Conjunction Fallacy Research Articles

A Cure for Type 1 Diabetes: Are We There Yet?

Type 1 diabetes (T1D) affects over 2 million people in the United States and has no known cure. The discovery and first use of insulin in humans 102 years ago marked a revolutionary course of treatment for the disease, and although the formulations and delivery systems have advanced, insulin administration remains the standard of care today. While improved treatment options represent notable progress in T1D management, finding a functional cure for the disease remains the ultimate goal. Approaches to curing T1D have historically focused on blunting the autoimmune response, although sustained effects of immune modulation have proven elusive. Islet transplant therapies have also proven effective, although a lack of available donor tissue and the need for immunosuppression to prevent both host-graft rejection and the autoimmune response have reserved such treatments for those who already require immunosuppressive regimens for other reasons or undergo severe hypoglycemic events in conjunction with hypoglycemic unawareness. With the advent of human stem cell research, the focus has shifted toward generating an abundance of allogeneic, functional beta-like cells that can be transplanted into the patients. Immunoisolation devices have also shown some promise as a method of preventing immune rejection and the autoimmune destruction of transplanted cells. Finally, advances in new immune therapies, if used in the early stages of T1D progression, have proven to delay the onset of diabetes. Stem cell-based therapies are a promising approach to curing T1D. The ongoing clinical trials show some success, although they currently require immunosuppressant agents. Encapsulation devices provide a method of immunoisolation that does not require immunosuppression; however, the devices tested thus far eventually lead to cell death and fibrotic tissue growth. Substantial research efforts are underway to develop new approaches to protect the stem cell-derived beta cells upon transplantation.

Cross Correlation Between Plasmaspheric Hiss Waves and Enhanced Radiation Levels at Aviation Altitudes

AbstractEnhanced radiation in the Earth's atmosphere can pose serious hazards to pilots, aircraft passengers, and commercial space travelers. Recent results have shown, statistically, that there is a strong correlation between dose rates observed by Automated Radiation Measurements for Aerospace Safety (ARMAS) instruments at aviation altitudes (>9 km) and plasmaspheric hiss wave power measured by NASA's Van Allen Probes within the inner magnetosphere. Plasmaspheric hiss waves play a very important role in removing energetic electrons from the Earth's radiation belts by precipitating them into the upper atmosphere. These relativistic electrons generally drift eastwards along closed magnetic drift shells. In this study, we use magnetic conjunction events between ARMAS and the Van Allen Probes to analyze the causality between plasmaspheric hiss waves and enhanced radiation observed at aviation altitude. We specifically study how the size of the conjunction window and a shift in L and MLT of the conjunction window affect the correlation between dose rates and plasmaspheric hiss wave power. This is to determine if the observed enhanced radiation at aviation altitude is indeed caused by the plasmaspheric hiss waves in the inner magnetosphere. The results show that the enhanced radiation levels are only correlated with plasmaspheric hiss waves within conjunction windows of −1 L 1 and 0 MLT 2. The correlation between dose rate and hiss wave power increases slightly if ARMAS is shifted approximately 1 hr in MLT to the east of the Van Allen Probes, consistent with the drift trajectory of the electrons precipitating into the atmosphere.

Comparisons of Energetic Electron Observations Between FIREBIRD‐II CubeSats and POES/MetOp Satellites From 2018 to 2020

AbstractPrecipitation into the atmosphere is one of the main processes by which high energy electrons trapped in Earth's inner magnetosphere are lost from the system. Precipitating electrons can affect the chemical composition of the atmosphere and provide insight into the complex dynamics of the Van Allen radiation belts. This study compares energetic electron precipitation measurements at low‐Earth‐orbit by the Focused Investigations of Relativistic Electron Burst Intensity, Range, and Dynamics (FIREBIRD‐II) CubeSats with NOAA Polar‐orbiting Operational Environmental Satellite (POES) and ESA Meteorological Operational satellite (MetOp) satellites, which are equipped with the Medium‐Energy Proton Electron Detector (MEPED). The analysis considers 51 high quality conjunction events at >300 keV during times of low to moderate geomagnetic activity. The spacecraft capture similar electron flux variability, and FIREBIRD‐II observations fall between POES/MetOp and telescopes, likely a result of FIREBIRD‐II sampling both precipitating and mirrored electrons due to uncertainties in pointing direction. Results demonstrate the value of high‐resolution differential energy observations of electron precipitation by low‐cost CubeSats such as FIREBIRD‐II, especially during periods of low flux.

