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Harris JE. An AI-Enhanced Electronic Health Record Could Boost Primary Care Productivity. JAMA 2023; 330:801-802. [PMID: 37548970 DOI: 10.1001/jama.2023.14525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
This Viewpoint discusses ways that artificial intelligence (AI) may improve the productivity of primary care physicians with easier and more accurate use of AI-enhanced electronic health records.
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Affiliation(s)
- Jeffrey E Harris
- Adult Medicine Department, Eisner Health, Los Angeles, California
- Department of Economics, Massachusetts Institute of Technology, Cambridge
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Chen K, Wilson-Barthes M, Harris JE, Galárraga O. Incentivizing COVID-19 vaccination among racial/ethnic minority adults in the United States: $209 per dose could convince the hesitant. Health Econ Rev 2023; 13:4. [PMID: 36629981 PMCID: PMC9832714 DOI: 10.1186/s13561-023-00417-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND More than two years into the coronavirus disease (COVID-19) pandemic, it remains unclear whether financial incentives can reduce vaccine hesitancy and improve uptake among key unvaccinated populations. This study estimated the willingness of racial/ethnic minority adults in the United States to accept financial incentives for COVID-19 vaccination and the minimum amount needed to vaccinate a sufficiently high percentage of this population. METHODS From August through September 2021, we conducted an online survey of 367 Black/African American and Hispanic patients, age ≥ 18 years, from 8 community health centers in Rhode Island. Contingent valuation questions assessed respondents' willingness-to-accept (WTA) incentives for COVID-19 vaccination using random-starting-points and iterative incentive offers of $5 to $50 per dose. Ordered logistic regression models examined associations between respondent characteristics and WTA. Predictive probabilities were modeled using both within-survey range and out-of-survey range incentive offer amounts and compared against vaccination thresholds needed to reach herd immunity. RESULTS Less than 30% of unvaccinated survey respondents were WTA an incentive of $50/dose for vaccination. Models using out-of-survey incentive offer amounts greater than $50 suggested that 85% of respondents would agree $140/dose (95% CI: $43-$236) could convince other people to accept vaccination, while $209/dose (95% CI: -$91-$509) would be needed for 85% of respondents to accept vaccination themselves. CONCLUSIONS Findings from this analysis may inform the design of incentive schemes aiming to reduce racial/ethnic disparities in vaccine and booster uptake, which will continue to be important as new variants of SARS-CoV-2 emerge.
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Affiliation(s)
- Kevin Chen
- Warren Alpert Medical School of Brown University, Providence, RI 02903 USA
| | - Marta Wilson-Barthes
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912 USA
| | - Jeffrey E. Harris
- Department of Economics, Massachusetts Institute of Technology, Cambridge, MA 02142 USA
| | - Omar Galárraga
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI 02912 USA
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Harris JE. Concentric regulatory zones failed to halt surging COVID-19: Brooklyn 2020. Front Public Health 2022; 10:970363. [PMID: 36568788 PMCID: PMC9768182 DOI: 10.3389/fpubh.2022.970363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 11/11/2022] [Indexed: 12/13/2022] Open
Abstract
Methods We relied on reports of confirmed case incidence and test positivity, along with data on the movements of devices with location-tracking software, to evaluate a novel scheme of three concentric regulatory zones introduced by then New York Governor Cuomo to address an outbreak of COVID-19 in South Brooklyn in the fall of 2020. The regulatory scheme imposed differential controls on access to eating places, schools, houses of worship, large gatherings and other businesses within the three zones, but without restrictions on mobility. Results Within the central red zone, COVID-19 incidence temporarily declined from 131.2 per 100,000 population during the week ending October 3 to 62.5 per 100,000 by the week ending October 31, but then rebounded to 153.6 per 100,000 by the week ending November 28. Within the intermediate orange and peripheral yellow zones combined, incidence steadily rose from 28.8 per 100,000 during the week ending October 3 to 109.9 per 100,000 by the week ending November 28. Data on device visits to pairs of eating establishments straddling the red-orange boundary confirmed compliance with access controls. More general analysis of device movements showed stable patterns of movement between and beyond zones unaffected by the Governor's orders. A geospatial regression model of COVID-19 incidence in relation to device movements across zip code tabulation areas identified a cluster of five high-movement ZCTAs with estimated reproduction number 1.91 (95% confidence interval, 1.27-2.55). Discussion In the highly populous area of South Brooklyn, controls on access alone, without restrictions on movement, were inadequate to halt an advancing COVID-19 outbreak.
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Affiliation(s)
- Jeffrey E. Harris
- Massachusetts Institute of Technology, Cambridge, MA, United States,Eisner Health, Los Angeles, CA, United States,*Correspondence: Jeffrey E. Harris
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Schlosser A, Harris JE, Ramick M, Howard R, Razon S. Resistance And Endurance Training Improve Exercise Enjoyment And Happiness In Young Adults. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000880252.96917.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Harris JE. Mobility was a significant determinant of reported COVID-19 incidence during the Omicron Surge in the most populous U.S. Counties. BMC Infect Dis 2022; 22:691. [PMID: 35971063 PMCID: PMC9376582 DOI: 10.1186/s12879-022-07666-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 08/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Significant immune escape by the Omicron variant, along with the emergence of widespread worry fatigue, have called into question the robustness of the previously observed relation between population mobility and COVID-19 incidence. METHODS We employed principal component analysis to construct a one-dimensional summary indicator of six Google mobility categories. We related this mobility indicator to case incidence among 111 of the most populous U.S. counties during the Omicron surge from December 2021 through February 2022. RESULTS Reported COVID-19 incidence peaked earlier and declined more rapidly among those counties exhibiting more extensive decline in mobility between December 20 and January 3. Based upon a fixed-effects, longitudinal cohort model, we estimated that every 1% decline in mobility between December 20 and January 3 was associated with a 0.63% decline in peak incidence during the week ending January 17 (95% confidence interval, 0.40-0.86%). Based upon a cross-sectional analysis including mean household size and vaccination participation as covariates, we estimated that the same 1% decline in mobility was associated with a 0.36% decline in cumulative reported COVID-19 incidence from January 10 through February 28 (95% CI, 0.18-0.54%). CONCLUSION Omicron did not simply sweep through the U.S. population until it ran out of susceptible individuals to infect. To the contrary, a significant fraction managed to avoid infection by engaging in risk-mitigating behaviors. More broadly, the behavioral response to perceived risk should be viewed as an intrinsic component of the natural course of epidemics in humans.
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Affiliation(s)
- Jeffrey E Harris
- Massachusetts Institute of Technology, Cambridge, MA, 02139, USA. .,Eisner Health, Los Angeles, CA, 90015, USA.
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Harris JE, Gleason PM. Application of Path Analysis and Structural Equation Modeling in Nutrition and Dietetics. J Acad Nutr Diet 2022; 122:2023-2035. [PMID: 35863617 DOI: 10.1016/j.jand.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Jeffrey E Harris
- Department of Nutrition, West Chester University, West Chester, PA
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Bibeau K, Pandya AG, Ezzedine K, Jones H, Gao J, Lindley A, Harris JE. Vitiligo Prevalence and Quality of Life Among Adults in Europe, Japan, and the United States. J Eur Acad Dermatol Venereol 2022; 36:1831-1844. [PMID: 35611638 PMCID: PMC9544885 DOI: 10.1111/jdv.18257] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 04/27/2022] [Indexed: 11/29/2022]
Abstract
Background Vitiligo, an autoimmune disorder characterised by skin depigmentation, is associated with reduced quality of life (QoL). Vitiligo may be under‐reported, in part because of misconceptions that it is a cosmetic disease. Objectives This survey sought to characterise vitiligo prevalence and explore the relationship between sociodemographic and clinical characteristics with QoL in a population‐based, multinational study. Methods Participants aged ≥18 years were recruited via an online panel in Europe, Japan and the USA to answer questions regarding skin disorders they may have experienced. Those reporting vitiligo (diagnosed or undiagnosed) or vitiligo signs (experiencing loss of skin colour but unaware of vitiligo and not diagnosed) were included in the analyses of vitiligo prevalence. Participants who self‐reported physician‐diagnosed vitiligo were given a broader survey to characterise disease progression, management and QoL (as measured with the Vitiligo‐specific QoL [VitiQoL] instrument). Results The total estimated vitiligo prevalence among 35 694 survey participants (Europe, n = 18 785; USA, n = 8517; Japan, n = 8392) was 1.3% (diagnosed, 0.6%; undiagnosed, 0.4%; vitiligo signs, 0.3%). Among 219 patients formally diagnosed with vitiligo (Europe, n = 150; USA, n = 48; Japan, n = 21), total VitiQoL scores were associated with age (P = 0.00017), disease extent (P < 0.0001), disease progression (P < 0.0001), disease management (P < 0.0001) and time since diagnosis (P = 0.0015). Behaviour scores varied based on skin phototype (P = 0.024) and ethnicity (P = 0.048). Higher total VitiQoL scores were reported in patients with head lesions (P = 0.027) and those with head and hand and/or wrist lesions (P = 0.018). Substantial high concern (rated 8–10 on an 11‐point Likert scale) for lesions was found across all body areas and varied with geographical region. Conclusions The vitiligo prevalence rate may be higher than previously reported, with a substantial proportion attributed to people who have not received a formal diagnosis. Among formally diagnosed patients with vitiligo, QoL was most severely impacted by more progressive and higher extent of disease.
