavier, and more emissions intensive to produce, with lower utilization factors, greater charging infrastructure requirements, and life-cycle implications that are more sensitive to uncertain, time-sensitive, and location-specific factors. To reduce air emission and oil dependency impacts from passenger vehicles, strategies to promote adoption of HEVs and PHEVs with small battery packs offer more social benefits per dollar spent.

Chipping Away at the Glass Ceiling: Gender Spillovers in Corporate Leadership

Abstract: This paper examines the role of women helping women in corporate America. Using a merged panel of directors and executives for large U.S. corporations between 1997 and 2009, we find a positive association between the female share of the board of directors in the previous year and the female share among current top executives. The relationship’s timing suggests that causality runs from boards to managers and not the reverse. This pattern of women helping women at the highest levels of firm leadership highlights the continued importance of a demand-side “glass ceiling” in explaining the slow progress of women in business.

Assuring Finite Moments for Willingness to Pay in Random Coefficient Models

Abstract: Random coefficient models such as mixed logit are increasingly being used to allow for random heterogeneity in willingness to pay (WTP) measures. In the most commonly used specifications, the distribution of WTP for an attribute is derived from the distribution of the ratio of individual coefficients. Since the cost coefficient enters the denominator, values of the cost coefficient that are close to zero induce large values of WTP, with unboundedly large values of WTP resulting from cost coefficients arbitrarily close to zero. In this paper, the authors identify a criterion to determine whether the distribution of WTP has finite moments. Using this criterion, the authors show that some popular distributions used for the cost coefficient in random coefficient models, including normal, truncated normal, uniform and triangular, imply infinite moments for the distribution of WTP, even if truncated or bounded at zero. The authors also point out that relying on simulation approaches to obtain moments of WTP from the estimated distribution of the cost and attribute coefficients can mask the problem by giving finite moments when the true ones are infinite. The authors identify several approaches that analysts can utilise to assure that the distribution of WTP has finite moments.

Central Line Bundle Implementation in US Intensive Care Units and Impact on Bloodstream Infections

Abstract: Background Central line-associated bloodstream infections (CLABSI) represent a serious patient safety issue. To prevent these infections, bundled interventions are increasingly recommended. We examine the extent of adoption of Central Line (CL) Bundle elements throughout US intensive care units (ICU) and determine their effectiveness in preventing CLABSIs.

Advancing the Science of Patient Safety

Abstract: Despite a decade's worth of effort, patient safety has improved slowly, in part because of the limited evidence base for the development and widespread dissemination of successful patient safety practices. The Agency for Healthcare Research and Quality sponsored an international group of experts in patient safety and evaluation methods to develop criteria to improve the design, evaluation, and reporting of practice research in patient safety. This article reports the findings and recommendations of this group, which include greater use of theory and logic models, more detailed descriptions of interventions and their implementation, enhanced explanation of desired and unintended outcomes, and better description and measurement of context and of how context influences interventions. Using these criteria and measuring and reporting contexts will improve the science of patient safety.

Children with diabetes compared to peers: depressed? Distressed? A meta-analytic review.

Abstract: Background It is not clear from the literature whether children with diabetes have more psychological difficulties than their peers.

Current Guidelines Have Limited Applicability to Patients with Comorbid Conditions: A Systematic Analysis of Evidence-Based Guidelines