Embedded State Estimation for Optimization of Cislunar Space Domain Awareness Constellation Design

The traffic in cislunar space is expected to increase over the coming years, leading to a higher likelihood of conjunction events among active satellites, orbital debris, and noncooperative satellites. This increase necessitates enhanced space domain awareness (SDA) capabilities that include state estimation for targets of interest. Both Earth surface-based and space-based observation platforms in geosynchronous orbit or below face challenges such as range, exclusion, and occlusion that hinder observation. Motivated by the need to place space-based observers in the cislunar space regime to overcome these challenges, this paper proposes a cislunar SDA constellation design and analysis framework that integrates state estimation into an optimization problem for determining the placement of observers for optimal state estimation performance on a set of targets. The proposed multiobserver placement optimization problem samples from a range of possible target orbits. Upon convergence, the optimized constellation is validated against a broader set of targets to assess its effectiveness. Two comparative analyses are presented to evaluate the effects of changes in the sensor tasking procedure and sensor fidelity on the optimized constellation, comparing these to a single observer baseline case. The results demonstrate that the optimized constellations can provide accurate state estimation for various orbit families.

Abstract C012: Evaluation of skin cancer screening education provided by dermatologists with The Sun Bus for medical students

Abstract Introduction: Medical student curriculum is lacking in standardized training of skills for conducting the skin cancer screening examination. Dermatology is not a standard clinical rotation during medical school, and many medical students do not have much exposure to the specialty of dermatology for hands-on training in skin examinations by dermatologists. We sought to create an event in conjunction with the Sun Bus that included education about dermatology and skin examination for medical students. Objectives We sought to assess how the effects on knowledge of dermatology and skin cancer prevention and screening among participating medical students changed from participating in the educational event. Methods: The Health Education and Awareness Team of Texas Tech University Health Sciences Center El Paso collaborated with The Sun Bus to organize a training event for medical students. During this event, students had the opportunity to listen to a panel about dermatology as well as the basics of skin cancer screening from working dermatologists. Students also received a brief training on skin cancer screening provided by The Sun Bus and conducted screenings alongside dermatologists during a free skin cancer screening event. Students completed voluntary pre-event and post-event surveys. Results The vast majority of students did not feel confident in their ability to screen for skin cancer prior to attending the event. This research showed improved student confidence in providing skin cancer screenings and identifying suspicious skin lesions from the intervention. Conclusion: Medical students lack standardized training in dermatology and in the dermatologic skin cancer screening examination. This student educational event represents a meaningful intervention that improved medical students’ confidence in providing skin cancer screenings and identifying suspicious skin lesions. Bibliography The Sun Bus. https://www.thesunbus.org/about-us Accessed 11 Dec 2023. Compres E, Holzem K, Ibler E, Bierman JA, Rademaker AW, Kundu RV. A Brief Dermatology Curriculum in Skin Cancer Detection and Prevention to Improve Medical Student Knowledge and Confidence. MedEdPORTAL. 2020;16:11049. Published 2020 Dec 29. doi:10.15766/mep_2374-8265.11049 Moore MM, Geller AC, Zhang Z, et al. Skin cancer examination teaching in US medical education. Arch Dermatol. 2006;142(4):439-444. doi:10.1001/archderm.142.4.439 Ivanov NN, Swan A, Guseman EH, Whipps J, Jensen LL, Beverly EA. Medical Students' Knowledge, Attitudes, and Behaviors With Regard to Skin Cancer and Sun-Protective Behaviors. J Am Osteopath Assoc. 2018;118(7):444-454. doi:10.7556/jaoa.2018.098 Ivanov NN, Swan A, Guseman EH, Whipps J, Jensen LL, Beverly EA. Medical Students' Knowledge, Attitudes, and Behaviors With Regard to Skin Cancer and Sun-Protective Behaviors. J Am Osteopath Assoc. 2018;118(7):444-454. doi:10.7556/jaoa.2018.098 Citation Format: Elian A. Martin Lopez, Hannah Riva, Shravya Kichena Kichena, Daniel Lovasz, Brian Kan, Tannis Hogg, Jessica Chacon. Evaluation of skin cancer screening education provided by dermatologists with The Sun Bus for medical students [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C012

Treatment of epistemic uncertainty in conjunction analysis with Dempster-Shafer theory

