We present constraints on an astrophysical population of neutrino sources imposed by recent data from the IceCube neutrino observatory. By using the IceCube point source search method to model the ...detection of sources, our detection criterion is more sensitive than using the observation of high-energy neutrino multiplets for source identification. We frame the problem as a Bayesian hierarchical model to connect the high-level population parameters to the IceCube data, allowing us to consistently account for all relevant sources of uncertainty in our model assumptions. Our results show that sources with a local density of n0 ≳ 10−7 Mpc−3 and luminosity L ≲ 1043 erg s−1 are the most likely candidates, but that populations of rare sources with n0 ≃ 10−9 Mpc−3 and L ≃ 1045 erg s−1 can still be consistent with the IceCube observations. We demonstrate that these conclusions are strongly dependent on the source evolution considered, for which we consider a wide range of models. In doing so, we present realistic, model-independent constraints on the population parameters that reflect our current state of knowledge from astrophysical neutrino observations. We also use our framework to investigate constraints in the case of possible source detections and future instrument upgrades. Our approach is flexible and can be used to model specific source cases and extended to include multimessenger information.
While Chile recently decriminalized abortion in cases of rape, lethal fetal anomaly, and to save a woman's life, most abortions are still criminalized. We assessed medical and midwifery school ...faculty and students' views on punishing and reporting people involved in unlawful abortion, and their understanding of their obligation to protect patient confidentiality and to report unlawful abortions.
We interviewed 30 medical and midwifery school clinician faculty from seven public, private, secular and Catholic-affiliated universities, all located in the metropolitan region of Santiago, Chile. Medical (n = 239) and midwifery (n = 79) students at these same seven universities completed an online survey. We coded faculty interview transcripts, and analyzed codes related to maintaining patient confidentiality and reporting unlawful abortion. We summarized student views related to reporting and imprisoning people involved in unlawful abortion, and used general estimating equation (GEE) models to identify the factors associated with support for criminalization.
Faculty and students generally did not support reporting or imprisoning anyone involved in an unlawful abortion and believed that protecting patient information takes precedence over reporting. Yet, faculty described pressures to report in the public sector and several cases where they or their colleagues were involved in reports. Most students somewhat/strongly agreed (78%) that patient information concerning an unlawful abortion should be kept confidential; 35% strongly/somewhat agreed that a clinician involved in an unlawful surgical abortion should be imprisoned, and 18% agreed that the woman involved should be imprisoned, with students from secular universities being significantly less likely to support reporting and punishing people involved in unlawful abortion, than students from Catholic universities.
There is a need to clarify clinicians' ethical obligations in abortion care, in particular in Catholic universities, so that they can ensure that their patients have access to high quality confidential health care services.
•Laws around maintaining confidentiality and reporting unlawful abortions conflict.•Most clinical faculty and students support protecting patient confidentiality.•Clinicians perceive pressure to report unlawful abortions in the public sector.•Public sector bureaucracy and fragmented relationships with patients facilitate reporting.•Respondents support protecting patient information over reporting abortions.
