The COVID-19 pandemic has raised a host of ethical challenges, but key among these has been the possibility that health care systems might need to ration scarce critical care resources. Rationing ...policies for pandemics differ by institution, health system, and applicable law. Most seem to agree that a patient's ability to benefit from treatment and to survive are first-order considerations. However, there is debate about what clinical measures should be used to make that determination and about other factors that might be ethically appropriate to consider. In this paper, we discuss resource allocation and several related ethical challenges to the healthcare system and society, including how to define benefit, how to handle informed consent, the special needs of pediatric patients, how to engage communities in these difficult decisions, and how to mitigate concerns of discrimination and the effects of structural inequities.
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DOBA, IJS, IZUM, KILJ, NUK, OILJ, PILJ, PNG, PRFLJ, SAZU, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Objective
Alzheimer's disease (AD) is found at autopsy in up to one third of patients with primary progressive aphasia (PPA), but clinical features that predict AD pathology in PPA are not well ...defined. We studied the relationships between language presentation, Aβ amyloidosis, and glucose metabolism in three PPA variants using 11C‐Pittsburgh compound B (11CPIB) and 18F‐labeled fluorodeoxyglucose positron emission tomography (18FFDG‐PET).
Methods
Patients meeting PPA criteria (N = 15) were classified as logopenic aphasia (LPA), progressive nonfluent aphasia (PNFA), or semantic dementia (SD) based on language testing. 11CPIB distribution volume ratios were calculated using Logan graphical analysis (cerebellar reference). 18FFDG images were normalized to pons. Partial volume correction was applied.
Results
Elevated cortical PIB (by visual inspection) was more common in LPA (4/4 patients) than in PNFA (1/6) and SD (1/5) (p < 0.02). In PIB‐positive PPA, PIB uptake was diffuse and indistinguishable from the pattern in matched AD patients (n = 10). FDG patterns were focal and varied by PPA subtype, with left temporoparietal hypometabolism in LPA, left frontal hypometabolism in PNFA, and left anterior temporal hypometabolism in SD. FDG uptake was significant asymmetric (favoring left hypometabolism) in PPA (p < 0.005) but not in AD.
Interpretation
LPA is associated with Aβ amyloidosis, suggesting that subclassification of PPA based on language features can help predict the likelihood of AD pathology. Language phenotype in PPA is closely related to metabolic changes that are focal and anatomically distinct between subtypes, but not to amyloid deposition patterns that are diffuse and similar to AD. Ann Neurol 2008
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
BACKGROUND:National efforts are underway to reduce hospital readmissions. Few studies have used administrative data to provide a global view of readmission among people experiencing homelessness, who ...often utilize multiple hospital systems.
OBJECTIVE:To examine the 30-day hospital readmission rate and factors associated with readmission following discharge among homeless Medicaid members in Massachusetts.
METHODS:We analyzed medical record and Medicaid administrative data for 1269 hospitalizations between 2013 and 2014 for 458 unique patients attributed to Boston Health Care for the Homeless Program. Generalized Estimating Equations were used to investigate factors associated with readmission.
RESULTS:Of all hospitalizations, 27% resulted in readmission, more than double the average national Medicaid readmission rate. Leaving against medical advice was associated with increased readmission, while having a Health Care for the Homeless primary care practitioner was associated with reduced readmission. Among the most frequently admitted individuals, being discharged to medical respite care was associated with reduced readmission.
CONCLUSIONS:To break the readmission cycle, health care providers serving homeless individuals could focus on assuring access to medical respite care and extending outreach efforts that increase primary care engagement. This may be especially important for accountable care systems, as safety net providers increasingly assume financial risk for patients’ total cost and quality of care.
Highlights • This review summarises the methods used to assess image quality in CT. • CT optimisation is separated into two phases (unit and protocol oriented). • Signal detection theory as well as ...the task-based approach are presented. • The strengths and weaknesses of the different methods presented are addressed. • A summary of CT's figure of merits is provided.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
In the field of augmented reality, there is a need for very bright color microdisplays to meet the user specifications. Today, one of the most promising technology to manufacture such displays ...involves a blue micro-LED technology and quantum dots-based color conversion layers. Despite recent progress, the external power conversion efficiencies (EPCE) of these layers remain under ∼25%, below the needs (>40%) to reach a white luminance of 100,000 cd/m 2 . In this work, we have synthesized CdSe x S 1-x nanoplatelet-based conversion layers for red and green conversion, and measured their absorption properties and EPCE performances with respect to layer thickness. On this basis, a model was developed that reliably predicts the layer EPCE while using only few input data, namely the layer absorption coefficients and the photoluminescence quantum yield (PLQY) of color photoresist. It brings a new insight into the conversion process at play at a micro-LED level and provides a simple method for extensive optimization of conversion materials. Finally, this study highlights the outstanding red conversion efficiency of photoresist layers made of core-double shell CdSe x S 1-x nanoplatelets with 31% EPCE (45% external PLQY) for 8 µm-thick conversion layer.
Abstract
Purpose
Comorbidities making up metabolic syndrome (MetS), such as obesity, type 2 diabetes, and chronic cardiovascular disease can lead to increased risk of coronavirus disease-2019 ...(COVID-19) with a higher morbidity and mortality. SARS-CoV-2 antibodies are higher in severely or critically ill COVID-19 patients, but studies have not focused on levels in convalescent patients with MetS, which this study aimed to assess.