The paper presents an approach to the modelling of epistemic uncertainty in Conjunction Data Messages (CDM) and the classification of conjunction events according to the confidence in the probability of collision. The approach proposed in this paper is based on Dempster-Shafer Theory (DSt) of evidence and starts from the assumption that the observed CDMs are drawn from a family of unknown distributions. The Dvoretzky–Kiefer–Wolfowitz (DKW) inequality is used to construct robust bounds on such a family of unknown distributions starting from a time series of CDMs. A DSt structure is then derived from the probability boxes constructed with DKW inequality. The DSt structure encapsulates the uncertainty in the CDMs at every point along the time series and allows the computation of the belief and plausibility in the realisation of a given probability of collision. The methodology proposed in this paper is tested on a number of real events and compared against existing practices in the European and French Space Agencies. We will show that the classification system proposed in this paper is more conservative than the approach taken by the European Space Agency but provides an added quantification of uncertainty in the probability of collision.

Probability errors in children's judgements about the likelihood of social characteristics.

The studies reported here investigated mechanisms underlying children's tendency to commit the conjunction fallacy (judging that a conjunction of two events is more likely than one of the events in isolation) when judging people's characteristics. Study 1 investigated these errors in 4- and 5-year-olds (N = 58) using a newly developed social judgement task in which children judged whether a conjunction or one of its elements would apply to a protagonist. Children made conjunction fallacy errors at chance level. Study 2 (N = 71) replicated these findings using an adapted version of the task, in which children separately judged the likelihood of the conjunction and each of its events. Study 3 investigated age-related changes in conjunction fallacy errors in a sample of 148 children aged 4 to 11 years old and 130 adults. This study also investigated how providing background information on the protagonist influenced error rate. Unlike younger children, 10- and 11-year-olds committed the conjunction fallacy at chance level in the absence of background information, but providing information consistent with the likely component of the conjunction significantly increased their error rate. Adults' error rate also significantly increased after the introduction of background information. Across all three studies, conjunction fallacy errors were unrelated to cognitive and social-cognitive abilities, such as verbal ability, theory of mind, and inhibitory control (Studies 1 and 2), and prejudice and hindsight bias (Study 3). These findings suggest that it is only in the second decade of life that children use social information to inform their judgements about people and that social decision-making errors are not determined by core aspects of cognitive and social-cognitive development. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The conjunction fallacy: confirmation or relevance?

The conjunction fallacy is the well-documented reasoning error on which people rate a conjunction A ∧ B as more probable than one of its conjuncts, A. Many explanations appeal to the fact that B has a high probability in the given scenarios, but Katya Tentori and collaborators have challenged such approaches. They report experiments suggesting that degree of confirmation—rather than probability—is the central determinant of the conjunction fallacy. In this paper, we have two goals. First, we address a confound in Tentori et al.’s experiments: they failed to control for the fact that in their stimuli where B is confirmed, it is also conversationally relevant in the sense that it fits with the topic or question under discussion. Conversely, when B has a high probability but is not confirmed, it is conversationally irrelevant. Consequently, it is possible that conversational relevance, rather than confirmation, is responsible for the differences they found between confirmed and probable hypotheses. Second, inspired by recent theoretical work, we aim to give the first empirical investigation of the hypothesis that this type of conversational relevance on its own—independently of degree of confirmation—can be an important factor in the conjunction fallacy. We report on two experiments that vary Tentori et al.’s design by making B relevant without changing its degree of probability or confirmation. We found that doing so increases the rate of the conjunction fallacy, suggesting that relevance plays an important role in the conjunction fallacy.

A culture-independent nucleic acid diagnostics method for use in the detection and quantification of Burkholderia cepacia complex contamination in aqueous finished pharmaceutical products.