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Affiliation(s)
- K Bibeau
- Incyte Corporation, Wilmington, DE, USA
| | - A G Pandya
- Palo Alto Foundation Medical Group, Sunnyvale, CA, USA.,University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - K Ezzedine
- Department of Dermatology, Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris, France
| | - H Jones
- Incyte Corporation, Wilmington, DE, USA
| | - J Gao
- Incyte Corporation, Wilmington, DE, USA
| | - A Lindley
- Incyte Corporation, Wilmington, DE, USA
| | - J E Harris
- University of Massachusetts Medical School, Worcester, MA, USA
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Harris JE. Timely epidemic monitoring in the presence of reporting delays: anticipating the COVID-19 surge in New York City, September 2020. BMC Public Health 2022; 22:871. [PMID: 35501734 PMCID: PMC9058738 DOI: 10.1186/s12889-022-13286-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/21/2022] [Indexed: 02/05/2023] Open
Abstract
Background During a fast-moving epidemic, timely monitoring of case counts and other key indicators of disease spread is critical to an effective public policy response. Methods We describe a nonparametric statistical method, originally applied to the reporting of AIDS cases in the 1980s, to estimate the distribution of reporting delays of confirmed COVID-19 cases in New York City during the late summer and early fall of 2020. Results During August 15–September 26, the estimated mean delay in reporting was 3.3 days, with 87% of cases reported by 5 days from diagnosis. Relying upon the estimated reporting-delay distribution, we projected COVID-19 incidence during the most recent 3 weeks as if each case had instead been reported on the same day that the underlying diagnostic test had been performed. Applying our delay-corrected estimates to case counts reported as of September 26, we projected a surge in new diagnoses that had already occurred but had yet to be reported. Our projections were consistent with counts of confirmed cases subsequently reported by November 7. Conclusion The projected estimate of recently diagnosed cases could have had an impact on timely policy decisions to tighten social distancing measures. While the recent advent of widespread rapid antigen testing has changed the diagnostic testing landscape considerably, delays in public reporting of SARS-CoV-2 case counts remain an important barrier to effective public health policy. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13286-7.
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Affiliation(s)
- Jeffrey E Harris
- Massachusetts Institute of Technology, Cambridge, MA, 02139, USA. .,Eisner Health, Los Angeles, CA, 90015, USA.
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Harris JE. Geospatial Analysis of a COVID-19 Outbreak at the University of Wisconsin - Madison: Potential Role of a Cluster of Local Bars. Epidemiol Infect 2022; 150:1-31. [PMID: 35380104 PMCID: PMC9043656 DOI: 10.1017/s0950268822000498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 02/10/2022] [Accepted: 03/08/2022] [Indexed: 11/16/2022] Open
Abstract
We combined smartphone mobility data with census track-based reports of positive case counts to study a coronavirus disease 2019 (COVID-19) outbreak at the University of Wisconsin–Madison campus, where nearly 3000 students had become infected by the end of September 2020. We identified a cluster of twenty bars located at the epicentre of the outbreak, in close proximity to campus residence halls. Smartphones originating from the two hardest-hit residence halls (Sellery-Witte), where about one in five students were infected, were 2.95 times more likely to visit the 20-bar cluster than smartphones originating in two more distant, less affected residence halls (Ogg-Smith). By contrast, smartphones from Sellery-Witte were only 1.55 times more likely than those from Ogg-Smith to visit a group of 68 restaurants in the same area [rate ratio 1.91, 95% confidence interval (CI) 1.29–2.85, P < 0.001]. We also determined the per-capita rates of visitation to the 20-bar cluster and to the 68-restaurant comparison group by smartphones originating in each of 21 census tracts in the university area. In a multivariate instrumental variables regression, the visitation rate to the bar cluster was a significant determinant of the per-capita incidence of positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests in each census tract (elasticity 0.88, 95% CI 0.08–1.68, P = 0.032), while the restaurant visitation rate showed no such relationship. The potential super-spreader effects of clusters or networks of places, rather than individual sites, require further attention.
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Affiliation(s)
- Jeffrey E Harris
- Professor of Economics, Emeritus, Massachusetts Institute of Technology, Cambridge MA 02139; Physician, Eisner Health, Los AngelesCA90015.
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Abstract
The decades-long effort to produce a workable HIV vaccine has hardly been a waste of public and private resources. To the contrary, the scientific know-how acquired along the way has served as the critical foundation for the development of vaccines against the novel, pandemic SARS-CoV-2 virus. We retell the real-world story of HIV vaccine research – with all its false leads and missteps – in a way that sheds light on the current state of the art of antiviral vaccines. We find that HIV-related R&D had more than a general spillover effect. In fact, the repeated failures of phase 2 and 3 clinical trials of HIV vaccine candidates have served as a critical stimulus to the development of successful vaccine technologies today. We rebut the counterargument that HIV vaccine development has been no more than a blind alley, and that recently developed vaccines against COVID-19 are really descendants of successful vaccines against Ebola, MERS, and SARS. These successful vaccines likewise owe much to the vicissitudes of HIV vaccine development. We then discuss how the failures of HIV vaccine development have taught us how adapt SARS-CoV-2 vaccines to immune escape from emerging variants. Finally, we inquire whether recent advances in the development of vaccines against SARS-CoV-2 might in turn further the development of an HIV vaccine - what we describe as a reverse spillover effect.
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Affiliation(s)
- Jeffrey E Harris
- Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA
- Eisner Health, Los Angeles, CA 90015, USA
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Abstract
We studied the possible role of the subways in the spread of SARS-CoV-2 in New York City during late February and March 2020. Data on cases and hospitalizations, along with phylogenetic analyses of viral isolates, demonstrate rapid community transmission throughout all five boroughs within days. The near collapse of subway ridership during the second week of March was followed within 1–2 weeks by the flattening of COVID-19 incidence curve. We observed persistently high entry into stations located along the subway line serving a principal hotspot of infection in Queens. We used smartphone tracking data to estimate the volume of subway visits originating from each zip code tabulation area (ZCTA). Across ZCTAs, the estimated volume of subway visits on March 16 was strongly predictive of subsequent COVID-19 incidence during April 1–8. In a spatial analysis, we distinguished between the conventional notion of geographic contiguity and a novel notion of contiguity along subway lines. We found that the March 16 subway-visit volume in subway-contiguous ZCTAs had an increasing effect on COVID-19 incidence during April 1–8 as we enlarged the radius of influence up to 5 connected subway stops. By contrast, the March 31 cumulative incidence of COVID-19 in geographically-contiguous ZCTAs had an increasing effect on subsequent COVID-19 incidence as we expanded the radius up to three connected ZCTAs. The combined evidence points to the initial citywide dissemination of SARS-CoV-2 via a subway-based network, followed by percolation of new infections within local hotspots.
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Affiliation(s)
- Jeffrey E Harris
- Department of Economics, Massachusetts Institute of Technology, Cambridge, MA, United States.,Eisner Health, Los Angeles, CA, United States
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Harris JE. COVID-19 Incidence and Hospitalization During the Delta Surge Were Inversely Related to Vaccination Coverage Among the Most Populous U.S. Counties. Health Policy Technol 2021; 11:100583. [PMID: 34868833 PMCID: PMC8629773 DOI: 10.1016/j.hlpt.2021.100583] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective We tested whether COVID-19 incidence and hospitalization rates during the Delta surge were inversely related to vaccination coverage among the 112 most populous counties in the United States, comprising 44 percent of the country's total population. Methods We measured vaccination coverage as the percent of the county population fully vaccinated as of July 15, 2021. We measured COVID-19 incidence as the number of confirmed cases per 100,000 population during the 14-day period ending August 12, 2021 and hospitalization rates as the number of confirmed COVID-19 admissions per 100,000 population during the same 14-day period. Results In log-linear regression models, a 10-percentage-point increase in vaccination coverage was associated with a 28.3% decrease in COVID-19 incidence (95% confidence interval, 16.8 - 39.7%), a 44.9 percent decrease in the rate of COVID-19 hospitalization (95% CI, 28.8 - 61.0%), and a 16.6% decrease in COVID-19 hospitalizations per 100 cases (95% CI, 8.4 - 24.8%). Inclusion of demographic covariables, as well as county-specific diabetes prevalence, did not weaken the observed inverse relationship with vaccination coverage. A significant inverse relationship between vaccination coverage and COVID-19 deaths per 100,000 during August 20 – September 16 was also observed. The cumulative incidence of COVID-19 through June 30, 2021, a potential indicator of acquired immunity due to past infection, had no significant relation to subsequent case incidence or hospitalization rates in August. Conclusion Higher vaccination coverage was associated not only with significantly lower COVID-19 incidence during the Delta surge, but also significantly less severe cases of the disease. Public Interest Summary We tested whether COVID-19 incidence and hospitalization rates during the Delta variant-related surge were inversely related to vaccination coverage among the 112 most populous counties in the United States, together comprising 44 percent of the country's total population. A 10-percentage-point increase in vaccination coverage was associated with a 28.3% decrease in COVID-19 incidence, a 44.9 percent decrease in the rate of COVID-19 hospitalization, and a 16.6% decrease in COVID-19 hospitalizations per 100 cases. Inclusion of demographic covariables, as well as county-specific diabetes prevalence, did not weaken the observed inverse relationship with vaccination coverage. A significant inverse relationship between vaccination coverage and COVID-19 deaths per 100,000 during August 20 – September 16 was also observed. Higher vaccination coverage was associated not only with significantly lower COVID-19 incidence during the Delta surge, but also significantly less severe cases of the disease.
