The effectiveness of financial incentives for COVID-19 vaccination: A systematic review.

Financial incentives are a controversial strategy for increasing vaccination. In this systematic review, we evaluated: 1) the effects of incentives on COVID-19 vaccinations; 2) whether effects differed based on study outcome, study design, incentive type and timing, or sample sociodemographic characteristics; and 3) the cost of incentives per additional vaccine administered. We searched PubMed, EMBASE, Scopus, and Econlit up to March 2022 for terms related to COVID, vaccines, and financial incentives, and identified 38 peer-reviewed, quantitative studies. Independent raters extracted study data and evaluated study quality. Studies examined the impact of financial incentives on COVID-19 vaccine uptake (k = 18), related psychological outcomes (e.g., vaccine intentions, k = 19), or both types of outcomes. For studies of vaccine uptake, none found that financial incentives had a negative effect on uptake, and most rigorous studies found that incentives had a positive effect on uptake. By contrast, studies of vaccine intentions were inconclusive. While three studies concluded that incentives may negatively impact vaccine intentions for some individuals, they had methodological limitations. Study outcomes (uptake versus intentions) and study design (experimental versus observational frameworks) appeared to influence results more than incentive type or timing. Additionally, income and political affiliation may moderate responses to incentives. Most studies evaluating cost per additional vaccine administered found that they ranged from $49-75. Overall, fears about financial incentives decreasing COVID-19 vaccine uptake are not supported by the evidence. Financial incentives likely increase COVID-19 vaccine uptake. While these increases appear to be small, they may be meaningful across populations. Registration: PROSPERO, CRD42022316086 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022316086).

The speed of perception: the effects of over-speed video training on pitch recognition in collegiate softball players.

During interceptive motor tasks, experts demonstrate distinct visual search behavior (from novices) that is reflective of information extraction from optimal environmental cues, which subsequently aids anticipatory movements. While some forms of visual training have been employed in sport, over-speed video training is rarely applied to perceptual-cognitive sport contexts. The purpose of the present study was to determine whether over-speed video training can enhance visual information processing and augment visual behavior for a pitch-recognition task. Twelve collegiate softball players were recruited for the study. A between-subjects, repeated measures design was implemented to assess changes in participants' pitch recognition on a video-based occlusion task after one of two training interventions: (A) over-speed video training (n = 6) or (B) regular video training (n = 6). Both training interventions required individuals to view 400 videos of different pitches over the span of 10 days. The over-speed group viewed the videos at gradually increasing video speeds (+ 0.05 × each day). Performance (i.e., identifying pitch type and location), quiet-eye duration (i.e., total QE, QE-early and QE-late) and cortical activation (i.e., alpha wave activity/asymmetry; F3/F4 and P7/P8) were measured during the pitch-recognition tasks. Results showed significant performance improvements across groups, but no differences between groups. Both interventions were associated with a reduction in alpha wave activity for P8, an increase in alpha activity for F3, and a significant increase in QE-late. An increase in QE-late was associated with a decrease in P7/P8 alpha asymmetry and improvements in pitch-type recognition. Consistent with the extant literature, our results support the importance of a later QE offset for successful performance on perceptual tasks, potentially extending to perceputal-motor tasks. Although participants in the over-speed condition did not experience significantly larger improvements in performance than controls, this study highlights the association between QE and brain activity reflective of expertise.

Telehealth for an Aging Population: How Can Law Influence Adoption Among Providers, Payors, and Patients?

Telehealth continues to experience substantial investment, innovation, and unprecedented growth. However, telehealth has been slow to transform healthcare. Recent developments in telehealth technologies suggest great potential for chronic care management, mental health services, and care delivery in the home-all of which should be particularly impactful for an aging population with physical and cognitive limitations. While this alignment of technological capacity and market demand is promising, legal barriers remain for telehealth operators to scale up across large geographic areas. To better understand how federal and state law can be reformed to enable greater telehealth utilization, we review and extract lessons from (1) establishment of a healthcare relationship, (2) state licensure laws, and (3) reimbursement. We analyze these areas because of the legal ambiguities or inconsistencies they raise depending on the state, which seem to be hampering telehealth growth without necessarily improving quality of care. We propose several solutions for a more unified approach to telehealth regulation that incorporate core bioethics principles of doctor-patient relationship, competence, patient autonomy, as well as population-wide questions of resource allocation and access. Lawmakers should clarify that healthcare relationships may be established outside of in-person meetings, align licensure laws via an interstate compact or federal preemption, and expand Centers for Medicare and Medicaid plans to reimburse telehealth delivery in the home.

Vaccines and Airline Travel: A Federal Role to Protect the Public Health.