The Burkholderia cepacia complex (Bcc) is the number one bacterial complex associated with contaminated Finished Pharmaceutical Products (FPPs). This has resulted in multiple healthcare related infection morbidity and mortality events in conjunction with significant FPP recalls globally. Current microbiological quality control of FPPs before release for distribution depends on lengthy, laborious, non-specific, traditional culture-dependent methods which lack sensitivity. Here, we present the development of a culture-independent Bcc Nucleic Acid Diagnostic (NAD) method for detecting Bcc contaminants associated with Over-The-Counter aqueous FPPs. The culture-independent Bcc NAD method was validated to be specific for detecting Bcc at different contamination levels from spiked aqueous FPPs. The accuracy in Bcc quantitative measurements was achieved by the high degree of Bcc recovery from aqueous FPPs. The low variation observed between several repeated Bcc quantitative measurements further demonstrated the precision of Bcc quantification in FPPs. The robustness of the culture-independent Bcc NAD method was determined when its accuracy and precision were not significantly affected during testing of numerous aqueous FPP types with different ingredient matrices, antimicrobial preservative components and routes of administration. The culture-independent Bcc NAD method showed an ability to detect Bcc in spiked aqueous FPPs at a concentration of 20 Bcc CFU/mL. The rapid (≤ 4 hours from sample in to result out), robust, culture-independent Bcc NAD method presented provides rigorous test specificity, accuracy, precision, and sensitivity. This method, validated with equivalence to ISO standard ISO/TS 12869:2019, can be a valuable diagnostic tool in supporting microbiological quality control procedures to aid the pharmaceutical industry in preventing Bcc contamination of aqueous FPPs for consumer safety.

Orbital Tolerance and Intrinsic Orbital Capacity for Electric Propulsion Constellations

Large constellations are typically designed using sets of periodic orbits and satellite control boxes sized to ensure compatible phasing between coorbital constellation planes to prevent conjunction events. This work investigates how the control action for orbit maintenance influences feasible intrashell and intershell distances in a satellite constellation. Two-dimensional lattice flower constellations are simulated in an environment inclusive of orbital perturbations, with onboard sensors and an electric propulsion system constituting the satellite guidance, navigation, and control system. An analysis to define estimates for minimum separation distances is performed as a function of control, propulsion, orbit, environmental, and spacecraft characteristics. An estimate of the intrinsic (geometric) orbital capacity is proposed, based on current and advanced technologies, in order to quantify the number of admissible spacecraft and orbital shells in a selected altitude range. Simulation results are used to improve the fidelity of intrinsic orbital capacity estimates and to understand factors that influence the number of admissible satellite locations in low Earth orbit.

How general is the natural frequency effect? The case of joint probabilities.

Natural frequencies are known to improve performance in Bayesian reasoning. However, their impact in situations with two binary events has not yet been completely examined, as most researchers in the last 30 years focused only on conditional probabilities. Nevertheless, situations with two binary events consist of 16 elementary probabilities and so we widen the scope and focus on joint probabilities. In this article, we theoretically elaborate on the importance of joint probabilities, for example, in situations like the Linda problem. Furthermore, we implemented a study in a 2×5×2 design with the factors information format (probabilities vs. natural frequencies), visualization type ("Bayesian text" vs. tree diagram vs. double tree diagram vs. net diagram vs. 2×2 table), and context (mammography vs. economics problem). Additionally, all four "joint questions" (i.e., were asked for. The main factor of interest was whether there is a format effect in the five visualization types named above. Surprisingly, the advantage of natural frequencies was not found for joint probabilities and, most strikingly, the format interacted with the visualization type. Specifically, while people's understanding of joint probabilities in a double tree seems to be worse than the understanding of the corresponding natural frequencies (and, thus, the frequency effect holds true), the opposite seems to be true in the 2 × 2 table. Hence, the advantage of natural frequencies compared to probabilities in typical Bayesian tasks cannot be found in the same way when joint probability or frequency tasks are asked.

A Comparison of Auroral Oval Proxies With the Boundaries of the Auroral Electrojets

AbstractThe boundaries of the auroral oval and auroral electrojets are an important source of information for understanding the coupling between the solar wind and the near‐earth plasma environment. Of these two types of boundaries the auroral electrojet boundaries have received comparatively little attention, and even less attention has been given to the connection between the two. Here we introduce a technique for estimating the electrojet boundaries, and other properties such as total current and peak current, from 1‐D latitudinal profiles of the eastward component of equivalent current sheet density. We apply this technique to a preexisting database of such currents along the 105° magnetic meridian, estimated using ground‐based magnetometers, producing a total of 11 years of 1‐min resolution electrojet boundaries during the period 2000–2020. Using statistics and conjunction events we compare our electrojet boundary data set with an existing electrojet boundary data set, based on Swarm satellite measurements, and auroral oval proxies based on particle precipitation and field‐aligned currents. This allows us to validate our data set and investigate the feasibility of an auroral oval proxy based on electrojet boundaries. Through this investigation we find the proton precipitation auroral oval is a closer match with the electrojet boundaries. However, the bimodal nature of the electrojet boundaries as we approach the noon and midnight discontinuities makes an average electrojet oval poorly defined. With this and the direct comparisons differing from the statistics, defining the proton auroral oval from electrojet boundaries across all local and universal times is challenging.