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Affiliation(s)
- Jeffrey E Harris
- Professor of Economics, Emeritus, Massachusetts Institute of Technology, Cambridge MA 02139 USA.,Physician, Eisner Health, Los Angeles CA 90015 USA
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Harris JE, Zoellner J. Pointers and Pitfalls in Interpreting Nutrition and Dietetics Research: The Importance of Statistical and Clinical Significance. J Acad Nutr Diet 2021; 122:709-721. [PMID: 34728413 DOI: 10.1016/j.jand.2021.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 11/26/2022]
Abstract
This monograph focuses on understanding statistical and clinical significance and is one of a research and statistics series published by the statistical team of the Journal of the Academy of Nutrition and Dietetics. The content covers the research questions, the definition of clinical significance, hypothesis testing, p-values, effect sizes, sample sizes, confidence intervals, power analyses, minimal clinically important differences, and validity. This monograph concludes with a summary of the importance of clinical and statistical results, for nutrition professionals to consider when assessing statistical and clinical significance. The assessment will help readers make subjective clinical judgements in the application of research findings based on their experience.
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Affiliation(s)
- Jeffrey E Harris
- Professor of Nutrition, 222D Sturzebecker Health Science Center, West Chester University of PA, 855 South New Street, West Chester, PA 19383
| | - Jamie Zoellner
- Professor, Department of Public Health Sciences, University of Virginia, School of Medicine, P.O. Box 800717, Charlottesville, VA 22908-0717, 16 East Main St, Christiansburg, VA 24073.
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Razon S, Wolfrum LD, Harris JE. Body Self-perceptions Of Students In Exercise Science Major. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000762696.51395.c2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Galárraga O, Harris JE. Effect of an abrupt change in sexual and reproductive health policy on teen birth rates in Ecuador, 2008-2017. Econ Hum Biol 2021; 41:100967. [PMID: 33388633 PMCID: PMC8068587 DOI: 10.1016/j.ehb.2020.100967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 12/02/2020] [Accepted: 12/11/2020] [Indexed: 06/12/2023]
Abstract
Several countries have implemented "family-centered" abstinence-only policies for teenagers, as opposed to encouraging utilization and expansion of reproductive health services and education. Little is known, however, about the effects of these more restrictive policies on adolescent birth rates at the national level or their differential effects by race and ethnicity. The extant literature is even scarcer in low- and middle-income countries. We analyze an unexpected policy change in Ecuador that abruptly reversed course and restricted reproductive health services for teenage women in 2014. We use a canton- and time-fixed effects difference-in-differences analysis of Ecuador's 221 cantons with time-varying controls to analyze the impact of the abrupt policy change on the difference of teen (15-19 years) minus young adult (20-24 years) birth rates. In a difference-in-difference-in-differences analysis, the policy change increases birth rates by 8.5 births per 1000 women in cantons with higher indigenous concentration. Results are robust to changes in the comparison population (young adults vs. women in their late 20 s or in their early 30 s), pre-intervention control periods, population weighting, serial correlation, logarithmic model specification, adjustments for intervention year, definition of indigenous concentration, and potential delays in policy implementation.
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Affiliation(s)
- Omar Galárraga
- Health Services Policy & Practice, School of Public Health, Brown University, Providence, RI, 02912, United States.
| | - Jeffrey E Harris
- Department of Economics, Massachusetts Institute of Technology, Cambridge, MA, 02142, United States; NBER, United States.
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Abstract
We observed wide variation in the incidence of confirmed COVID-19 cases in 300 communities making up Los Angeles County, the largest county by population in the United States. The surge in incidence from October 19, 2020 to January 10, 2021, accounting for two-thirds of all confirmed cases since the start of the epidemic, was concentrated in communities with a high prevalence of multi-generational households. This indicator of household structure was a more important predictor of the surge in incidence than the prevalence of households with low income or with at least one high-risk worker. Based upon a spatial adaptation of the standard SIR model, the cumulative incidence of COVID-19, adjusted for underascertainment of both asymptomatic and symptomatic cases, ranged from under 10% in low multi-generational communities to over 30% in high multi-generational communities.
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Abstract
The Wisconsin Supreme Court's nullification of a carefully crafted, statewide regulatory scheme led to the substitution of a motley collection of asynchronous, uncoordinated local reopening plans that ultimately facilitated a resurgence of COVID-19. The distinct paths of epidemic containment and subsequent resurgence in Wisconsin's two most populous counties, Milwaukee and Dane, can be directly mapped into their respective volumes of bar traffic. A seemingly small relaxation of social distancing rules can result in a relatively large increase in the incidence of new infections. This study relies exclusively on publicly available, aggregate health data that contain no individual identifiers. The author has no competing interests and no funding sources to declare. This article represents to the sole opinion of its author and does not necessarily represent the opinions of the Massachusetts Institute of Technology, the National Bureau of Economic Research, Eisner Health, or any other organization.
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Affiliation(s)
- Jeffrey E Harris
- Massachusetts Institute of Technology, Cambridge MA 02139, United States
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Harris JE. Correction to: Data from the COVID-19 epidemic in Florida suggest that younger cohorts have been transmitting their infections to less socially mobile older adults. Rev Econ Househ 2020; 18:1039. [PMID: 32922243 PMCID: PMC7480208 DOI: 10.1007/s11150-020-09507-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
[This corrects the article DOI: 10.1007/s11150-020-09496-w.].
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Kuspinar A, Verschoor CP, Beauchamp MK, Dushoff J, Ma J, Amster E, Bassim C, Dal Bello-Haas V, Gregory MA, Harris JE, Letts L, Neil-Sztramko SE, Richardson J, Valaitis R, Vrkljan B. Modifiable factors related to life-space mobility in community-dwelling older adults: results from the Canadian Longitudinal Study on Aging. BMC Geriatr 2020; 20:35. [PMID: 32005107 PMCID: PMC6995110 DOI: 10.1186/s12877-020-1431-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/15/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The most common methods for measuring mobility in older adulthood include performance-based tests, such as the Timed-Up-and-Go and gait speed. While these measures have strong predictive validity for adverse outcomes, they are limited to assessing what older adults do in standardized settings, rather than what they do in their daily life. Life-space mobility, which is the ability to move within environments that expand from one's home to the greater community, has been proposed as a more comprehensive measure of mobility. The aim of this study was to determine the association between modifiable factors and life-space mobility in older adults enrolled in the Canadian Longitudinal Study on Aging (CLSA). METHODS Life-space mobility was measured using the Life Space Index (LSI). Explanatory factors included physical, psychosocial and cognitive determinants, as well as pain, fatigue, driving status, nutrition, body mass index, smoking status, and vision. To estimate the association between the LSI and explanatory variables, univariate and multivariable ordinary least squares regression analyses were performed. RESULTS All adults 65 years and older (n = 12,646) were included in the analysis. Fifty percent were women and the mean age was 73.0 (SD5.7). The mean LSI score was 80.5, indicating that, on average, the sample was able to move outside of their neighborhood independently. All explanatory variables were significantly associated with the LSI except for balance and memory. The top 3 variables that explained the most variation in the LSI were driving, social support and walking speed. CONCLUSION To our knowledge, this was the first study to examine the association between life-space mobility and a comprehensive set of modifiable factors that were selected based on a theoretical framework and existing research evidence. This study had two important messages. First, driving, social support and walking speed emerged as the most significant correlates of life-space mobility in older adults. Second, life-space mobility is multifactorial and interventions that are pragmatic in their design and testing are needed that consider the complexity involved. A multi-disciplinary approach to examining life-space mobility in older adults is needed to optimize opportunities for healthy aging and develop strategies that support mobility in older adulthood.