Abstract: BACKGROUND: Guidelines traditionally focus on the diagnosis and treatment of single diseases. As almost half of the patients with a chronic disease have more than one disease, the applicability of guidelines may be limited. The aim of this study was to assess the extent that guidelines address comorbidity and to assess the supporting evidence of recommendations related to comorbidity. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a systematic analysis of evidence-based guidelines focusing on four highly prevalent chronic conditions with a high impact on quality of life: chronic obstructive pulmonary disease, depressive disorder, diabetes mellitus type 2, and osteoarthritis. Data were abstracted from each guideline on the extent that comorbidity was addressed (general comments, specific recommendations), the type of comorbidity discussed (concordant, discordant), and the supporting evidence of the comorbidity-related recommendations (level of evidence, translation of evidence). Of the 20 guidelines, 17 (85%) addressed the issue of comorbidity and 14 (70%) provided specific recommendations on comorbidity. In general, the guidelines included few recommendations on patients with comorbidity (mean 3 recommendations per guideline, range 0 to 26). Of the 59 comorbidity-related recommendations provided, 46 (78%) addressed concordant comorbidities, 8 (14%) discordant comorbidities, and for 5 (8%) the type of comorbidity was not specified. The strength of the supporting evidence was moderate for 25% (15/59) and low for 37% (22/59) of the recommendations. In addition, for 73% (43/59) of the recommendations the evidence was not adequately translated into the guidelines. CONCLUSIONS/SIGNIFICANCE: Our study showed that the applicability of current evidence-based guidelines to patients with comorbid conditions is limited. Most guidelines do not provide explicit guidance on treatment of patients with comorbidity, particularly for discordant combinations. Guidelines should be more explicit about the applicability of their recommendations to patients with comorbidity. Future clinical trials should also include patients with the most prevalent combinations of chronic conditions.

Climate change and growth scenarios for California wildfire

Abstract: Large wildfire occurrence and burned area are modeled using hydroclimate and landsurface characteristics under a range of future climate and development scenarios. The range of uncertainty for future wildfire regimes is analyzed over two emissions pathways (the Special Report on Emissions Scenarios [SRES] A2 and B1 scenarios); three global climate models (Centre National de Recherches Meteorologiques CM3, Geophysical Fluid Dynamics Laboratory CM2.1 and National Center for Atmospheric Research PCM1); three scenarios for future population growth and development footprint; and two thresholds for defining the wildland-urban interface relative to housing density. Results were assessed for three 30-year time periods centered on 2020, 2050, and 2085, relative to a 30-year reference period centered on 1975. Increases in wildfire burned area are anticipated for most scenarios, although the range of outcomes is large and increases with time. The increase in wildfire burned area associated with the higher emissions pathway (SRES A2) is substantial, with increases statewide ranging from 36% to 74% by 2085, and increases exceeding 100% in much of the forested areas of Northern California in every SRES A2 scenario by 2085.

Melatonin Versus Placebo in Children with Autism Spectrum Conditions and Severe Sleep Problems Not Amenable to Behaviour Management Strategies: A Randomised Controlled Crossover Trial

Abstract: Twenty-two children with autism spectrum disorders who had not responded to supported behaviour management strategies for severe dysomnias entered a double blind, randomised, controlled crossover trial involving 3 months of placebo versus 3 months of melatonin to a maximum dose of 10 mg. 17 children completed the study. There were no significant differences between sleep variables at baseline. Melatonin significantly improved sleep latency (by an average of 47 min) and total sleep (by an average of 52 min) compared to placebo, but not number of night wakenings. The side effect profile was low and not significantly different between the two arms.

Patient Cost-Sharing and Healthcare Spending Growth

Abstract: In this paper, we explore the role patient incentives play in slowing healthcare spending growth. Evidence suggests that while patients do indeed respond to financial incentives, cost-sharing does not uniformly improve value; rather, cost-sharing provisions must be deliberately structured and targeted to reduce care of low marginal value. Other mechanisms may be helpful in targeting particular populations or types of utilization. The spillover effects between privately insured and publicly insured populations as well as market imperfections suggest a potential role for public policy in promoting insurance design that slows spending growth while increasing the health that each dollar buys.

Conceptualizing the prospective relationship between social support, stress, and depressive symptoms among adolescents.