Deep learning of sleep apnea-hypopnea events for accurate classification of obstructive sleep apnea and determination of clinical severity

Background/Objective: Automatic apnea/hypopnea events classification, crucial for clinical applications, often faces challenges, particularly in hypopnea detection. This study aimed to evaluate the efficiency of a combined approach using nasal respiration flow (RF), peripheral oxygen saturation (SpO2), and ECG signals during polysomnography (PSG) for improved sleep apnea/hypopnea detection and obstructive sleep apnea (OSA) severity screening. MethodsAn Xception network was trained using main features from RF, SpO2, and ECG signals obtained during PSG. In addition, we incorporated demographic data for enhanced performance. The detection of apnea/hypopnea events was based on RF and SpO2 feature sets, while the screening and severity categorization of OSA utilized predicted apnea/hypopnea events in conjunction with demographic data. ResultsUsing RF and SpO2 feature sets, our model achieved an accuracy of 94 % in detecting apnea/hypopnea events. For OSA screening, an exceptional accuracy of 99 % and an AUC of 0.99 were achieved. OSA severity categorization yielded an accuracy of 93 % and an AUC of 0.91, with no misclassification between normal and mild OSA versus moderate and severe OSA. However, classification errors predominantly arose in cases with hypopnea-prevalent participants. ConclusionsThe proposed method offers a robust automatic detection system for apnea/hypopnea events, requiring fewer sensors than traditional PSG, and demonstrates exceptional performance. Additionally, the classification algorithms for OSA screening and severity categorization exhibit significant discriminatory capacity.

Risk and attributable fraction estimation for the impact of exposure to compound drought and hot events on daily stroke admissions

The projection indicates that compound drought and hot events (CDHEs) will intensify, posing risks to cardiovascular health by potentially increasing stroke incidents. However, epidemiological evidence on this topic remains scarce. This study investigates the association between exposure to CDHEs and the risk of daily stroke admissions, specifically examining the effects on various stroke categories such as Subarachnoid Hemorrhage (SAH), Intracerebral Hemorrhage (ICH), Ischemic Stroke (IS), Transient Ischemic Attack (TIA), and other types of stroke. Data on daily stroke admissions from 2010 to 2015 were obtained from the Urban Employee Basic Medical Insurance (UEBMI) and Urban Resident Basic Medical Insurance (URBMI) claims databases in Guangzhou, China. Hot events were identified as days when the daily mean temperature exceeded the 75th percentile during the warm season (May to October) over the study period. The Standardized Precipitation Evapotranspiration Index (SPEI) was utilized to identify drought conditions, with thresholds set at -1 and -1.5 for low-severity and high-severity drought events, respectively. Through a generalized additive model (GAM), we analyzed the cumulative effects of CDHE exposure on daily stroke admissions and calculated the Attributable Fraction (AF) related to CDHEs. The analysis included 179,963 stroke admission records. We observed a significant increase in stroke admission risks due to exposure to hot events coupled with high-severity drought conditions (RR = 1.18, 95%CI: 1.01-1.38), with IS being the most affected category (RR = 1.20, 95%CI: 1.03-1.40). The AF of total stroke admission attributed to hot events in conjunction with high-severity drought conditions was 24.40% (95%CI: 1.86%-50.20%). The combination of hot events with high-severity drought conditions is likely linked to an increased risk of stroke and IS admissions, which providing new insights into the impact of temperature and climate-related hazards on cardiovascular health.

Adieu Bias: Debiasing Intuitions Among French Speakers.

Recent debiasing studies have shown that a short, plain-English explanation of the correct solution strategy can improve reasoning performance. However, these studies have predominantly focused on English-speaking populations, who were tested with problem contents designed for an English-speaking test environment. Here we explore whether the key findings of previous debiasing studies can be extended to native French speakers living in continental Europe (France). We ran a training session with a battery of three reasoning tasks (i.e., base-rate neglect, conjunction fallacy, and bat-and-ball) on 147 native French speakers. We used a two-response paradigm in which participants first gave an initial intuitive response, under time pressure and cognitive load, and then gave a final response after deliberation. Results showed a clear training effect, as early as the initial (intuitive) stage. Immediately after training, most participants solved the problems correctly, without the need for a deliberation process. The findings confirm that the intuitive debiasing training effect extends to native French speakers.