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Affiliation(s)
- A Kuspinar
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - C P Verschoor
- Health Sciences North Research Institute, Sudbury, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - M K Beauchamp
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - J Dushoff
- Department of Biology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - J Ma
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - E Amster
- Department of History, Faculty of Humanities, McMaster University, Hamilton, Ontario, Canada
| | - C Bassim
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - V Dal Bello-Haas
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - M A Gregory
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - J E Harris
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - L Letts
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - S E Neil-Sztramko
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - J Richardson
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - R Valaitis
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - B Vrkljan
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Harris JE. Data from the COVID-19 epidemic in Florida suggest that younger cohorts have been transmitting their infections to less socially mobile older adults. Rev Econ Househ 2020; 18:1019-1037. [PMID: 32863808 PMCID: PMC7443153 DOI: 10.1007/s11150-020-09496-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/11/2020] [Indexed: 05/04/2023]
Abstract
We analyzed the daily incidence of newly reported COVID-19 cases among adults aged 20-39 years, 40-59 years, and 60 or more years in the sixteen most populous counties of the state of Florida from March 1 through June 27, 2020. In all 16 counties, an increase in reported COVID-19 case incidence was observed in all three age groups soon after the governor-ordered Full Phase 1 reopening went into effect. Trends in social mobility, but not trends in testing, track case incidence. Data on hospitalization do not support the hypothesis that the observed increase in case incidence was merely the result of liberalization of testing criteria. Parameter estimates from a parsimonious two-group heterogeneous SIR model strongly support the hypothesis that younger persons, having first acquired their infections through increasing social contact with their peers, then transmitted their infections to older, less socially mobile individuals. Without such cross-infection, an isolated epidemic among older people in Florida would be unsustainable.
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Gleason PM, Harris JE. The Bayesian Approach to Decision Making and Analysis in Nutrition Research and Practice. J Acad Nutr Diet 2019; 119:1993-2003. [PMID: 31585828 DOI: 10.1016/j.jand.2019.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 07/09/2019] [Indexed: 11/29/2022]
Abstract
This is part of a series of monographs on research design and analysis. The purpose of this article is to describe the purposes of and approach to conducting Bayesian decision making and analysis. Bayesian decision making involves basing decisions on the probability of a successful outcome, where this probability is informed by both prior information and new evidence the decision maker obtains. The statistical analysis that underlies the calculation of these probabilities is Bayesian analysis. In recent years, the Bayesian approach has been applied more commonly in both nutrition research and clinical decision making, and registered dietitian nutritionists would benefit from gaining a deeper understanding of this approach. This article provides a background of Bayesian decision making and analysis, and then presents applications of the approach in two different areas-medical diagnoses and nutrition policy research. It concludes with a description of how Bayesian decision making may be used in everyday life to allow each of us to appropriately weigh established beliefs and prior knowledge with new data and information in order to make well-informed and wise decisions.
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Eleftheriadou V, Hamzavi I, Pandya AG, Grimes P, Harris JE, Huggins RH, Lim HW, Elbuluk N, Bhatia B, Tovar-Garza A, Nahhas AF, Braunberger T, Ezzedine K. International Initiative for Outcomes (INFO) for vitiligo: workshops with patients with vitiligo on repigmentation. Br J Dermatol 2018; 180:574-579. [PMID: 30030843 DOI: 10.1111/bjd.17013] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND There is no cure or firm clinical recommendations for the treatment of vitiligo. One of the main issues is the heterogeneity of outcome measures used in randomized controlled trials for vitiligo. OBJECTIVES To define successful repigmentation from the patients' point of view and to propose how and when repigmentation should be evaluated in clinical trials in vitiligo. METHODS We conducted three workshops with patients with vitiligo and their parents or caregivers. Workshop 1 was held at World Vitiligo Day (Detroit, MI), workshop 2 at the University of Texas Southwestern Medical Center and workshop 3 at the Vitiligo and Pigmentation Institute of Southern California, University of California. RESULTS Seventy-three participants were recruited. Consensus on the following questions was achieved unanimously: (i) the definition of 'successful repigmentation' was 80-100% of repigmentation of a target lesion and (ii) both an objective and a subjective scale to measure repigmentation should be used. CONCLUSIONS This was the largest patients' outcomes workshop. We followed the guidance from the CSG-COUSIN and the Vitiligo Global Issues Consensus Group. Our recommendations to use percentage of repigmentation quartiles (0-25%, 26-50%, 51-79%, 80-100%) and the Vitiligo Noticeability Scale are based on the best available current evidence. A limitation of the research is that the workshops were conducted only in the U.S.A., due to pre-existing organisational support and the availability of funding.
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Affiliation(s)
- V Eleftheriadou
- Centre of Evidence Based Dermatology, Kings Meadow Campus, University of Nottingham, Nottingham, U.K
| | - I Hamzavi
- Multicultural Dermatology Center, Henry Ford Hospital, Detroit, MI, U.S.A
| | - A G Pandya
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, U.S.A
| | - P Grimes
- Vitiligo and Pigmentation Institute of Southern California, Los Angeles, CA, U.S.A
| | - J E Harris
- Department of Dermatology, Vitiligo Clinic and Research Center, University of Massachusetts, Medical School, Worcester, MA, U.S.A
| | - R H Huggins
- Multicultural Dermatology Center, Henry Ford Hospital, Detroit, MI, U.S.A
| | - H W Lim
- Multicultural Dermatology Center, Henry Ford Hospital, Detroit, MI, U.S.A
| | - N Elbuluk
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, U.S.A
| | - B Bhatia
- Multicultural Dermatology Center, Henry Ford Hospital, Detroit, MI, U.S.A
| | - A Tovar-Garza
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, U.S.A
| | - A F Nahhas
- Multicultural Dermatology Center, Henry Ford Hospital, Detroit, MI, U.S.A
| | - T Braunberger
- Multicultural Dermatology Center, Henry Ford Hospital, Detroit, MI, U.S.A
| | - K Ezzedine
- Department of Dermatology, Hospital Henri Mondor, UPEC-Université Paris-Est Créteil, Paris, France
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McInerney-Leo AM, Wheeler L, Sturm RA, Tan JM, Harris JE, Anderson L, Jagirdar K, Brown MA, Leo PJ, Soyer HP, Duncan EL. Point mutation in p14 ARF -specific exon 1β of CDKN2A causing familial melanoma and astrocytoma. Br J Dermatol 2018; 178:e263-e264. [PMID: 29278422 DOI: 10.1111/bjd.16275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A M McInerney-Leo
- Translational Genomics Group, Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT) at Translational Research Institute, Woolloongabba, Queensland, Australia
| | - L Wheeler
- Translational Genomics Group, Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT) at Translational Research Institute, Woolloongabba, Queensland, Australia
| | - R A Sturm
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Australia
| | - J-M Tan
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Australia
- Dermatology Department, Princess Alexandra Hospital, Brisbane, Australia
| | - J E Harris
- Translational Genomics Group, Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT) at Translational Research Institute, Woolloongabba, Queensland, Australia
| | - L Anderson
- Translational Genomics Group, Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT) at Translational Research Institute, Woolloongabba, Queensland, Australia
| | - K Jagirdar
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Australia
| | - M A Brown
- Translational Genomics Group, Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT) at Translational Research Institute, Woolloongabba, Queensland, Australia
| | - P J Leo
- Translational Genomics Group, Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT) at Translational Research Institute, Woolloongabba, Queensland, Australia
| | - H P Soyer
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Australia
- Dermatology Department, Princess Alexandra Hospital, Brisbane, Australia
| | - E L Duncan
- Translational Genomics Group, Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT) at Translational Research Institute, Woolloongabba, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Endocrinology, Royal Brisbane and Women's Hospital, Herston, Australia
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Affiliation(s)
- M Rashighi
- Division of Dermatology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, 01605, U.S.A
| | - J E Harris
- Division of Dermatology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, 01605, U.S.A
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25
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Harris JE, Ares G, Gerstenblüth M, Machin L, Triunfo P. Impact of plain packaging of cigarettes on the risk perception of Uruguayan smokers: an experimental study. Tob Control 2017; 27:513-518. [PMID: 28887428 DOI: 10.1136/tobaccocontrol-2017-053639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 08/09/2017] [Accepted: 08/23/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Uruguay, a South American country of 3.4 million inhabitants that has already banned tobacco advertising, prohibited such terms as light, mild and low-tar and required graphic warnings covering 80% of cigarette packs, is considering the imposition of plain, standardised packaging. METHODS We conducted an experimental choice-based conjoint analysis of the impact of alternative cigarette package designs on the risk perceptions of 180 adult current Uruguayan smokers. We compared plain packaging, with a standardised brand description and the dark brown background colour required on Australian cigarette packages, to two controls: the current package design with distinctive brand elements and colours; and a modified package design, with distinctive brand elements and the dark brown background colour. Graphic warnings were also varied. RESULTS Plain packaging significantly reduced the probability of perceiving the stimulus cigarettes as less harmful in comparison to the current package design (OR 0.398, 95% CI 0.333 to 0.476, p<0.001) and the modified package design (OR 0.729, 95% CI 0.626 to 0.849, p<0.001). CONCLUSIONS Plain packaging enhanced the perceived risk of cigarette products even in a highly regulated setting such as Uruguay. Both the elimination of distinctive brand elements and the use of Australia's dark brown background colour contributed to the observed effect.