This Article explores two ways in which airline travel is an important vector for the spread of infectious disease, and argues that airlines have market-based and liability-based reasons to require that passengers be vaccinated. Going further, the Article explores whether the federal government has the legal and constitutional authority-especially under the Commerce Clause-to encourage or mandate that airlines implement such a vaccine screen. By disrupting the spread of disease at key network nodes where individuals interact and then connect with other geographic regions, and by creating another incentive for adult vaccination, an airline vaccine screen could be an effective and legally viable tool for the protection of public health.

A randomized study of how physicians interpret research funding disclosures.

BACKGROUND: The effects of clinical-trial funding on the interpretation of trial results are poorly understood. We examined how such support affects physicians' reactions to trials with a high, medium, or low level of methodologic rigor. METHODS: We presented 503 board-certified internists with abstracts that we designed describing clinical trials of three hypothetical drugs. The trials had high, medium, or low methodologic rigor, and each report included one of three support disclosures: funding from a pharmaceutical company, NIH funding, or none. For both factors studied (rigor and funding), one of the three possible variations was randomly selected for inclusion in the abstracts. Follow-up questions assessed the physicians' impressions of the trials' rigor, their confidence in the results, and their willingness to prescribe the drugs. RESULTS: The 269 respondents (53.5% response rate) perceived the level of study rigor accurately. Physicians reported that they would be less willing to prescribe drugs tested in low-rigor trials than those tested in medium-rigor trials (odds ratio, 0.64; 95% confidence interval [CI], 0.46 to 0.89; P=0.008) and would be more willing to prescribe drugs tested in high-rigor trials than those tested in medium-rigor trials (odds ratio, 3.07; 95% CI, 2.18 to 4.32; P<0.001). Disclosure of industry funding, as compared with no disclosure of funding, led physicians to downgrade the rigor of a trial (odds ratio, 0.63; 95% CI, 0.46 to 0.87; P=0.006), their confidence in the results (odds ratio, 0.71; 95% CI, 0.51 to 0.98; P=0.04), and their willingness to prescribe the hypothetical drugs (odds ratio, 0.68; 95% CI, 0.49 to 0.94; P=0.02). Physicians were half as willing to prescribe drugs studied in industry-funded trials as they were to prescribe drugs studied in NIH-funded trials (odds ratio, 0.52; 95% CI, 0.37 to 0.71; P<0.001). These effects were consistent across all levels of methodologic rigor. CONCLUSIONS: Physicians discriminate among trials of varying degrees of rigor, but industry sponsorship negatively influences their perception of methodologic quality and reduces their willingness to believe and act on trial findings, independently of the trial's quality. These effects may influence the translation of clinical research into practice.

Upper-extremity spinal reflex inhibition is reproducible and strongly related to grip force poststroke.

PURPOSE: Impaired reflex regulation is assumed to contribute to upper-extremity motor impairment poststroke; however, the relationship between reflex inhibition and motor function remains unclear. To address this question, it is first necessary to determine the reproducibility of reflex responses. The objective of this study was to establish the test-retest reliability of flexor carpi radialis H-reflex inhibition in healthy control and stroke participants and investigate the correlation between H-reflex inhibition and grip strength. MATERIALS AND METHODS: Eighteen persons poststroke (mean ± SD: age 63 ± 13 years; 6 ± 5 years poststroke; 13 males) and 16 healthy controls (age: 62 ± 12 years) participated. Reflex inhibition was tested on 2 separate days by conditioning the H-reflex with radial nerve stimulation at two different interstimulus intervals: 13 ms (presynaptic Ia inhibition-PSI) and 0 ms (disynaptic inhibition). Pearson's and intraclass correlation coefficients [two-way mixed model-ICC (1, 2)], and standard error of measurement (SEM) were calculated. RESULTS: Relative reliability (ICCs) ranged from good to excellent (0.61-0.78). SEM was low (range 10-19%, stroke; 15-20%, healthy controls). Paretic grip strength and paretic limb PSI revealed a positive correlation (r = 0.70; p < 0.0125). Disynaptic inhibition and paretic grip strength were not correlated. CONCLUSIONS: To our knowledge, this is the first study to demonstrate reproducibility of reflex inhibition in individuals poststroke. Furthermore, we quantify smallest real differences, which provide an estimate of the magnitude of effect required to determine a meaningful change, exceeding measurement error. The correlation between PSI and grip strength suggests the potential contribution of PSI to grip force production and upper-extremity motor function.

Scaling cost-sharing to wages: how employers can reduce health spending and provide greater economic security.