Methods
This retrospective study focused on adult convalescent outpatients with SARS-CoV-2 positive serology during the COVID-19 pandemic at NewYork Presbyterian/Weill Cornell. Data collected for descriptive and correlative analysis included SARS-COV-2 immunoglobin G (IgG) levels and history of MetS comorbidities from April 17, 2020 to May 20, 2020. Additional data, including SARS-CoV-2 IgG levels, body mass index (BMI), hemoglobin A1c (HbA1c) and lipid levels were collected and analyzed for a second cohort from May 21, 2020 to June 21, 2020. SARS-CoV-2 neutralizing antibodies were measured in a subset of the study cohort.
Results
SARS-CoV-2 IgG levels were significantly higher in convalescent individuals with MetS comorbidities. When adjusted for age, sex, race, and time duration from symptom onset to testing, increased SARS-CoV-2 IgG levels remained significantly associated with obesity (P < 0.0001). SARS-CoV-2 IgG levels were significantly higher in patients with HbA1c ≥6.5% compared to those with HbA1c <5.7% (P = 0.0197) and remained significant on multivariable analysis (P = 0.0104). A positive correlation was noted between BMI and antibody levels 95% confidence interval: 0.37 (0.20-0.52) P < 0.0001. Neutralizing antibody titers were higher in COVID-19 individuals with BMI ≥ 30 (P = 0.0055).
Conclusion
Postconvalescent SARS-CoV-2 IgG and neutralizing antibodies are elevated in obese patients, and a positive correlation exists between BMI and antibody levels.
The Arctic climate is changing. Permafrost is warming, hydrological processes are changing and biological and social systems are also evolving in response to these changing conditions. Knowing how ...the structure and function of arctic terrestrial ecosystems are responding to recent and persistent climate change is paramount to understanding the future state of the Earth system and how humans will need to adapt. Our holistic review presents a broad array of evidence that illustrates convincingly; the Arctic is undergoing a system-wide response to an altered climatic state. New extreme and seasonal surface climatic conditions are being experienced, a range of biophysical states and processes influenced by the threshold and phase change of freezing point are being altered, hydrological and biogeochemical cycles are shifting, and more regularly human sub-systems are being affected. Importantly, the patterns, magnitude and mechanisms of change have sometimes been unpredictable or difficult to isolate due to compounding factors. In almost every discipline represented, we show how the biocomplexity of the Arctic system has highlighted and challenged a paucity of integrated scientific knowledge, the lack of sustained observational and experimental time series, and the technical and logistic constraints of researching the Arctic environment. This study supports ongoing efforts to strengthen the interdisciplinarity of arctic system science and improve the coupling of large scale experimental manipulation with sustained time series observations by incorporating and integrating novel technologies, remote sensing and modeling. PUBLICATION ABSTRACT
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CEKLJ, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Abstract Introduction The present study investigated the relationship between beta-amyloid (Aβ) and cognition in a late middle-aged cohort at risk for Alzheimer's disease (AD). Methods One ...eighty-four participants (mean age = 60; 72% parental history of AD) completed a C-11Pittsburgh compound B positron emission tomography scan and serial cognitive evaluations. A global measure of Aβ burden was calculated, and composite scores assessing learning, delayed memory, and executive functioning were computed. Results Higher Aβ was associated with classification of psychometric mild cognitive impairment (MCI) at follow-up ( P < .01). Linear mixed effects regression results indicated higher Aβ was associated with greater rates of decline in delayed memory ( P < .01) and executive functioning ( P < .05). Apolipoprotein E ( APOE ) ε4 status moderated the relationship between Aβ and cognitive trajectories ( P values <.01). Discussion In individuals at risk for AD, greater Aβ in late middle age is associated with increased likelihood of MCI at follow-up and steeper rates of cognitive decline.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Abstract Context Pain and itch are common symptoms reported by patients with scleroderma (SSc), which can markedly diminish function and health-related quality of life (HRQL). Objectives The aim of ...this exploratory study was to examine the impact that pain, itch, and the interaction of both, have on function (depressive symptoms, overall disability, fatigue, sleep disturbance) and HRQL in patients with SSc. Methods A total of 964 patients from the Canadian Scleroderma Research Group Registry completed questionnaires measuring itch and pain severity, function, and HRQL. Multiple regression analyses were performed to examine the impact that pain, itch and pain*itch interaction have on each outcome variable while controlling for demographic measures. A P -value of ≤ 0.01 was required for a difference to be deemed statistically significant. Results Our results revealed that patients with SSc who reported higher pain and itch severity were also more likely to have greater depressive symptoms, overall disability, sleep and fatigue problems, even when demographic measures were controlled for ( P -values ≤ 0.001). Similar results were obtained for HRQL, regardless of the domains ( P -values ≤ 0.001). A significant association between pain*itch interaction and sleep ( P = 0.002), physical functioning ( P = 0.003) and general health ( P ≤ 0.001) variables also was found. Further investigation of the nature of the pain*itch interaction showed that the effect of pain severity on outcome variables diminishes as itch severity increases. Conclusion Both pain and itch appear to have a detrimental impact on functioning and HRQL in patients with SSc, suggesting that more targeted approaches to symptom management are warranted.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Neutrinos are the Standard Model (SM) particles which we understand the least, often due to how weakly they interact with the other SM particles. Beyond this, very little is known about interactions ...among the neutrinos, i.e., their self-interactions. The SM predicts neutrino self-interactions at a level beyond any current experimental capabilities, leaving open the possibility for beyond-the-SM interactions across many energy scales. In this white paper, we review the current knowledge of neutrino self-interactions from a vast array of probes, from cosmology, to astrophysics, to the laboratory. We also discuss theoretical motivations for such self-interactions, including neutrino masses and possible connections to dark matter. Looking forward, we discuss the capabilities of searches in the next generation and beyond, highlighting the possibility of future discovery of this beyond-the-SM physics.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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