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Affiliation(s)
- Jeffrey E Harris
- Department of Economics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Gastón Ares
- Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la Republica Uruguay, Montevideo, Uruguay
| | - Mariana Gerstenblüth
- Departamento de Economía, Facultad de Ciencias Sociales, Universidad de la Republica Uruguay, Montevideo, Uruguay
| | - Leandro Machin
- Centro de Investigación Básica en Psicología, Facultad de Psicología, Universidad de la Republica Uruguay, Montevideo, Uruguay
| | - Patricia Triunfo
- Departamento de Economía, Facultad de Ciencias Sociales, Universidad de la Republica Uruguay, Montevideo, Uruguay
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26
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Januszewski J, Beckman JM, Harris JE, Turner AW, Yen CP, Uribe JS. Biomechanical study of rod stress after pedicle subtraction osteotomy versus anterior column reconstruction: A finite element study. Surg Neurol Int 2017; 8:207. [PMID: 28966814 PMCID: PMC5609360 DOI: 10.4103/sni.sni_44_17] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 07/03/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In an effort to minimize rod fractures and nonunion in pedicle subtraction osteotomy (PSO) constructs, surgeons have adopted multirod constructs and interbody cages. Anterior column realignment (ACR) with posterior column osteotomies is a minimally invasive alternative to PSO in sagittal balance correction, however, there is a paucity of evidence with respect to rod survival. METHODS Three-dimensional (3D) finite-element-model of a T12-sacrum spine segment was used to compare a 25° PSO at L3 and an ACR with a posterior column osteotomy and 30° hyperlordotic interbody cage at L3-4. The amount of overall T12-S1 lordosis correction was the same for each condition. Each simulation included cobalt chromium alloy primary rods with: (1) PSO; (2) PSO with an interbody cage (IB) at L2-3 (PSO+IB); (3) PSO with accessory (A) rods and IB at L2-3 (PSO+IB+A); (4) PSO with satellite (S) rods and IB at L2-3 (PSO+IB+2S); (5) ACR; 6) ACR with satellite rods (ACR + 2S). A 400 N follower preload was simulated for each condition. RESULTS PSO condition had the largest rod stress of 286 MPa in flexion. Adding interbody support reduced the rod stress by 15%. The 4-rod constructs further reduced rod stress, with the satellite rod condition facilitating the largest reduction. The rod stress in the ACR+2S was equivalent to the PSO+2S, with 50% reduction in rod stress. CONCLUSION The rod stress with an ACR was comparable to a PSO coupled with interbody support. These results suggest an ACR is a viable MIS alternative to a PSO without the need for a large posterior osteotomy.
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Affiliation(s)
- Jacob Januszewski
- Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Joshua M Beckman
- Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
| | | | | | - Chun Po Yen
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Juan S Uribe
- Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
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Nazzal C, Harris JE. Lower incidence of myocardial infarction after smoke-free legislation enforcement in Chile. Bull World Health Organ 2017; 95:674-682. [PMID: 29151635 PMCID: PMC5691402 DOI: 10.2471/blt.16.189894] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 06/22/2017] [Accepted: 06/26/2017] [Indexed: 11/27/2022] Open
Abstract
Objective To evaluate the impact of a complete smoking ban in enclosed spaces on the incidence of acute myocardial infarction in Chile. Methods The population-based study involved residents of urban areas, where 80% of the Chilean population live, aged 20 years or older who had a myocardial infarction. Monthly myocardial infarction incidence and mortality rates at health-care facilities between January 2011 and December 2014 were derived from admission and mortality databases. Regression discontinuity methods were used to estimate the near-immediate impact on disease incidence of enforcing smoke-free legislation in March 2013. The same analysis was performed for ischaemic stroke, degenerative disc disease and colon cancer. Data on the concentration of fine respirable particulates were included in an additional analysis of myocardial infarction incidence in the Santiago metropolitan area. Results The enforcement of smoke-free legislation was associated with an abrupt, near-immediate decline of 0.639 cases of myocardial infarction per 100 000 adults per month (95% confidence interval, CI: 0.242 to 1.036; relative decline: 7.8%). Similar declines were observed in men and women and in people aged over and under 70 years. However, enforcement of the legislation was not associated with a significant change in the rate of ischaemic stroke, degenerative disc disease or colon cancer. The abrupt decline in myocardial infarction incidence was also observed when data on fine respirable particulates were included in an analysis for Santiago. Conclusion The enforcement of extensive smoke-free legislation in Chile was associated with an abrupt, near-immediate decline in the incidence of myocardial infarction.
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Affiliation(s)
- Carolina Nazzal
- School of Public Health, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Jeffrey E Harris
- Department of Economics, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts, MA 02139, United States of America
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28
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Zoellner J, Harris JE. Mixed-Methods Research in Nutrition and Dietetics. J Acad Nutr Diet 2017; 117:683-697. [DOI: 10.1016/j.jand.2017.01.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 01/19/2017] [Indexed: 10/20/2022]
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Harris JE, Lopez-Valcarcel BG, Barber P, Ortún V. Allocation of Residency Training Positions in Spain: Contextual Effects on Specialty Preferences. Health Econ 2017; 26:371-386. [PMID: 26880315 DOI: 10.1002/hec.3318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 12/15/2015] [Accepted: 12/21/2015] [Indexed: 06/05/2023]
Abstract
In Spain's 'MIR' system, medical school graduates are ranked by their performance on a national exam and then sequentially choose from the available residency training positions. We took advantage of a unique survey of participants in the 2012 annual MIR cycle to analyze preferences under two different choice scenarios: the residency program actually chosen by each participant when it came her turn (the 'real') and the program that she would have chosen if all residency training programs had been available (the 'counterfactual'). Utilizing conditional logit models with random coefficients, we found significant differences in medical graduates' preferences between the two scenarios, particularly with respect to three specialty attributes: work hours/lifestyle, prestige among colleagues, and annual remuneration. In the counterfactual world, these attributes were valued preferentially by those nearer to the top, while in the real world, they were valued preferentially by graduates nearer to the bottom of the national ranking. Medical graduates' specialty preferences, which we conclude, are not intrinsically stable but depend critically on the 'rules of the game'. The MIR assignment system, by restricting choice, effectively creates an externality in which those at the bottom, who have fewer choices, want what those at the top already have. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jeffrey E Harris
- Department of Economics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Beatriz G Lopez-Valcarcel
- Department of Quantitative Methods in Economics and Management, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Patricia Barber
- Department of Quantitative Methods in Economics and Management, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Vicente Ortún
- Faculty of Economic and Business Sciences, Universitat Pompeu Fabra, Barcelona, Spain
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Harris JE, Mays J, Ratcliff G, Chase S, Vemich L, Colantonio A. Level of agreement of occupational titles between persons with traumatic brain injury and their informants. Work 2017; 53:561-7. [PMID: 26835851 DOI: 10.3233/wor-152223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Returning to work is one of the most important goals cited by individuals with traumatic brain injury (TBI). However, they may have difficulty evoking past work history. The ability to recall work history is integral to the rehabilitation process of return to work. OBJECTIVE The aim of this study was to determine 1) the level of agreement on the reporting of occupations and 2) if agreement is affected when specific occupational details are required in recall between adults with traumatic brain injury and their informants. METHODS This is a retrospective cohort study of 259 individuals, with moderate to severe traumatic brain injury, and their selected informants (e.g. spouse, parent). Interviews were conducted separately for the individual and respective informant to gather information on type of occupation at time of injury and at time of interview. Reported occupations were coded using a standard classification system. Level of agreement was analyzed by interclass correlation coefficients and percent agreement, and the significance of bias was calculated. RESULTS Participants were a mean age of 44.5 at time of study with 40% employed compared to 77% at time of injury. Agreement between participants and their informants for occupational title was high for both time periods though more so at the time of injury compared to current status. Level of agreement for specificity was moderate to high however, decreased as need for specificity of detail increased. CONCLUSION While participant-informant responses appear to be reliable for occupational classification, when detailed information is required corroborating information is likely needed.
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Affiliation(s)
- J E Harris
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - J Mays
- Bloorview-MacMillan Children's Centre, Toronto, Ontario, Canada
| | - G Ratcliff
- HealthSouth Harrnarville Rehabilitation Center, Pittsburgh, PA, USA
| | - S Chase
- Working Order, Pittsburgh, PA, USA
| | - L Vemich
- Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
| | - A Colantonio
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada.,Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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Bess S, Harris JE, Turner AWL, LaFage V, Smith JS, Shaffrey CI, Schwab FJ, Haid RW. The effect of posterior polyester tethers on the biomechanics of proximal junctional kyphosis: a finite element analysis. J Neurosurg Spine 2017; 26:125-133. [DOI: 10.3171/2016.6.spine151477] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Proximal junctional kyphosis (PJK) remains problematic following multilevel instrumented spine surgery. Previous biomechanical studies indicate that providing less rigid fixation at the cranial aspect of a long posterior instrumented construct, via transition rods or hooks at the upper instrumented vertebra (UIV), may provide a gradual transition to normal motion and prevent PJK. The purpose of this study was to evaluate the ability of posterior anchored polyethylene tethers to distribute proximal motion segment stiffness in long instrumented spine constructs.
