A rich tradition of research has addressed income inequality and health, but the issue has achieved a fresh currency with the reversals of economic fortunes wrought by the Great Recession. This paper ...analyses the degree to which changing inequality induced by the Great Recession impacted Europeans’ subjective health (self-rated health and satisfaction with health). To address this question, we analyse the multilevel European Quality of Life Survey conducted mainly in 2003, 2008, and 2012 which provides representative samples from 24 European countries at all three time points, as well as national-level data on inequality (Gini coefficient) and appropriate national-level and individual-level controls. We find that, net of GDP, inequality has no statistically significant impact before, during or after the Great Recession. Turning to determinants, our variance-components multi-level models controlling for known individual-level predictors show that inequality remains insignificant at all time points, while individual family income is strongly related to subjective health GDP per capita has little effect except indirectly through income. We also assessed impacts specifically for vulnerable, at-risk groups. Including GDP per capita, Gini coefficient, and individual level controls, our model explains about one quarter of the variance in health status (R-squared >.23). All in all, our results support a rational choice, materialist hypothesis: that absolute prosperity of the individual matters to subjective health, but income inequality does not, in Europe in this period. This supports a policy emphasis on increasing levels of pay, and on poverty relief, rather than on reducing inequality.
We report on the first search for Terrestrial Gamma‐ray Flashes (TGFs) from altitudes where they are thought to be produced. The Airborne Detector for Energetic Lightning Emissions (ADELE), an array ...of gamma‐ray detectors, was flown near the tops of Florida thunderstorms in August/September 2009. The plane passed within 10 km horizontal distance of 1213 lightning discharges and only once detected a TGF. If these discharges had produced TGFs of the same intensity as those seen from space, every one should have been seen by ADELE. Separate and significant nondetections are established for intracloud lightning, negative cloud‐to‐ground lightning, and narrow bipolar events. We conclude that TGFs are not a primary triggering mechanism for lightning. We estimate the TGF‐to‐flash ratio to be on the order of 10−2 to 10−3 and show that TGF intensities cannot follow the well‐known power‐law distribution seen in earthquakes and solar flares, due to our limits on the presence of faint events.
Key Points
TGFs are not associated with most lightning flashes
Therefore TGFs are not an important lightning trigger
There is no large population of “mini” TGFs
Abstract Context Family caregivers of individuals with serious illness who undergo intensive life-sustaining medical procedures at the end of life may be at risk of negative consequences including ...depression. Objective To determine the association between patients’ use of life-sustaining procedures at the end of life and depressive symptoms in their surviving spouses. Methods We used data from the Health and Retirement Study, a longitudinal survey of U.S. residents, linked to Medicare claims data. We included married Medicare beneficiaries aged 65 years and older who died between 2000-2011 (n=1258) and their surviving spouses. The use of life-sustaining procedures (i.e., intubation/mechanical ventilation; tracheostomy; gastrostomy tube insertion; enteral/parenteral nutrition; and cardiopulmonary resuscitation) in the last month of life was measured via claims data. Using propensity score matching, we compared change in depressive symptoms of surviving spouses. Results Eighteen percent of decedents underwent one or more life-sustaining procedures in the last month of life. Those whose spouses underwent life-sustaining procedures had a 0.32 point increase in depressive symptoms after death (scale range =0-8) and a greater likelihood of clinically significant depression (OR=1.51) compared to a matched sample of spouses of those who did not have procedures (p<.05). Conclusion Surviving spouses of those who undergo intensive life-sustaining procedures at the end of life experience a greater magnitude of increase in depressive symptoms than those whose spouses do not undergo such procedures. Further study of the circumstances and decision-making surrounding these procedures is needed to understand their relationship with survivors' negative mental health consequences and how best to provide appropriate support.
We formulate a new second-order closure turbulence model by employing a recent closure for the pressure-temperature correlation at the equation level. As a result, we obtain new heat flux equations ...that avoid the long-standing issue of a finite critical Richardson number. The new, structurally simpler model improves on the Mellor-Yamada 1982 and Galperin et al. 1988 models; key feature includes enhanced mixing under stable conditions facilitating agreement with observational, experimental and high-resolution numerical data sets. The model predicts a planetary boundary layer height deeper than predicted by models with low critical Richardson numbers, as demonstrated in single column model runs of the GISS ModelE general circulation model.
To examine the effect of the histology of carcinoma and sarcoma components on survival outcome of uterine carcinosarcoma.
A multicenter retrospective study was conducted to examine uterine ...carcinosarcoma cases that underwent primary surgical staging. Archived slides were examined and histologic patterns were grouped based on carcinoma (low-grade versus high-grade) and sarcoma (homologous versus heterologous) components, correlating to clinico-pathological demographics and outcomes.
