Applying the Hierarchy of Controls: What Occupational Safety Can Teach us About Safely Navigating the Next Phase of the Global COVID-19 Pandemic

Eighteen months into the COVID-19 pandemic, and as the world struggles with global vaccine equity, emerging variants, and the reality that eradication is years away at soonest, we add to notion of “layered defenses” proposing a conceptual model for better understanding the differential applicability and effectiveness of precautions against SARS-CoV-2 transmission. The prevailing adaptation of Reason's Swiss cheese model conceives of all defensive layers as equally protective, when in reality some are more effective than others. Adapting the hierarchy of controls framework from occupational safety provides a better framework for understanding the relative benefit of different hazard control strategies to minimize the spread of SARS-CoV-2.

Subjective Social Class and Life Satisfaction: The Role of Class Consistency and Identity Uncertainty

Drawing on a recent perspective that inconsistent class identities can negatively impact psychological outcomes, the current research explored if the relative benefit of higher subjective social class for life satisfaction would differ depending on whether it is consistent with one’s objective social class. In Study 1, across two independent samples from Singapore (N = 1045) and the US (N = 492), higher subjective social class predicted higher life satisfaction more strongly among those high in objective social class, but less strongly among those low in objective social class. In Study 2, these patterns were replicated in another large US sample (N = 1030), and appeared to be driven by lower status-based identity uncertainty (SBIU) linked to higher subjective social class perceptions among high objective social class participants. The role of class-identity perceptions in explaining social class disparities in subjective well-being is discussed.

Does the effectiveness of IUI in couples with unexplained subfertility depend on their prognosis of natural conception? A replication of the H2Oil study

STUDY QUESTION Can we replicate the finding that the benefit of IUI-ovarian stimulation (IUI-OS) compared to expectant management for couples with unexplained subfertility depends on the prognosis of natural conception? SUMMARY ANSWER The estimated benefit of IUI-OS did not depend on the prognosis of natural conception but did depend on when treatment was started after diagnosis, with starting IUI-OS later yielding a larger absolute and relative benefit of treatment. WHAT IS KNOWN ALREADY IUI-OS is often the first-line treatment for couples with unexplained subfertility. Two randomized controlled trials (RCTs) compared IUI-OS to expectant management using different thresholds for the prognosis of natural conception as inclusion criteria and found different results. In a previous study (a Dutch national cohort), it was found that the benefit of IUI-OS compared to expectant management seemed dependent on the prognosis of natural conception, but this finding warrants replication. STUDY DESIGN, SIZE, DURATION We conducted a secondary analysis of the H2Oil study (n = 1119), a multicentre RCT that evaluated the effect of oil-based contrast versus water-based contrast during hysterosalpingography (HSG). Couples were randomized before HSG and followed up for 3–5 years. We selected couples with unexplained subfertility who received HSG and had follow-up or pregnancy data available. Follow-up was censored at the start of IVF, after the last IUI cycle or at last contact and was truncated at a maximum of 18 months after the fertility workup. PARTICIPANTS/MATERIALS, SETTING, METHODS The endpoint was time to conception leading to an ongoing pregnancy. We used the sequential Cox approach comparing in each month the ongoing pregnancy rates over the next 6 months of couples who started IUI-OS to couples who did not. We calculated the prognosis of natural conception for individual couples, updated this over consecutive failed cycles and evaluated whether prognosis modified the effect of starting IUI-OS. We corrected for known predictors of conception using inverse probability weighting. MAIN RESULTS AND THE ROLE OF CHANCE Data from 975 couples were available. There were 587 couples who received at least one IUI-OS cycle within 18 months after HSG of whom 221 conceived leading to an ongoing pregnancy (rate: 0.74 per couple per year over a median follow-up for IUI of 5 months). The median period between HSG and starting IUI-OS was 4 months. Out of 388 untreated couples, 299 conceived naturally (rate: 0.56 per couple per year over a median follow-up of 4 months). After creating our mimicked trial datasets, starting IUI-OS was associated with a higher chance of ongoing pregnancy by a pooled, overall hazard ratio of 1.50 (95% CI: 1.19–1.89) compared to expectant management. We did not find strong evidence that the effect of treatment was modified by a couple’s prognosis of achieving natural conception (Akaike’s Information Criterion (AIC) decreased by 1 point). The effect of treatment was dependent on when couples started IUI-OS (AIC decreased by more than 2 points). The patterns of estimated absolute chances over time for couples with increasingly better prognoses were different from the previous study but the finding that starting later yields a larger benefit of treatment was similar. We found IUI-OS increased the absolute chance of pregnancy by at least 5% compared to expectant management. The absolute chance of pregnancy after IUI-OS seems less variable between couples and starting times of treatment than the absolute chance after expectant management. LIMITATIONS, REASONS FOR CAUTION This is a secondary analysis, as the H2Oil trial was not designed with this research question in mind. Owing to sample size restrictions, it remained difficult to distinguish between the ranges of prognoses in which true benefit was found. WIDER IMPLICATIONS OF THE FINDINGS We replicated the finding that starting IUI-OS later after diagnosis yields a larger absolute and relative benefit of treatment. We did not replicate the dependency of the effect of IUI-OS on the prognosis of natural conception and could not identify clear thresholds for the prognosis of natural conception when IUI-OS was and/or was not effective. Because many of these couples still have good chances of natural conception at the time of diagnosis, we suggest clinicians should advise couples to delay the start of IUI-OS for several months to avoid unnecessary treatment. STUDY FUNDING/COMPETING INTEREST(S) The H2Oil study (NTR 3270) was an investigator-initiated study that was funded by the two academic institutions (AMC and VUmc) of the Amsterdam UMC. The follow-up study (NTR 6577) was also an investigator-initiated study with funding by Guerbet, France. The funders had no role in study design, collection, analysis and interpretation of the data. B.W.M. is supported by an Investigator grant (GNT1176437) from the Australian National Health and Medical Research Council (NHMRC). K.D. reports receiving travel and speaker fees from Guerbet. B.W.M. reports consultancy for ObsEva, Merck, Merck KGaA, iGenomix and Guerbet. V.M. reports receiving travel- and speaker fees as well as research grants from Guerbet.