The role of cognitive biases in conspiracy beliefs: A literature review

AbstractIn recent years, several studies have found that conspiracy believers tend to be more susceptible to cognitive biases (e.g., conjunction fallacy, proportionality bias, agency detection bias, etc.). The aim of this work is to review such literature, systematizing these concepts in a unifying framework of conspiracy mentality as a set of biased cognitive processes, which categorizes cognitive biases in two classes: those that contribute to belief formation and those that contribute to belief updating. Drawing on several empirical results, this paper summarizes the role of cognitive biases in conspiratorial thinking, offering some insights for future research and raising questions about the possible weaknesses of this approach.

Proprotein convertase subtilisn/kexin type 9 inhibitors and small interfering RNA therapy for cardiovascular risk reduction: A systematic review and meta-analysis.

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality worldwide. Atherosclerosis occurs due to accumulation of low-density lipoprotein cholesterol (LDL-c) in the arterial system. Thus, lipid lowering therapy is essential for both primary and secondary prevention. Proprotein convertase subtilisn/kexin type 9 (PCSK9) inhibitors (Evolocumab, Alirocumab) and small interfering RNA (siRNA) therapy (Inclisiran) have been demonstrated to lower LDL-c and ASCVD events in conjunction with maximally tolerated statin therapy. However, the degree of LDL-c reduction and the impact on reducing major adverse cardiac events, including their impact on mortality, remains unclear. The purpose of this study is to examine the effects of PCSK9 inhibitors and small interfering RNA (siRNA) therapy on LDL-c reduction and major adverse cardiac events (MACE) and mortality by conducting a meta-analysis of randomized controlled trials. Using Pubmed, Embase, Cochrane Library and clinicaltrials.gov until April 2023, we extracted randomized controlled trials (RCTs) of PCSK9 inhibitors (Evolocumab, Alirocumab) and siRNA therapy (Inclisiran) for lipid lowering and risk of MACE. Using random-effects models, we pooled the relative risks and 95% CIs and weighted least-squares mean difference in LDL-c levels. We estimated odds ratios with 95% CIs among MACE subtypes and all-cause mortality. Fixed-effect model was used, and heterogeneity was assessed using the I2 statistic. In all, 54 studies with 87,669 participants (142,262 person-years) met criteria for inclusion. LDL-c percent change was reported in 47 studies (n = 62,634) evaluating two PCSK9 inhibitors and siRNA therapy. Of those, 21 studies (n = 41,361) included treatment with Evolocumab (140mg), 22 (n = 11,751) included Alirocumab (75mg), and 4 studies (n = 9,522) included Inclisiran (284mg and 300mg). Compared with placebo, after a median of 24 weeks (IQR 12-52), Evolocumab reduced LDL-c by -61.09% (95% CI: -64.81, -57.38, p<0.01) and Alirocumab reduced LDL-c by -46.35% (95% CI: -51.75, -41.13, p<0.01). Inclisiran 284mg reduced LDL-c by -54.83% (95% CI: -59.04, -50.62, p = 0.05) and Inclisiran 300mg reduced LDL-c by -43.11% (95% CI: -52.42, -33.80, p = 0.01). After a median of 8 months (IQR 6-15), Evolocumab reduced the risk of myocardial infarction (MI), OR 0.72 (95% CI: 0.64, 0.81, p<0.01), coronary revascularization, 0.77 (95% CI: 0.70, 0.84, p<0.01), stroke, 0.79 (95% CI: 0.66, 0.94, p = 0.01) and overall MACE 0.85 (95% CI: 0.80, 0.89, p<0.01). Alirocumab reduced MI, 0.57 (0.38, 0.86, p = 0.01), cardiovascular mortality 0.35 (95% CI: 0.16, 0.77, p = 0.01), all-cause mortality 0.60 (95% CI: 0.43, 0.84, p<0.01), and overall MACE 0.35 (0.16, 0.77, p = 0.01). PCSK9 inhibitors (Evolocumab, Alirocumab) and siRNA therapy (Inclisiran) significantly reduced LDL-c by >40% in high-risk individuals. Additionally, both Alirocumab and Evolocumab reduced the risk of MACE, and Alirocumab reduced cardiovascular and all-cause mortality.