METHODS
A finite element model of a T7–L5 spine segment was created to evaluate range of motion (ROM), intradiscal pressure, pedicle screw loads, and forces in the posterior ligament complex within and adjacent to the proximal terminus of an instrumented spine construct. Six models were tested: 1) intact spine; 2) bilateral, segmental pedicle screws (PS) at all levels from T-11 through L-5; 3) bilateral pedicle screws from T-12 to L-5 and transverse process hooks (TPH) at T-11 (the UIV); 4) pedicle screws from T-11 to L5 and 1-level tethers from T-10 to T-11 (TE-UIV+1); 5) pedicle screws from T-11 to L-5 and 2-level tethers from T-9 to T-11 (TE-UIV+2); and 6) pedicle screws and 3-level tethers from T-8 to T-11 (TE-UIV+3).
RESULTS
Proximal-segment range of motion (ROM) for the PS construct increased from 16% at UIV−1 to 91% at UIV. Proximal-segment ROM for the TPH construct increased from 27% at UIV−1 to 92% at UIV. Posterior tether constructs distributed ROM at the UIV and cranial adjacent segments most effectively; ROM for TE-UIV+1 was 14% of the intact model at UIV−1, 76% at UIV, and 98% at UIV+1. ROM for TE-UIV+2 was 10% at UIV−1, 51% at UIV, 69% at UIV+1, and 97% at UIV+2. ROM for TE-UIV+3 was 7% at UIV−1, 33% at UIV, 45% at UIV+1, and 64% at UIV+2. Proximal segment intradiscal pressures, pedicle screw loads, and ligament forces in the posterior ligament complex were progressively reduced with increasing number of posterior tethers used.
CONCLUSIONS
Finite element analysis of long instrumented spine constructs demonstrated that posterior tethers created a more gradual transition in ROM and adjacent-segment stress from the instrumented to the noninstrumented spine compared with all PS and TPH constructs. Posterior tethers may limit the biomechanical risk factor for PJK; however, further clinical research is needed to evaluate clinical efficacy.
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Affiliation(s)
- Shay Bess
- 1Department of Orthopaedic Surgery, New York University/Hospital for Joint Diseases
| | | | | | - Virginie LaFage
- 3Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Justin S. Smith
- 4Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia; and
| | - Christopher I. Shaffrey
- 4Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia; and
| | - Frank J. Schwab
- 3Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
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Beto JA, Champagne CM, Dennett CC, Harris JE. The Challenge of Connecting Dietary Changes to Improved Disease Outcomes: The Balance between Positive, Neutral, and Negative Publication Results. J Acad Nutr Diet 2016; 116:917-20. [PMID: 27050727 DOI: 10.1016/j.jand.2016.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 02/18/2016] [Indexed: 01/08/2023]
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Harris JE, Balsa AI, Triunfo P. Tobacco control campaign in Uruguay: Impact on smoking cessation during pregnancy and birth weight. J Health Econ 2015; 42:186-96. [PMID: 25985121 DOI: 10.1016/j.jhealeco.2015.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 04/13/2015] [Accepted: 04/20/2015] [Indexed: 05/08/2023]
Abstract
We analyzed a nationwide registry of all pregnancies in Uruguay during 2007-2013 to assess the impact of three types of tobacco control policies: (1) provider-level interventions aimed at the treatment of nicotine dependence, (2) national-level increases in cigarette taxes, and (3) national-level non-price regulation of cigarette packaging and marketing. We estimated models of smoking cessation during pregnancy at the individual, provider and national levels. The rate of smoking cessation during pregnancy increased from 15.4% in 2007 to 42.7% in 2013. National-level non-price policies had the largest estimated impact on cessation. The price response of the tobacco industry attenuated the effects of tax increases. While provider-level interventions had a significant effect, they were adopted by relatively few health centers. Quitting during pregnancy increased birth weight by an estimated 188 g. Tobacco control measures had no effect on the birth weight of newborns of non-smoking women.
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Affiliation(s)
- Jeffrey E Harris
- Department of Economics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
| | - Ana Inés Balsa
- Departamento de Economía, Facultad de Ciencias Empresariales y Economía, Universidad de Montevideo, Montevideo 11500, Uruguay.
| | - Patricia Triunfo
- Departamento de Economía, Facultad de Ciencias Sociales, Universidad de la República, Montevideo 11200, Uruguay.
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Gleason PM, Boushey CJ, Harris JE, Zoellner J. Publishing Nutrition Research: A Review of Multivariate Techniques—Part 3: Data Reduction Methods. J Acad Nutr Diet 2015; 115:1072-82. [DOI: 10.1016/j.jand.2015.03.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 03/06/2015] [Indexed: 12/20/2022]
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Lopez-Valcarcel BG, Ortún V, Barber P, Harris JE. Respuesta de los autores. Aten Primaria 2015; 47:257. [PMID: 25510490 PMCID: PMC6983785 DOI: 10.1016/j.aprim.2014.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 05/22/2014] [Indexed: 11/26/2022] Open
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Harris JE, Hebert A. Utilization of motor imagery in upper limb rehabilitation: a systematic scoping review. Clin Rehabil 2015; 29:1092-107. [DOI: 10.1177/0269215514566248] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 12/06/2014] [Indexed: 11/15/2022]
Abstract
Objective: To determine how motor imagery is being delivered in upper limb rehabilitation to guide practice and research. Data source: MEDLINE, PubMed, CINAHL, EMBASE, PsychINFO databases were searched from 1987 to November 2014 Study selection: English, adults, any clinical population or diagnosis, intervention for upper limb with an outcome measure used. All types of studies were included. Two authors independently selected studies for review using consensus. Data extraction: Seven motor imagery elements were extracted using a model implemented in sport research: PETTLEP model (Physical, Environment, Task, Timing, Learning, Emotion, and Perspective). Results: The search yielded 1107 articles with 1059 excluded leaving 48 articles for full review. A total of 38 articles involved individuals with stroke, five articles involved individuals with complex regional pain syndrome, and five articles for other conditions. Motor imagery elements most commonly described were physical, environment, task, and perspective. Elements less commonly described were timing, learning, and emotional aspects. There were significant differences between study populations (e.g. stroke and complex regional pain syndrome) and within populations on how motor imagery was delivered. Conclusion: Many of the imagery elements reviewed are not being considered or reported on in the selected studies. How motor imagery is being delivered within and between populations is inconsistent, which may lead to difficulties in determining key elements of effectiveness.
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Affiliation(s)
- JE Harris
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - A Hebert
- Hotel Dieu Shaver Rehabilitation Center, St. Catherines, Ontario, Canada
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McInerney-Leo AM, Duncan EL, Leo PJ, Gardiner B, Bradbury LA, Harris JE, Clark GR, Brown MA, Zankl A. COL1A1 C-propeptide cleavage site mutation causes high bone mass, bone fragility and jaw lesions: a new cause of gnathodiaphyseal dysplasia? Clin Genet 2014; 88:49-55. [PMID: 24891183 DOI: 10.1111/cge.12440] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 05/04/2014] [Accepted: 05/28/2014] [Indexed: 01/26/2023]
Abstract
Gnathodiaphyseal dysplasia (GDD) is a rare autosomal dominant condition characterized by bone fragility, irregular bone mineral density (BMD) and fibro-osseous lesions in the skull and jaw. Mutations in Anoctamin-5 (ANO5) have been identified in some cases. We aimed to identify the causative mutation in a family with features of GDD but no mutation in ANO5, using whole exome capture and massive parallel sequencing (WES). WES of two affected individuals (a mother and son) and the mother's unaffected parents identified a mutation in the C-propeptide cleavage site of COL1A1. Similar mutations have been reported in individuals with osteogenesis imperfecta (OI) and paradoxically increased BMD. C-propeptide cleavage site mutations in COL1A1 may not only cause 'high bone mass OI', but also the clinical features of GDD, specifically irregular sclerotic BMD and fibro-osseous lesions in the skull and jaw. GDD patients negative for ANO5 mutations should be assessed for mutations in type I collagen C-propeptide cleavage sites.