Abstract: The goal of the current study is to examine the relationship amongst social support, stress, and depressive symptoms within a transactional and diathesis-stress framework using a multi-wave, longitudinal design. At the initial assessment, adolescents (n = 258) completed self-report measures assessing social support (peer, classmate, parent, and total), dependent interpersonal stress, anxious symptoms, and depressive symptoms. Additionally, participants reported stress and symptomology in each of the four waves spanning six months. Results of time-lagged, idiographic, multilevel modeling indicated that stress mediated the relationship between lower parental, classmate, and total social support and subsequent depressive, but not anxious, symptoms. In contrast, lower levels of peer support were not associated with higher levels of stress and subsequent depressive symptoms. Additionally, only classmate support deficits significantly moderated the relationship between stress and depressive symptoms. Overall, the results suggest that deficits in parental and classmate support may play a greater role in contributing to adolescent depression as compared to deficits in peer support.

Applying a propensity score-based weighting model to interrupted time series data: Improving causal inference in programme evaluation

Abstract: Often, when conducting programme evaluations or studying the effects of policy changes, researchers may only have access to aggregated time series data, presented as observations spanning both the pre- and post-intervention periods. The most basic analytic model using these data requires only a single group and models the intervention effect using repeated measurements of the dependent variable. This model controls for regression to the mean and is likely to detect a treatment effect if it is sufficiently large. However, many potential sources of bias still remain. Adding one or more control groups to this model could strengthen causal inference if the groups are comparable on pre-intervention covariates and level and trend of the dependent variable. If this condition is not met, the validity of the study findings could be called into question. In this paper we describe a propensity score-based weighted regression model, which overcomes these limitations by weighting the control groups to represent the average outcome that the treatment group would have exhibited in the absence of the intervention. We illustrate this technique studying cigarette sales in California before and after the passage of Proposition 99 in California in 1989. While our results were similar to those of the Synthetic Control method, the weighting approach has the advantage of being technically less complicated, rooted in regression techniques familiar to most researchers, easy to implement using any basic statistical software, may accommodate any number of treatment units, and allows for greater flexibility in the choice of treatment effect estimators.

Evaluating Translational Research: A Process Marker Model

Abstract: The concept of translational research has become critically important in contemporary biomedical research and practice. It is the subject of a rapidly growing literature, catching the attention of most leading biomedical journals and becoming the central focus of several new publications. Translational research is showing up in everything from research grant proposals to the curricula of leading medical schools and schools of public health. It is the focus of considerable effort in the biomedical industry (Birmingham, 2002) and is increasingly central to discussions of public health. The National Institutes of Health have made it a central priority, part of their “Roadmap” initiative. One of their primary programs, the Clinical and Translational Science Awards (CTSA), currently expends over $350 million per year to fund 55 research centers and by 2012 is expected to fund 60 centers at a cost of approximately a half billion dollars per year, making it the largest program at NIH. What is behind this considerable investment in translational research? One of the most significant motivations comes from a relatively small number of studies that show that it takes a long time to move basic scientific ideas to practice and health impacts. For instance, Westfall, Mold and Fagnon (2007) asserted that “It takes an estimated average of 17 years for only 14% of new scientific discoveries to enter day-to-day clinical practice” (p. 403). They based their claim on earlier work (Balas & Boren, 2000) that similarly stated “Studies suggest that it takes an average of 17 years for research evidence to reach clinical practice” (p.66) at a rate of 50% use in the relevant population. Other work (Contopoulos-Ioannidis, Alexiou, Gouvias, & Ioannidis, 2008) suggests that the median translation lag was 24 years between first description and earliest highly cited article. Because these studies typically only measure part of the process of moving from research to practice and eventually to health outcomes and impacts, these are likely to be significant underestimates. Translational research in many ways can trace its primary impetus to the notion that this time lag is seen as too long, certainly longer than necessary, and that there must be a better way to move research to practice more quickly without sacrificing quality or increasing costs. Proposed solutions include everything from better management of scientific research and increased process efficiency to wholesale rethinking of the biomedical research-practice endeavor for the 21st century. This paper focuses on the length of time that translational research takes. We do so because the long duration and time estimates to move research to practice were critical to making the policy case for significant investments in translational research. Nevertheless, temporality and duration concerns need to be considered in the context of many other factors including quality of research, cost, ethics, management, potential impacts, and so on (Rubio et al., 2010). The success of the translational research endeavor will ultimately be judged by whether it reduces the time and duration issue while at least preserving the current status of other factors like quality or cost. We argue here that one of the major tasks for evaluators involved in translational research is to help assess whether efforts like the CTSAs can reduce the time it takes to move research to practice and health impacts and increase the rate and volume of translation -- all while ensuring the quality and cost-efficiency of the conduct of research. This paper examines the concept of translational research from the perspective of evaluators charged with assessing translational efforts. In doing so we hope to: a) consider the most prominent models of translational research that have been offered in the literature, b) synthesize the major features that are shared across these models in order to show underlying commonalities, and c) suggest a new synthetic framework for evaluating progress in enhancing research translation that is consistent with existing models but avoids some of the major current problems. Specifically, we offer here an alternative to the dominant contemporary tendency to define translational research in terms of a series of discrete “phases.” We contend that this phased approach is insufficiently precise for most evaluation purposes and instead argue for the identification of key operational and measureable markers along a generalized process pathway from research to practice.