Understanding the Interaction between Cyclists’ Traffic Violations and Enforcement Strategies: An Evolutionary Game-Theoretic Analysis

An evolutionary game-theoretic analysis method is developed in this study to understand the interactions between cyclists’ traffic violations and the enforcement strategies. The evolutionary equilibrium stabilities were analysed under a fixed (FPS) and a dynamic penalty strategy (DPS). The simulation-based numerical experiments show that: (i) the proposed method can be used to study the interactions between traffic violations and the enforcement strategies; (ii) FPS and DPS can reduce cyclists’ probability of committing traffic violations when the perceived traffic violations’ relative benefit is less than the traffic violation penalty and the enforcement cost is less than the enforcement benefit, and using DPS can yield a stable enforcement outcome for law enforcement compared to using FPS; and (iii) strategy-related (penalty amount, enforcement effectiveness, and enforcement cost) and attitudinal factors (perceived relative benefit, relative public image cost, and cyclists’ attitude towards risk) can affect the enforcement strategy’s impacts on reducing cyclists’ traffic violations.

SURG-15. A NOVEL RISK MODEL TO DEFINE THE RELATIVE BENEFIT OF MAXIMAL EXTENT OF RESECTION WITHIN PROGNOSTIC GROUPS IN NEWLY DIAGNOSED DIFFUSE LOW-GRADE GLIOMA

BACKGROUND The overall prognostic significance of maximal surgical resection in patients with diffuse low-grade glioma has been well established. Nonetheless, prior studies omit the combined importance of molecular subclass, patient characteristics, and chemoradiation. Similar to findings recently published in newly diagnosed glioblastoma, incorporation of these interactive factors may redefine the relative benefit of cytoreductive surgery. METHODS We examine the interactive effects of volumetric extent of resection with molecular and clinical factors to develop a new roadmap for cytoreductive surgery. Based on a 20-year retrospective cohort of 556 patients with WHO II diffuse low-grade glioma treated with surgery at UCSF 444 had complete records for survival modeling and recursive partitioning (RPA) to investigate multivariate relationships of overall and progression free survival. RESULTS Regardless of molecular subtype, patients with tumor volume under 55cm3 and postoperative volume of residual under 1.9cm3 experience the longest OS (median OS: not reached). Patients with volume of residual over 1.9cm3 experience a OS similar to that of patients with large (over 55cm3) oligodendrogliomas (median OS: not reached). Patients faring worst have large (over 55cm3) astrocytic gliomas (median OS: 84.8 months). Patients not treated with chemotherapy and either ATRX wild-type tumors or ATRX-mutant tumors with small (under 1cm3) volume of residual have the longest PFS together with chemotherapy treated patients who receive either no radiation or radiation for p53-mutant tumors under 30cm3 (median PFS 119 months). Patients with the shortest PFS are under 32-years with larger volume of residual (>1cm3), who receive no chemotherapy for ATRX-mutant tumors together with patients who receive both chemoradiation for larger (>30cm3) p53 mutant tumors (median PFS 30.8 months). CONCLUSION This is the first study to combine extent of resection with molecular and clinical information which paves the way for rethinking surgical strategies for individual patients with newly diagnosed low-grade gliomas.

IMPLEMENTATION OF INNOVATION IN PUBLIC SERVICES OF THE CLASS II IMMIGRATION OFFICE TPI SINGARAJA THROUGH THE DRIVE THRU PASSPORT PICKING

Public assistance is a type of government obligation in completing its obligations. The Immigration Office Class II TPI Singaraja as a public specialist organization consistently offers great support and attempts to react to protests and reactions presented by people in general through a leap forward or advancement as an assistance without dropping identification recovery. This constant visa recovery administration is propelled by a drive-through joint where candidates who apply for an identification can gather their finished visa through an exceptional counter without escaping their vehicle. This investigation plans to decide the execution of public help advancements at the Immigration Office Class II TPI Singaraja through administrations without plummeting for identification recovery. As per the hypothesis of development ascribes from Everett M. Rogers, among others: relative benefit, similarity, intricacy, trialability, and discernibleness. The exploration system utilized in this examination is a subjective spellbinding methodology. This investigation utilizes a few information examination strategies, specifically: gathering research information, lessening research information, introducing research information, and reaching inferences. The consequences of the examination show that the execution of public help developments at the Immigration Office Class II TPI Singaraja through the assistance without getting down for taking visas got a positive reaction, this can be seen from the relative benefit advancement characteristic which shows the numerous benefits in its execution. As a rule, the execution of this public assistance development is working out positively, yet in its execution in the field once in a while there are deterrents that should get consideration, for instance the restricted land claimed by every Immigration Office including the Class II migration office of TPI Singaraja to make administration courses without getting off visa assortment

Comment on Schosser (2018) “Incentive Systems for Risky Investment Decisions under Unknown Preferences: Ortner et al. Revisited”

Schosser (Games 2018, 9, 26) claims to have found an alternative solution to design appropriate performance measures than the State-Contingent Relative Benefit Cost Allocation (RBCA) introduced by Ortner et al. (Management Accounting Research 2017, 36, 43–50), which he states is simpler and more powerful. However, this note reveals that the performance measures proposed by Schosser are, in fact, a specific subset of State-Contingent Robust RBCA performance measures and thus do not represent a new solution.