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Affiliation(s)
- A M McInerney-Leo
- Human Genetics Group, The University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia
| | - E L Duncan
- Human Genetics Group, The University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia.,Department of Endocrinology, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia
| | - P J Leo
- Human Genetics Group, The University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia
| | - B Gardiner
- Human Genetics Group, The University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia
| | - L A Bradbury
- Human Genetics Group, The University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia
| | - J E Harris
- Human Genetics Group, The University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia
| | - G R Clark
- Human Genetics Group, The University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia.,Department of Medical Genetics, Academic Laboratory of Medical Genetics, Addenbrooke's Hospital, Cambridge, UK
| | - M A Brown
- Human Genetics Group, The University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia
| | - A Zankl
- Discipline of Genetic Medicine, The University of Sydney, Sydney, Australia.,Academic Department of Medical Genetics, Sydney Children's Hospital Network (Westmead), Sydney, Australia
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González Lopez-Valcarcel B, Ortún V, Barber P, Harris JE. [Important differences between faculties of medicine. Implications for family and community medicine]. Aten Primaria 2014; 46:140-6. [PMID: 24238767 PMCID: PMC6985598 DOI: 10.1016/j.aprim.2013.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 07/24/2013] [Accepted: 08/29/2013] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To determine if there are significant differences between universities in the proclivity to choose Family and Community Medicine (FCM), given the constraints imposed by the number of choice. To test the hypothesis that the Schools of Medicine that have the FCM as a compulsory subject in the degree (3 of 27) had the highest preference for this specialty. DESIGN Observational study on the data file of all the individuals taking the MIR examination between 2003 and 2011. LOCATION Spain. PARTICIPANTS All those who sat the examinations called by MIR 2003-2011. MAIN MEASUREMENTS Position in the ranking of each candidate, elected position (specialty and center), post code of residence, sex, nationality and university in which they studied, and post code location for the residence chosen. RESULTS The percentage electing FCM is highly correlated with the position in the ranking: 8% of graduates for the 'best' college, 46% for the worst. Very noticeable and consistent differences in the preparation for the MIR among the 27 medical schools. Ranking in the exam, female and foreigner, help predict the choice of FCM. The FCM compulsory curriculum from three universities does not seem to exert any influence. CONCLUSIONS The convenient yardstick competition between the schools of medicine, FCM in their curriculum and the emphasis on the most attractive attributes of the specialty can contribute to the necessary renewal of FCM.
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Affiliation(s)
- Beatriz González Lopez-Valcarcel
- Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Vicente Ortún
- Centre de Recerca en Economia i Salut (CRES) y Departamento de Economía y Empresa, Universidad Pompeu Fabra, Barcelona, España.
| | - Patricia Barber
- Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Jeffrey E Harris
- Departamento de Economía, Massachusetts Institute of Technology, Cambridge, Massachusetts, Estados Unidos; Providence Community Health Centers, Providence, Rhode Island, Estados Unidos
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Abstract
OBJECTIVE To investigate the determinants of specialty choice among graduating medical students in Spain, a country that entered into a severe, ongoing economic crisis in 2008. SETTING Since 2008, the percentage of Spanish medical school graduates electing Family and Community Medicine (FCM) has experienced a reversal after more than a decade of decline. DESIGN A nationwide cross-sectional survey conducted online in April 2011. PARTICIPANTS We invited all students in their final year before graduation from each of Spain's 27 public and private medical schools to participate. MAIN OUTCOME MEASURES Respondents' preferred specialty in relation to their perceptions of: (1) the probability of obtaining employment; (2) lifestyle and work hours; (3) recognition by patients; (4) prestige among colleagues; (5) opportunity for professional development; (6) annual remuneration and (7) the proportion of the physician's compensation from private practice. RESULTS 978 medical students (25% of the nationwide population of students in their final year) participated. Perceived job availability had the largest impact on specialty preference. Each 10% increment in the probability of obtaining employment increased the odds of preferring a specialty by 33.7% (95% CI 27.2% to 40.5%). Job availability was four times as important as compensation from private practice in determining specialty choice (95% CI 1.7 to 6.8). We observed considerable heterogeneity in the influence of lifestyle and work hours, with students who preferred such specialties as Cardiovascular Surgery and Obstetrics and Gynaecology valuing longer rather than shorter workdays. CONCLUSIONS In the midst of an ongoing economic crisis, job availability has assumed critical importance as a determinant of specialty preference among Spanish medical students. In view of the shortage of practitioners of FCM, public policies that take advantage of the enhanced perceived job availability of FCM may help steer medical school graduates into this specialty.
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Affiliation(s)
- Jeffrey E Harris
- Department of Economics,Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | | | - Vicente Ortún
- Facultad de Ciencias Económicas y Empresariales, Universitat Pompeu Fabra, Barcelona, Spain
| | - Patricia Barber
- Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain
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Abstract
BACKGROUND In 2005, Uruguay initiated a series of comprehensive anti-smoking measures. We aimed to assess the effect of Uruguay's anti-tobacco campaign. METHODS We did a population-based trend analysis, using neighbouring Argentina, which has not instituted such extensive anti-tobacco measures, as a control. We assessed three key endpoints in both countries: per-person consumption of cigarettes, as measured by tax records; the prevalence of tobacco use in adolescents, as measured by school-based surveys; and the prevalence of tobacco use in adults, as measured by nationwide household-based surveys. FINDINGS During 2005-11, per-person consumption of cigarettes in Uruguay decreased by 4·3% per year (95% CI 2·4 to 6·2), whereas per-person consumption in Argentina increased by 0·6% per year (-1·2 to 2·5; p=0·002 for difference in trends). During 2003-09, the 30-day prevalence of tobacco use in Uruguayan students aged 13 years, 15 years, and 17 years decreased by an estimated 8·0% per year (4·5 to 11·6), compared with a decrease of 2·5% annually (0·5 to 4·5) in Argentinian students during 2001-09 (p=0·02 for difference in trends). From 2005 to 2011, the prevalence of current tobacco use in Uruguay decreased annually by an estimated 3·3% (2·4 to 4·1), compared with an annual decrease in Argentina of 1·7% (0·8 to 2·6; p=0·02 for difference in trends). INTERPRETATION Uruguay's comprehensive tobacco-control campaign has been associated with a substantial, unprecedented decrease in tobacco use. Decreases in tobacco use in other low-income and middle-income countries of the magnitude seen in Uruguay would have a substantial effect on the future global burden of tobacco-related diseases. FUNDING J William Fulbright Foreign Scholarship Board and the US Department of State.
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Affiliation(s)
- Winston Abascal
- National Programme for Tobacco Control, Ministry of Public Health, Montevideo, Uruguay
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Harris JE, Sheean PM, Gleason PM, Bruemmer B, Boushey C. Publishing nutrition research: a review of multivariate techniques--part 2: analysis of variance. J Acad Nutr Diet 2011; 112:90-8. [PMID: 22709639 DOI: 10.1016/j.jada.2011.09.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 09/16/2011] [Indexed: 11/16/2022]
Abstract
This article is the eighth in a series exploring the importance of research design, statistical analysis, and epidemiology in nutrition and dietetics research, and the second in a series focused on multivariate statistical analytical techniques. The purpose of this review is to examine the statistical technique, analysis of variance (ANOVA), from its simplest to multivariate applications. Many dietetics practitioners are familiar with basic ANOVA, but less informed of the multivariate applications such as multiway ANOVA, repeated-measures ANOVA, analysis of covariance, multiple ANOVA, and multiple analysis of covariance. The article addresses all these applications and includes hypothetical and real examples from the field of dietetics.
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Affiliation(s)
- Jeffrey E Harris
- Department of Health, 213 Sturzebecker Health Sciences Center, West Chester University, West Chester, PA 19383, USA.
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Harris JE, Marshak-Rothstein A. Editorial: Interfering with B cell immunity. J Leukoc Biol 2011; 89:805-6. [PMID: 21628334 DOI: 10.1189/jlb.0111042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
Confronted with the recent high-profile failures of several clinical trials of promising candidate vaccines against HIV, many scientists have all but given up hope of producing a human-ready vaccine within the next decade. In this review I contend that although the scientific obstacles remain formidable, the economic challenges are just as real. The groundwork will be laid for a major scientific breakthrough in vaccine development only when there are new contractual structures that enhance private incentives for vaccine development; when we have clearly specified the rights to the profitable North American market; when we have established a system of liability protection for vaccine side effects; and when our clinical trials also test the behavioral consequences of vaccination.
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Affiliation(s)
- Jeffrey E Harris
- Massachusetts Institute of Technology in Cambridge, Massachusetts, and Blackstone Valley Community Health Care in Pawtucket, Rhode Island, USA.
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Greig JD, Lee MB, Harris JE. Review of enteric outbreaks in prisons: effective infection control interventions. Public Health 2011; 125:222-8. [PMID: 21440921 DOI: 10.1016/j.puhe.2010.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 11/23/2010] [Accepted: 12/17/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To identify documented outbreaks, worldwide, of enteric illness in correctional facilities over the last 10 years to understand the epidemiology of the outbreaks and explicitly identify effective infection control measures. STUDY DESIGN Review of literature and outbreak investigation reports. METHODS Computer-aided searches of literature databases and systematic searches of government websites were completed to identify relevant outbreak reports. Reference lists were hand-searched to validate the electronic search methodology. Reports identified through personal communications with public health officials were also included. RESULTS Of the 72 outbreaks meeting the inclusion criteria, 76% and 21% were associated with bacterial agents and viral agents, respectively. The majority of outbreaks were associated with Salmonella (n=20), Clostridium perfringens (n=14), norovirus (n=14), pathogenic Escherichia coli (n=10) and Campylobacter spp. (n=5). Transmission was primarily foodborne (67%). During an outbreak, the most common control measures included limiting movements of ill inmates and staff, and their exclusion from kitchen duty. The most common retrospectively reported preventative recommendations included monitoring food temperatures and effective infection control procedures. CONCLUSIONS It is essential to monitor food temperatures to prevent enteric outbreaks in prisons. Training in safe food handling should be offered to inmates who work in the kitchen. Enteric outbreaks are best controlled by effective infection control practices, while active surveillance and early diagnosis may prevent further spread of illness.