Descriptive Report of a Pharmacist-Directed Preconception Care Outreach Program in a Rural Maternity Care Desert.

Preconception care is the prevention and management of biomedical, behavioral, and social risk factors to improve pregnancy outcomes and overall health for reproductive-age patients. A community-based pharmacist-directed preconception care outreach program was developed for women ages 18-45 years living in a rural maternity care desert to help them identify potential health risks and provide them with the needed education, counseling, or referrals to address these risks. Supervised student pharmacists, pharmacy practice residents, and pharmacy faculty from a local University collaborated to provide this program at four community events in conjunction with a mobile health clinic. A summative evaluation was performed after the events concluded, modeled after the RE-AIM framework. One hundred and forty-one women were served by the outreach program. Nearly 98% reported at least one preconception health risk, and 45% reported a barrier preventing them from being able to have an appointment with a physician in the last year. The outreach program was feasible to implement and can be adapted to different settings. Pharmacist-directed outreach programs in rural communities may benefit patients who are not receiving or do not have access to such care in traditional healthcare settings.

Atmospheric Drivers Associated with Extreme Snow Ablation and Discharge Events in the Susquehanna River Basin: A Climatology

Abstract Extreme snow ablation can greatly impact regional hydrology, affecting streamflow, soil moisture, and groundwater supplies. Relatively little is known about the climatology of extreme ablation events in the eastern United States, and the causal atmospheric forcing mechanisms behind such events. Studying the Susquehanna River basin over a 50-yr period, here we evaluate the variability of extreme ablation and river discharge events in conjunction with a synoptic classification and global-scale teleconnection pattern analysis. Results indicate that an average of 4.2 extreme ablation events occurred within the basin per year, where some 88% of those events resulted in an increase in river discharge when evaluated at a 3-day lag. Both extreme ablation and extreme discharge events occurred most frequently during instances of southerly synoptic-scale flow, accounting for 35.7% and 35.8% of events, respectively. However, extreme ablation was also regularly observed during high pressure overhead and rain-on-snow synoptic weather types. The largest magnitude of snow ablation per extreme event occurred during occasions of rain-on-snow, where a basinwide, areal-weighted 5.7 cm of snow depth was lost, approximately 23% larger than the average extreme event. Interannually, southerly flow synoptic weather types were more frequent during winter seasons when the Arctic and North Atlantic Oscillations were positively phased. Approximately 30% of the variance in rain-on-snow weather type frequency was explained by the Pacific–North American pattern. Evaluating the pathway of physical forcing mechanisms from regional events up through global patterns allows for improved understanding of the processes resulting in extreme ablation and discharge across the Susquehanna basin. Significance Statement The purpose of this study is to better understand how certain weather patterns are related to extreme snowmelt and streamflow events and what causes those weather patterns to vary with time. This is valuable information for informing hazard preparation and resource management within the basin. We found that weather patterns with southerly winds were the most frequent patterns responsible for extreme melt and streamflow, and those patterns occurred more often when the Arctic and North Atlantic Oscillations were in their “positive” configuration. Future work should consider the potential for these patterns, and related impacts, to change over time.

Boosting debiasing: Impact of repeated training on reasoning

BackgroundRecent debiasing studies have shown that a short explanation about the correct solution to a reasoning problem can often improve performance of initially biased reasoners. Yet, with only one single training session, there is still a non-neglectable group of reasoners who remained biased. AimsWe explored whether repeated training on a battery of three reasoning tasks (i.e., bat-and-ball, base-rate neglect, and conjunction fallacy) can further boost reasoning performance. SampleWe recruited 120 adults, native English speakers, through Prolific Academic. MethodsWe ran two studies with a battery of three classic reasoning tasks (see above). We used a two-response paradigm in which participants first gave an initial intuitive response, under time pressure and cognitive load, and then gave a final response after deliberation. In Study 1, we ran two repeated training sessions within one week. In Study 2, we ran a third training session two months after the initial study. ResultsStudy 1 showed that after the first training session, most of the participants solved the problems correctly, as early as the initial intuitive stage. This training effect was further boosted by additional training, which helped almost the full sample to benefit. Study 2 indicated that these effects were robust and persisted after two months. ConclusionsThe repetition of the training can further boost performance compared to the effect of one single training. These results are consistent with the wider literature on repeated testing and can serve as a proof-of-principle for a repeated debias training approach.