Perceived discrimination and mental health symptoms among Black men with HIV.

Abstract: People living with HIV (PLWH) exhibit more severe mental health symptoms, including depression and posttraumatic stress disorder (PTSD) symptoms, than do members of the general public. We examined whether perceived discrimination, which has been associated with poor mental health in prior research, contributes to greater depression and PTSD symptoms among HIV-positive Black men who have sex with men (MSM), who are at high risk for discrimination from multiple stigmatized characteristics (HIV-serostatus, race/ethnicity, sexual orientation). A total of 181 Black MSM living with HIV completed audio computer-assisted self-interviews (ACASI) that included measures of mental health symptoms (depression, PTSD) and scales assessing perceived discrimination due to HIV-serostatus, race/ethnicity, and sexual orientation. In bivariate tests, all three perceived discrimination scales were significantly associated with greater symptoms of depression and PTSD (i.e., reexperiencing, avoidance, and arousal subscales; all p values < .05). The multivariate model for depression yielded a three-way interaction among all three discrimination types (p < .01), indicating that perceived racial discrimination was negatively associated with depression symptoms when considered in isolation from other forms of discrimination, but positively associated when all three types of discrimination were present. In multivariate tests, only perceived HIV-related discrimination was associated with PTSD symptoms (p < .05). Findings suggest that some types of perceived discrimination contribute to poor mental health among PLWH. Researchers need to take into account intersecting stigmata when developing interventions to improve mental health among PLWH.

What context features might be important determinants of the effectiveness of patient safety practice interventions

Abstract: Background Differences in contexts (eg, policies, healthcare organisation characteristics) may explain variations in the effects of patient safety practice (PSP) implementations. However, knowledge of which contextual features are important determinants of PSP effectiveness is limited and consensus is lacking on a taxonomy of which contexts matter. Methods Iterative, formal discussions were held with a 22-member technical expert panel composed of experts or leaders in patient safety, healthcare systems, and methods. First, potentially important contextual features were identified, focusing on five PSPs. Then, two surveys were conducted to determine the context likely to influence PSP implementations. Results The panel reached a consensus on a taxonomy of four broad domains of contextual features important for PSP implementations: safety culture, teamwork and leadership involvement; structural organisational characteristics (eg, size, organisational complexity or financial status); external factors (eg, financial or performance incentives or PSP regulations); and availability of implementation and management tools (eg, training organisational incentives). Panelists also tended to rate specific patient safety culture, teamwork and leadership contexts as high priority for assessing their effects on PSP implementations, but tended to rate specific organisational characteristic contexts as high priority only for use in PSP evaluations. Panelists appeared split on whether specific external factors and implementation/management tools were important for assessment or only description. Conclusion This work can guide research commissioners and evaluators on the contextual features of PSP implementations that are important to report or evaluate. It represents a first step towards developing guidelines on contexts in PSP implementation evaluations. However, the science of context measurement needs maturing.