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Affiliation(s)
- J D Greig
- Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, 160 Research Lane, Unit 206, Guelph, Ontario N1G 5B2, Canada.
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Abstract
A novel thermophilic, coccoid methanogen isolated from nonthermal freshwater sediments is described. Hydrogen plus carbon dioxide and formate were substrates for methanogenesis, and methane production was stimulated by yeast extract, Casamino Acids, and tryptose. Growth also occurred autotrophically. Elevated levels of sodium chloride were not required for maximum growth and were inhibitory above 2%. The minimum doubling time occurred at 57 degrees C, and the upper and lower limits for methane production were 62 and 26 degrees C, respectively. The optimum pH for growth was between 7.0 and 7.5. Inhibitory antibiotics included metronidazole, anisomycin, chloramphenicol, and lasalocid. Colonies were circular, dark yellow, shiny, and convex with entire edges. Cells were 1 to 2.5 mum in diameter, nonmotile, occurring singly or in pairs, and fimbriated. Cells were lysed by pronase or trypsin digestion, glass-distilled water, and 1% sodium dodecyl sulfate. Electron micrographs of thin sections showed a monolayered cell wall ca. 20 nm thick. The DNA base ratio was 49.2 mol% guanine plus cytosine. The whole cell protein pattern differed from that of other named coccoid methanogens.
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Affiliation(s)
- J E Harris
- Agricultural and Food Research Council Food Research Institute, Colney Lane, Norwich NR4 7UA, United Kingdom
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Harris JE. Spontaneous Disaggregation of Methanosarcina mazei S-6 and Its Use in the Development of Genetic Techniques for Methanosarcina spp. Appl Environ Microbiol 2010; 53:2500-4. [PMID: 16347467 PMCID: PMC204136 DOI: 10.1128/aem.53.10.2500-2504.1987] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
When monomethylamine was the growth substrate, spontaneous disaggregation of Methanosarcina mazei S-6 commenced at the mid-exponential phase and resulted in the formation of a suspension containing 10 to 10 free cells per ml. Free cells were osmotically fragile and amenable to extraction of DNA. Hypertonic media for the manipulation and regeneration of free cells into aggregates were developed, and plating efficiencies of 100% were achieved for M. mazei S-6 and LYC. Free cells of strain S-6 required MgCl(2) (10 mM) for growth, whereas aggregates did not. Specific growth rates of strains S-6 and LYC were increased by MgCl(2). Treatment with pronase caused sphere formation and removal of the protein wall of cells of strain S-6, but protoplasts could not be regenerated. The disaggregating enzyme produced by strain S-6 facilitated the preparation of suspensions of free cells of some strains of Methanosarcina barkeri. Although this provided a means of extracting high-molecular-weight DNA from M. barkeri, less than 0.1% of free cells were viable.
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Affiliation(s)
- J E Harris
- Agricultural and Food Research Council Institute of Food Research, Norwich Laboratory, Norwich NR4 7UA, United Kingdom
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Sosa-Rubi SG, Galárraga O, Harris JE. Heterogeneous impact of the "Seguro Popular" program on the utilization of obstetrical services in Mexico, 2001-2006: a multinomial probit model with a discrete endogenous variable. J Health Econ 2009; 28:20-34. [PMID: 18824268 PMCID: PMC2790917 DOI: 10.1016/j.jhealeco.2008.08.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Revised: 08/03/2008] [Accepted: 08/13/2008] [Indexed: 05/26/2023]
Abstract
OBJECTIVE We evaluated the impact of Seguro Popular (SP), a program introduced in 2001 in Mexico primarily to finance health care for the poor. We focused on the effect of household enrollment in SP on pregnant women's access to obstetrical services, an important outcome measure of both maternal and infant health. DATA We relied upon data from the cross-sectional 2006 National Health and Nutrition Survey (ENSANUT) in Mexico. We analyzed the responses of 3890 women who delivered babies during 2001-2006 and whose households lacked employer-based health care coverage. METHODS We formulated a multinomial probit model that distinguished between three mutually exclusive sites for delivering a baby: a health unit specifically accredited by SP; a non-SP-accredited clinic run by the Department of Health (Secretaría de Salud, or SSA); and private obstetrical care. Our model accounted for the endogeneity of the household's binary decision to enroll in the SP program. RESULTS Women in households that participated in the SP program had a much stronger preference for having a baby in a SP-sponsored unit rather than paying out of pocket for a private delivery. At the same time, participation in SP was associated with a stronger preference for delivering in the private sector rather than at a state-run SSA clinic. On balance, the Seguro Popular program reduced pregnant women's attendance at an SSA clinic much more than it reduced the probability of delivering a baby in the private sector. The quantitative impact of the SP program varied with the woman's education and health, as well as the assets and location (rural vs. urban) of the household. CONCLUSIONS The SP program had a robust, significantly positive impact on access to obstetrical services. Our finding that women enrolled in SP switched from non-SP state-run facilities, rather than from out-of-pocket private services, is important for public policy and requires further exploration.
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Affiliation(s)
- Sandra G. Sosa-Rubi
- Center for Evaluation Research and Surveys, Division of Health Economics, National Institute of Public Health (Instituto Nacional de Salud Pública), Cuernavaca, Morelos 62508, México
| | - Omar Galárraga
- Center for Evaluation Research and Surveys, Division of Health Economics, National Institute of Public Health (Instituto Nacional de Salud Pública), Cuernavaca, Morelos 62508, México; and Institute of Business and Economic Research (IBER), University of California, Berkeley, California 94720, USA
| | - Jeffrey E. Harris
- Department of Economics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02142, USA
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Harris JE, Boushey C, Bruemmer B, Archer SL. Publishing nutrition research: a review of nonparametric methods, part 3. ACTA ACUST UNITED AC 2008; 108:1488-96. [PMID: 18755321 DOI: 10.1016/j.jada.2008.06.426] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Accepted: 03/07/2008] [Indexed: 11/24/2022]
Abstract
This is the third article in a periodic five-part series on publishing nutrition research. These monographs are designed to assist in the interpretation of the Journal of the American Dietetic Association author guidelines and provide guidance in publishing and interpreting nutrition-related research articles. This installment focuses on the use of nonparametric statistical methods. The rationale for their use, their advantages and disadvantages, nonparametric alternatives to parametric tests, nonparametric statistical analysis, examples of their use, and helpful resources for further study are topics and issues addressed in this article.
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Affiliation(s)
- Jeffrey E Harris
- Department of Health, Sturzebecker Health Sciences Center, West Chester University, West Chester, PA 19383, USA.
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Bautista-Arredondo S, Gadsden P, Harris JE, Bertozzi SM. Optimizing resource allocation for HIV/AIDS prevention programmes: an analytical framework. AIDS 2008; 22 Suppl 1:S67-74. [PMID: 18664956 DOI: 10.1097/01.aids.0000327625.69974.08] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Although investment in HIV/AIDS prevention has increased worldwide, it remains uncertain how the additional resources can be most efficiently allocated to maximize the number of infections averted, especially at the country, regional and local levels. METHODS Data from developing countries in Africa, Asia and Latin America were reviewed on the allocation of HIV/AIDS prevention funds in relation to the prevalence of infection, as well as budgetary allocations for specific population groups at high risk of infection, such as sex workers, intravenous drug users and men who have sex with men. The variation in unit costs of voluntary counselling and testing in five countries was also examined. RESULTS Evidence was found of three distinct sources of inefficiency in the allocation of HIV/AIDS prevention resources: inefficiency in the mix of interventions selected; inefficient targeting of key populations; and technical inefficiency in the production of HIV prevention services. CONCLUSION A general conceptual framework for evaluating the efficiency of HIV/AIDS prevention programmes at the country, regional and local levels is proposed. This framework stresses three equally important components of programme efficiency: cost-effectiveness (the choice of the mix of interventions); targeting (the choice of the mix of target populations); and technical efficiency (the delivery of prevention services at least cost).
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Harris JE, González López-Valcárcel B. Asymmetric peer effects in the analysis of cigarette smoking among young people in the United States, 1992-1999. J Health Econ 2008; 27:249-264. [PMID: 18179836 DOI: 10.1016/j.jhealeco.2007.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2006] [Revised: 07/20/2007] [Accepted: 07/20/2007] [Indexed: 05/25/2023]
Abstract
We extend the recent literature on peer effects to test the possible role of asymmetric social influences in the determination of youth smoking. We analyzed cigarette smoking among people aged 15-24 in approximately 90,000 households in the 1992-1999 U.S. Current Population Surveys. The presence of additional smoking sibling in a household, we estimated, raised a young person's probability of smoking by 7.6%, while each non-smoking sibling lowered the probability by an estimated 3.5%. Moreover, the overall deterrent effect of an increase in cigarette price on the probability of smoking was approximately 60% greater than the estimated effect when peer influences were held constant. The concept of asymmetric social influence may have applications in other fields, including labor economics, education, crime prevention, and group dynamics.
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Affiliation(s)
- Jeffrey E Harris
- Department of Economics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
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