patient dialysis would lead to any meaningful misclassification of a dialysis unit's anemia management practice. We disagree with Zhang et al that our findings are inconsistent with a report that the dialysis chain using the smallest doses of ESAs also had the lowest mortality rates. 1 Our model suggests that centers using ESAs the most aggressively across all hematocrit categories would have increased mortality rates relative to the most conservative centers. Therefore, our results are quite compatible with the cited report.We agree with Dr Auerbach that IV iron is a useful aspect of anemia management. However, we note that a study of 10 169 hemodialysis patients found an 11% increased risk of all-cause mortality and a 12% increased risk of hospitalization in patients prescribed more than 10 vials of iron over a 6-month period compared with patients prescribed no iron. 2 That study cites 5 abstracts reporting associations between iron exposure and adverse events, including all-cause mortality and infection-related outcomes. It is likely true that most of the risk of anaphylaxis comes with use of high-molecular-weight iron dextran, but many other important aspects of IV iron use are not well understood. There is a lack of evidence on the comparative effectiveness and safety of different iron dosing strategies (including bolus vs maintenance dosing) and of the different iron complexes, which have different pharmacokinetic properties.Changes in reimbursement coupled with evidence suggesting that frequent use of iron may increase hemoglobin in patients who do not respond well to ESAs 3 are likely to lead to increasing use of IV iron for anemia management in hemodialysis patients. This makes it increasingly important to continue studying IV iron to identify agents and dosing protocols that maximize its considerable benefits while minimizing possible harms and unnecessary use.

The effectiveness of a pedometer intervention was affected by manipulating the goals given to participants and by providing social comparison feedback about how participants' performance compared with others. In study 1 (n = 148), university staff members received a low, medium, or high walking goal (10%, 50%, or 100% increase over baseline walking). Participants walked 1358 more steps per day (95% confidence interval [CI], 729, 1985), when receiving a high goal than when receiving a medium goal, but a medium goal did not increase walking relative to a low goal (554 more steps; 95% CI, -71,1179). In study 2 (n = 64), participants received individual feedback only or individual plus social comparison feedback. Participants walked 1120 more steps per day (95% CI, 538, 1703) when receiving social comparison feedback than when receiving only individual feedback. Goals and the performance of others act as reference points and influence the effect that pedometer feedback has on walking behavior, illustrating the applicability of the principles of behavioral economics and social psychology to the design of health behavior interventions.

Background COVID-19 related policies in the USA can be confusing: some states, but not others, implemented mask mandates mid-pandemic, and states reopened their economies to different levels with different timelines after initial shutdowns. Purpose The current research asks: How well does the public’s perception of such policies align with actual policies, and how well do actual versus perceived policies predict the public’s mask-wearing and social distancing behaviors during the COVID-19 pandemic? Methods We conducted a preregistered cross-sectional study among 1,073 online participants who were representative of the U.S. population on age, gender, and education on Monday–Tuesday, July 20–21, 2020. We asked participants which locations they visited in the past weekend, and their mask-wearing and social distancing behaviors at each location. We also measured participants’ beliefs about their state’s policies on mask mandate and business opening and obtained objective measures of these policies from publicly available data. Results Perception about the existence of mask mandate was 91% accurate in states with a mask mandate but only 46% accurate in states without one. Perception of state reopening level did not correlate with policy. It was the perceived but not actual state mask mandate that positively predicted both mask-wearing and social distancing, controlling for state COVID-19 cases, demographic factors, and participants’ numeracy and COVID-19 history. Conclusions The public’s perception of state-level mask mandates erred on the side of assuming there is one. Perception of reopening is almost completely inaccurate. Paradoxically, public perception that a mask mandate exists predicts preventive behaviors better than actual mandates.

The allocation of scarce public resources such as transplant organs and limited public funding involves a trade-off between equality-equal access and efficiency-maximizing total benefit. The current research explores how preferences shift when allocation decisions involve human lives versus when they do not. Fifteen experiments test this question using a variety of allocation scenarios including allocation of lifesaving medical aid, money, road construction, vaccines, and other resources. The results consistently show an increased preference for efficiency, when the allocation involves saving human lives, and equality, when the allocation involves outcomes with other consequences. We found no preference shift when stakes were manipulated in allocations where lives were not on the line, suggesting that the effect cannot be explained by lifesaving resources simply being higher stakes. These findings suggest a unique preference for efficiency for allocations involving life-and-death consequences that has implications for designing and conveying public resource allocation policies.