IMPORTANCE: In the US, access to medication abortion using history-based (no-test) eligibility assessment, including through telehealth and mailing of mifepristone, has grown rapidly. Additional ...evidence on the effectiveness and safety of these models is needed. OBJECTIVE: To evaluate whether medication abortion with no-test eligibility assessment and mailing of medications is as effective as in-person care with ultrasonography and safe overall. DESIGN, SETTING, AND PARTICIPANTS: Prospective, observational study with noninferiority analysis. Sites included 4 abortion-providing organizations in Colorado, Illinois, Maryland, Minnesota, Virginia, and Washington from May 2021 to March 2023. Eligible patients were seeking medication abortion up to and including 70 days’ gestation, spoke English or Spanish, and were aged 15 years or older. EXPOSURE: Study groups reflected the model of care selected by the patient and clinicians and included: (1) no-test (telehealth) eligibility assessment and mailing of medications (no-test + mail) (n = 228); (2) no-test eligibility assessment and pickup of medications (no-test + pickup) (n = 119); or (3) in-person with ultrasonography (n = 238). MAIN OUTCOMES AND MEASURES: Effectiveness, defined as a complete abortion without the need for repeating the mifepristone and misoprostol regimen or a follow-up procedure, and safety, defined as an abortion-related serious adverse event, including overnight hospital admission, surgery, or blood transfusion. Outcomes were derived from patient surveys and medical records. Primary analysis focused on the comparison of the no-test + mail group with the in-person with ultrasonography group. RESULTS: The mean age of the participants (N = 585) was 27.3 years; most identified as non-Hispanic White (48.6%) or non-Hispanic Black (28.1%). Median (IQR) gestational duration was 45 days (39-53) and comparable between study groups (P = .30). Outcome data were available for 91.8% of participants. Overall effectiveness was 94.4% (95% CI, 90.7%-99.2%) in the no-test + mail group and 93.3% (95% CI, 88.3%-98.2%) in the in-person with ultrasonography group in adjusted models (adjusted risk difference, 1.2 95% CI, −4.1 to 6.4), meeting the prespecified 5% noninferiority margin. Serious adverse events included overnight hospitalization (n = 4), blood transfusion (n = 2), and emergency surgery (n = 1) and were reported by 1.1% (95% CI, 0.4%-2.4%) of participants, with 3 in the no-test + mail group, 3 in the in-person with ultrasonography group, and none in the no-test + pickup group. CONCLUSIONS AND RELEVANCE: This prospective, observational study found that medication abortion obtained following no-test telehealth screening and mailing of medications was associated with similar rates of complete abortion compared with in-person care with ultrasonography and met prespecified criteria for noninferiority, with a low prevalence of adverse events.
Restrictions on the availability of medication abortion are a barrier to accessing early abortion. People seeking medication abortion may be interested in obtaining the medications through ...alternative models. The purpose of this study was to explore patient perspectives on obtaining abortion medications in advance of pregnancy or over the counter (OTC).
Between October 2017 and August 2018, we conducted 30 in-depth interviews with abortion patients who indicated support for alternative models. We recruited patients from 10 abortion clinics in states with a range of policy environments. We analyzed interviews using inductive and deductive iterative techniques.
Participants identified logistical benefits of these alternative models, including eliminating travel to a clinic and multiple appointments, and increased privacy around decision-making. Participants were interested in advance provision for its convenience and the sense of preparedness that would come with having the pills available at home, yet some had concerns about the pills being found or stolen. Privacy was the key factor considered for OTC access, including both the privacy benefits of avoiding a clinic and the concern of having one's privacy compromised within the community if purchasing the medications in public.
People who have previously had a medication abortion are interested in alternative methods of provision for reasons concerning convenience, privacy, and avoiding burdens related to hostile policy environments, such as long travel distances to clinics and multiple appointments. Concerns around these models were primarily safety concerns for young people. Further research is needed to evaluate the safety, effectiveness, acceptability, and feasibility of these alternative models of providing medication abortion.
The cosmic neutrino flux recently discovered by IceCube will be instrumental in probing the highest-energy astrophysical processes. Nevertheless, the origin of these neutrinos is still unknown. While ...it would be more straightforward to identify a transient, or galactic source, class, finding a population of distant, continuous sources is challenging. We introduce a source-type classification technique that incorporates all available information from catalogs of source candidates. We show that IceCube-Gen2 can statistically establish the origin of cosmic neutrinos, even for the most challenging source populations–starburst galaxies, AGN, or galaxy clusters–if neutrino track directions can be reconstructed with a precision ∼0.3°. We further show that the source catalog out to ∼100 Mpc can be sufficient for the most challenging source types, allowing for more straightforward source surveys. We also characterize the role of detector properties, namely angular resolution, size, and veto power in order to understand the effects of IceCube-Gen2’s design specifics.