In the employer-sponsored insurance market that covers most Americans; many workers are "underinsured." The evidence shows onerous out-of-pocket payments causing them to forgo needed care, miss work, and fall into bankruptcies and foreclosures. Nonetheless, many higher-paid workers are "overinsured": the evidence shows that in this domain, surplus insurance stimulates spending and price inflation without improving health. Employers can solve these problems together by scaling cost-sharing to wages. This reform would make insurance better protect against risk and guarantee access to care, while maintaining or even reducing insurance premiums. Yet, there are legal obstacles to scaled cost-sharing. The group-based nature of employer health insurance, reinforced by federal law, makes it difficult for scaling to be achieved through individual choices. The Affordable Care Act's (ACA) "essential coverage" mandate also caps cost-sharing even for wealthy workers that need no such cap. Additionally, there is a tax distortion in favor of highly paid workers purchasing healthcare through insurance rather than out-of-pocket. These problems are all surmountable. In particular, the ACA has expanded the applicability of an unenforced employee-benefits rule that prohibits "discrimination" in favor of highly compensated workers. A novel analysis shows that this statute gives the Internal Revenue Service the authority to require scaling and to thereby eliminate the current inequities and inefficiencies caused by the tax distortion. The promise is smarter insurance for over 150 million Americans.

Independent segmental inhibitory modulation of synaptic efficacy of the soleus H-reflex.

Synaptic efficacy associated with muscle spindle feedback is partly regulated via depression at the Ia-motorneuron synapse through paired reflex depression (PRD) and presynaptic inhibition (PI). The purpose of this study was to examine PRD and PI of the soleus H-reflex at rest and with a background voluntary muscle contraction. The experiment was conducted on 10 healthy males with no history of neurological deficits. Soleus H-reflex and M-wave curves were elicited in three conditions: unconditioned, PRD (two consecutive H-reflexes with 100 ms interval), and PI (1.2 × MT to tibialis anterior 100 ms prior to soleus H-reflex). Each condition was tested at rest and with a 10% soleus contraction. PRD and PI both produced a pronounced inhibition to the soleus motor pool at rest, with a significant difference observed between threshold values (78.9, 89.3, and 90.4% for unconditioned, PRD, and PI reflexes, respectively). During the voluntary contraction the threshold for both inhibitory mechanisms was significantly reduced, and were not different from the unconditioned H-reflex (74.5, 78.9, and 77.0% for unconditioned, PRD, and PI reflexes, respectively). The slope of PI and the PI Hmax/Mmax ratio were significantly altered during contraction whereas no differences were observed for PRD. The results suggest these inhibitory mechanisms depend on the interaction between background voluntary activation and stimulus intensity. This behavior of these inhibitory mechanisms underscores the specificity of spinal circuitry in the control of motor behaviors.

Temporal depression of the soleus H-reflex during passive stretch.

Synaptic efficacy associated with muscle spindle feedback is regulated via depression at the Ia-motoneurone synapse. The inhibitory effects of repetitive Ia afferent discharge on target motoneurones of different sizes were investigated during a passive stretch of ankle extensors in humans. H-reflex recruitment curves were collected from the soleus muscle for two conditions in ten subjects. H-reflexes were elicited during passive stretch at latencies of 50, 100, 300, and 500 ms after a slow (20°/s) dorsiflexion about the right ankle (from 100 to 90°). Control H-reflexes were recorded at corresponding static (without movement) ankle angles of 99, 98, 94, and 90° of flexion. The slope of the H-reflex recruitment curves (Hslp) was then calculated for both conditions. H-reflex values were similar for the static and passive stretch conditions prior to 50-100 ms, not showing the early facilitation typical of increased muscle spindle discharge rates. However, the H-reflex was significantly depressed by 300 ms and persisted through 500 ms. Furthermore, less than 300 ms into the stretch, there was significantly greater H-reflex depression with a lower stimulus intensity (20 % Mmax) versus a higher stimulus intensity (Hmax), though the effects begin to converge at later latencies (>300 ms). This suggests there is a distinct two-stage temporal process in the depression observed in the Ia afferent pathway for all motoneurones during a passive stretch. Additionally, there is not a single mechanism responsible for the depression, but rather both heterosynaptic presynaptic inhibition and homosynaptic post-activation depression are independently influencing the Ia-motoneurone pathway temporally during movement.

Comparative effectiveness of mandates and financial policies targeting COVID-19 vaccine hesitancy: A randomized, controlled survey experiment.

Experts debate whether COVID-19 vaccine mandates or financial incentives will reduce, rather than increase, interest in vaccination. Among 3,698 unvaccinated U.S. residents, we conducted a randomized, controlled survey-embedded experiment to estimate the absolute and relative psychological effects of vaccine policies specifying: mandates by employers or airlines, bars, and restaurants; lotteries for $1 million, $200,000, or $100,000; guaranteed cash for $1000, $200, or $100; and $1,000 as either a tax credit or penalty. Vaccine intention -the study outcome- predicts uptake and provides insight into the psychological mechanism that is most proximal to behavior (i.e., vaccination). Compared to controls, those who learned about the $1,000 cash reward policy were 17.1 (±5.3)% more likely to want vaccination. Employer mandates are more promising than other mandate policies (8.6 [+/- 7.4]% vs. 1.4 [+/- 6.0]%). The full results suggest that neither mandates nor financial incentives are likely to have counterproductive psychological effects. These policies are not mutually exclusive and, if implemented well, they may increase vaccine uptake.