ICU-acquired paresis (ICUAP) is common in survivors of critical illness. There is significant associated morbidity, including prolonged time on the ventilator and longer hospital stay. However, it is ...unclear whether ICUAP is independently associated with mortality, as sicker patients are more prone and existing studies have not adjusted for this.
To test the hypothesis that ICUAP is independently associated with increased mortality. Secondarily, to determine if handgrip dynamometry is a concise measure of global strength and is independently associated with mortality.
A prospective multicenter cohort study was conducted in intensive care units (ICU) of five academic medical centers. Adults requiring at least 5 days of mechanical ventilation without evidence of preexisting neuromuscular disease were followed until awakening and were then examined for strength.
We measured global strength and handgrip dynamometry. The primary outcome was in-hospital mortality and secondary outcomes were hospital and ICU-free days, ICU readmission, and recurrent respiratory failure. Subjects with ICUAP (average MRC score of < 4) had longer hospital stays and required mechanical ventilation longer. Handgrip strength was lower in subjects with ICUAP and had good test performance for diagnosing ICUAP. After adjustment for severity of illness, ICUAP was independently associated with hospital mortality (odds ratio OR, 7.8; 95% confidence interval CI, 2.4-25.3; P = 0.001). Separately, handgrip strength was independently associated with hospital mortality (OR, 4.5; 95% CI, 1.5-13.6; P = 0.007).
ICUAP is independently associated with increased hospital mortality. Handgrip strength is also independently associated with poor hospital outcome and may serve as a simple test to identify ICUAP. Clinical trial registered with www.clinicaltrials.gov (NCT00106665).
ObjectiveTo assess Chilean medical and midwifery students’ attitudes and willingness to become trained to provide abortion care, shortly after abortion was decriminalised in 2017.DesignWe fielded a ...cross-sectional, web-based survey of medical and midwifery students. We used generalised estimating equations to assess differences by type of university and degree sought.SettingWe recruited students from a combination of seven secular, religiously-affiliated, public and private universities that offer midwifery or medical degrees with a specialisation in obstetrics and gynaecology, located in Santiago, Chile.ParticipantsStudents seeking medical or midwifery degrees at one of seven universities were eligible to participate. We distributed the survey link to medical and midwifery students at these seven universities; 459 eligible students opened the survey link and 377 students completed the survey.Primary and secondary outcomesIntentions to become trained to provide abortion services was our primary outcome of interest. Secondary outcomes included moral views and concerns about abortion provision.ResultsMost students intend to become trained to provide abortion services (69%), 20% reported that they will not provide an abortion under any circumstance, half (50%) had one or more concern about abortion provision and 16% agreed/strongly agreed that providing abortions is morally wrong. Most believed that their university should train medical and midwifery students to provide abortion services (70%–79%). Secular university students reported higher intentions to provide abortion services (beta 0.47, 95% CI: 0.31 to 0.63), more favourable views (beta 0.52, CI: 0.32 to 0.72) and were less likley to report concerns about abortion provision (adjusted OR 0.47, CI: 0.23 to 0.95) than students from religious universities.ConclusionMedical and midwifery students are interested in becoming trained to provide abortion services and believe their university should provide this training. Integrating high-quality training in abortion care into medical and midwifery programmes will be critical to ensuring that women receive timely, non-judgemental and quality abortion care.
•Chilean medical and midwifery students support recent abortion decriminalization.•Students will soon practice in a context that supports recent decriminalization.•Students have more favorable views ...about abortion than the general public.•Most Catholic university students support recent decriminalization of abortion.•Even more secular university students support recent decriminalization of abortion.
Soon after Chile decriminalized abortion under three limited circumstances in 2017, we assessed medical and midwifery students’ attitudes about abortion morality and legality when compared to national opinions.
We administered an anonymous, online survey to medical and midwifery students from seven secular and religiously-affiliated universities in Santiago, Chile. We compared student responses to a nationally representative public opinion survey.