Distance running stride-to-stride variability for sagittal plane joint angles.

Recent research indicates that distance running stride-to-stride variability (SSV) is related to performance and injury. Previous studies have primarily focused on stride characteristics (stride length and time). We assessed SSV for sagittal plane joint angles with the primary purpose of testing for significant differences among the lower body joints. The secondary purpose was to determine if strong correlations exist among joint SSV measures. Thirty recreational adult runners participated in the study (8 females, 22 males, 39 ± 10 years; 53.1 ± 25.7 km/week). A 6-camera motion capture system (200 Hz) collected kinematic data during treadmill running at a preferred pace. A 2 by 3 repeated measures factorial ANOVA (phase-stance, swing; joint-hip, knee, ankle) was run (p = 0.05). There was a significant interaction effect (p < 0.001) and post hoc analysis revealed knee swing to be the most variable condition by far. For all three joints, there were strong correlations between stance and swing SSV (r = 0.80 to r = 0.88) and correlations among the joints were moderate to strong (r = 0.55 to 0.86). This study helps to better understand the joints/phases that contribute most to variability in the overall stride. Also, the strong correlations suggest that runners appear to have an overall SSV pattern that is similar across joints/phases.

The money blind: how to stop industry bias in biomedical science, without violating the First Amendment.

The pharmaceutical and medical device industries use billions of dollars to support the biomedical science that physicians, regulators, and patients use to make healthcare decisions--the decisions that drive an increasingly large portion of the American economy. Compelling evidence suggests that this industry money buys favorable results, biasing the outcomes of scientific research. Current efforts to manage the problem, including disclosure mandates and peer reviews, are ineffective. A blinding mechanism, operating through an intermediary such as the National Institutes of Health, could instead be developed to allow industry support of science without allowing undue influence. If the editors of biomedical journals fail to mandate that industry funders utilize such a solution, the federal government has several regulatory levers available, including conditioning federal funding and direct regulation, both of which could be done without violating the First Amendment.

Challenges in confirming drug effectiveness after early approval.

Reform requires clarity about whether, when, and how meaningful postapproval trials are possible.

Evidence Supporting the Value of Surgical Procedures: Can We Do Better?

There is an acknowledged need for higher-quality evidence to quantify the benefit of surgical procedures, yet not enough has been done to improve the evidence base. This lack of evidence can prevent fully informed decision-making, lead to unnecessary or even harmful treatment, and contribute to wasteful expenditures of scare health care resources. Barriers to evidence generation include not only the long-recognized technical difficulties and ethical challenges of conducting randomized surgical trials, but also legal challenges that limit incentives to conduct surgical research as well as market-based challenges that make it difficult for those funding surgical research to recoup investment costs. These legal and market dynamics differ substantially from those surrounding new drug or device development. Nevertheless, obstacles could be overcome and overall expenditures could be reduced if a share of federal health care agency budgets were reallocated to generating randomized trial data, standardizing outcome measures, and conducting observational studies analogous to those that have been facilitated for drugs via the Food and Drug Administration's Sentinel Initiative. Until better quality evidence is available, ethical principles require adequate disclosure of the limited evidence base supporting current surgical procedures.

Effects of political versus expert messaging on vaccination intentions of Trump voters.

To increase COVID-19 vaccine uptake in resistant populations, such as Republicans, focus groups suggest that it is best to de-politicize the issue by sharing five facts from a public health expert. Yet polls suggest that Trump voters trust former President Donald Trump for medical advice more than they trust experts. We conducted an online, randomized, national experiment among 387 non-vaccinated Trump voters, using two brief audiovisual artifacts from Spring 2021, either facts delivered by an expert versus political claims delivered by President Trump. Relative to the control group, Trump voters who viewed the video of Trump endorsing the vaccine were 85% more likely to answer "yes" as opposed to "no" in their intention to get fully vaccinated (RRR = 1.85, 95% CI 1.01 to 3.40; P = .048). There were no significant differences between those hearing the public health expert excerpt and the control group (for "yes" relative to "no" RRR = 1.14, 95% CI 0.61 to 2.12; P = .68). These findings suggest that a political speaker's endorsement of the COVID-19 vaccine may increase uptake among those who identify with that speaker. Contrary to highly-publicized focus group findings, our randomized experiment found that an expert's factually accurate message may not be effectual to increase vaccination intentions.