We examined three main outcomes related to abortion attitudes: (1) moral acceptability of abortion and legal support for abortion in (2) one or (3) all listed circumstances. We used general estimating equations to examine whether university type, field of study, and other student characteristics are associated with each outcome and compared student views toward abortion legality with those of the general public.
Among the 369 student respondents, most agreed that abortion can be a good thing for some women in some situations (82%). When compared to the general public, a larger proportion of students supported decriminalizing abortion in at least one (83% and 97%, respectively) or all (17% and 51%, respectively) seven listed circumstances. While secular university students held significantly more favorable views about abortion morality and legality than students from religiously-affiliated universities, the majority of students from both university types supported abortion in the three cases in which it was recently decriminalized.
Medical and midwifery students from not only secular but also religiously-affiliated universities are very supportive of the recent decriminalization of abortion, which presents training opportunities for both types of universities.
Glaucoma is the leading cause of irreversible blindness, affecting 76 million globally. It is characterized by irreversible damage to the optic nerve. Pharmacotherapy manages intraocular pressure ...(IOP) and slows disease progression. However, non-adherence to glaucoma medications remains problematic, with 41-71% of patients being non-adherent to their prescribed medication. Despite substantial investment in research, clinical effort, and patient education protocols, non-adherence remains high. Therefore, we aimed to determine if there is a substantive genetic component behind patients' glaucoma medication non-adherence. We assessed glaucoma medication non-adherence with prescription refill data from the Marshfield Clinic Healthcare System's pharmacy dispensing database. Two standard measures were calculated: the medication possession ratio (MPR) and the proportion of days covered (PDC). Non-adherence on each metric was defined as less than 80% medication coverage over 12 months. Genotyping was done using the Illumina HumanCoreExome BeadChip in addition to exome sequencing on the 230 patients (1) to calculate the heritability of glaucoma medication non-adherence and (2) to identify SNPs and/or coding variants in genes associated with medication non-adherence. Ingenuity pathway analysis (IPA) was utilized to derive biological meaning from any significant genes in aggregate. Over 12 months, 59% of patients were found to be non-adherent as measured by the MPR80, and 67% were non-adherent as measured by the PDC80. Genome-wide complex trait analysis (GCTA) suggested that 57% (MPR80) and 48% (PDC80) of glaucoma medication non-adherence could be attributed to a genetic component. Missense mutations in
,
,
,
,
,
,
,
, and
were all found to be significantly associated with glaucoma medication non-adherence by whole exome sequencing after Bonferroni correction (
< 10
) (PDC80). While missense mutations in
,
,
, and
were found to be significantly associated with medication non-adherence by whole exome sequencing after Bonferroni correction (
< 10
) (MPR80). The same coding SNP in
which functions in Alzheimer's disease pathophysiology was significant by both measures and increased risk for glaucoma medication non-adherence by three-fold (95% CI, 1.62-5.8). Although our study was underpowered for genome-wide significance, SNP rs6474264 within ZMAT4 (
5.54 × 10
) was found to be nominally significant, with a decreased risk for glaucoma medication non-adherence (OR, 0.22; 95% CI, 0.11-0.42)). IPA demonstrated significant overlap, utilizing, both standard measures including opioid signaling, drug metabolism, and synaptogenesis signaling. CREB signaling in neurons (which is associated with enhancing the baseline firing rate for the formation of long-term potentiation in nerve fibers) was shown to have
associations. Our results suggest a substantial heritable genetic component to glaucoma medication non-adherence (47-58%). This finding is in line with genetic studies of other conditions with a psychiatric component (e.g., post-traumatic stress disorder (PTSD) or alcohol dependence). Our findings suggest both risk and protective statistically significant genes/pathways underlying glaucoma medication non-adherence for the first time. Further studies investigating more diverse populations with larger sample sizes are needed to validate these findings.
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