Among 1192 cases identified, 906 cases were evaluated for histologic patterns (carcinoma/sarcoma) with high-grade/homologous (40.8%) being the most common type followed by high-grade/heterologous (30.9%), low-grade/homologous (18.0%), and low-grade/heterologous (10.3%). On multivariate analysis, high-grade/heterologous (5-year rate, 34.0%, P = 0.024) and high-grade/homologous (45.8%, P = 0.017) but not low-grade/heterologous (50.6%, P = 0.089) were independently associated with decreased progression-free survival (PFS) compared with low-grade/homologous (60.3%). In addition, older age, residual disease at surgery, large tumor, sarcoma dominance, deep myometrial invasion, lymphovascular space invasion, and advanced-stage disease were independently associated with decreased PFS (all, P < 0.01). Both postoperative chemotherapy (5-year rates, 48.6% versus 39.0%, P < 0.001) and radiotherapy (50.1% versus 44.1%, P = 0.007) were significantly associated with improved PFS in univariate analysis. However, on multivariate analysis, only postoperative chemotherapy remained an independent predictor for improved PFS hazard ratio (HR) 0.34, 95% confidence interval (CI) 0.27–0.43, P < 0.001. On univariate analysis, significant treatment benefits for PFS were seen with ifosfamide for low-grade carcinoma (82.0% versus 49.8%, P = 0.001), platinum for high-grade carcinoma (46.9% versus 32.4%, P = 0.034) and homologous sarcoma (53.1% versus 38.2%, P = 0.017), and anthracycline for heterologous sarcoma (66.2% versus 39.3%, P = 0.005). Conversely, platinum, taxane, and anthracycline for low-grade carcinoma, and anthracycline for homologous sarcoma had no effect on PFS compared with non-chemotherapy group (all, P > 0.05). On multivariate analysis, ifosfamide for low-grade/homologous (HR 0.21, 95% CI 0.07–0.63, P = 0.005), platinum for high-grade/homologous (HR 0.36, 95% CI 0.22–0.60, P < 0.001), and anthracycline for high-grade/heterologous (HR 0.30, 95% CI 0.14–0.62, P = 0.001) remained independent predictors for improved PFS. Analyses of 1096 metastatic sites showed that carcinoma components tended to spread lymphatically, while sarcoma components tended to spread loco-regionally (P < 0.001).
Characterization of histologic pattern provides valuable information in the management of uterine carcinosarcoma.
Purpose To conduct a systematic review to guide hand surgeons in an evidenced-based approach in managing postoperative pain. Methods We performed a literature review for primary research articles on ...management of postoperative pain in hand surgery patients using Medical Literature Analysis and Retrieval System Online (MEDLINE; PubMed), Excerpta Medica database (EMBASE), and the Cochrane Collaboration Library. Inclusion criteria were primary journal articles examining treatment of acute postoperative pain based on any modality. Data related to pain assessment, postoperative recovery, and total postoperative analgesic consumption were extracted. Results A total of 903 publications were reviewed; 184 publications underwent abstract review. After applying inclusion and exclusion criteria, 10 primary articles were selected for inclusion in this review. Data were noted to be heterogeneous and findings were compiled. Results were divided into groups evaluating postoperative pain medications or pain infusion catheters. Conclusions Although this review did not demonstrate a best practices model for postoperative pain management, it provides evidence for alternative medications and treatment strategies. The evidence available suggests that postoperative pain control should begin before surgery and that combining multiple strategies for pain treatment is beneficial. Given the increasing attention paid to narcotic prescriptions and the potential for abuse, surgeons should adopt evidence-based pain management practices. We provide an example algorithm for pain treatment in hand surgery based on available data and the authors’ experience. Type of study/level of evidence Therapeutic III.
In laboratory experiments using the engineering spare microcalorimeter detector from the ASTRO-E satellite mission, we recorded the x-ray emission of highly charged ions of carbon, nitrogen, and ...oxygen, which simulates charge exchange reactions between heavy ions in the solar wind and neutral gases in cometary comae. The spectra are complex and do not readily match predictions. We developed a charge exchange emission model that successfully reproduces the soft x-ray spectrum of comet Linear C/1999 S4, observed with the Chandra X-ray Observatory.
: Bisexual women, compared to heterosexual women, report greater amounts of alcohol use and heavy drinking. Alcohol expectancies (i.e., beliefs about alcohol outcomes) are a strong predictor of ...alcohol use, but few studies have examined the importance of alcohol expectancies in relation to alcohol use among bisexual women specifically or in comparison to heterosexual women.
: The current study examined 262 heterosexual and 225 bisexual women using an online survey about alcohol use, sexual risk-taking, and alcohol expectancy subtypes (sexuality, tension reduction, and aggression).
: Compared to heterosexual women, bisexual women reported greater sexuality and tension reduction expectancies after accounting for their level of drinking, but groups did not differ on aggression expectancies. Moreover, sexual identity status moderated the associations between sexuality and tension reduction expectancies and alcohol use, respectively. Specifically, our study findings suggested that sexuality and tension reduction alcohol expectancies were more strongly tied to alcohol use among bisexual women than heterosexual women.
: Taken together, in our study, bisexual women held stronger sexuality and tension reduction expectancies, as compared to heterosexual women. Interventions targeting alcohol expectancies may be considered when tailoring intervention content for this population.
The mergers of supermassive black hole binaries (SMBHBs) promise to be incredible sources of gravitational waves (GWs). While the oscillatory part of the merger gravitational waveform will be outside ...the frequency sensitivity range of pulsar timing arrays, the nonoscillatory GW memory effect is detectable. Further, any burst of GWs will produce GW memory, making memory a useful probe of unmodeled exotic sources and new physics. We searched the North American Nanohertz Observatory for Gravitational Waves (NANOGrav) 11 yr data set for GW memory. This data set is sensitive to very low-frequency GWs of ∼3 to 400 nHz (periods of ∼11 yr-1 month). Finding no evidence for GWs, we placed limits on the strain amplitude of GW memory events during the observation period. We then used the strain upper limits to place limits on the rate of GW memory causing events. At a strain of 2.5 × 10−14, corresponding to the median upper limit as a function of source sky position, we set a limit on the rate of GW memory events at <0.4 yr−1. That strain corresponds to an SMBHB merger with reduced mass of M ∼ 2 × 1010 and inclination of = π/3 at a distance of 1 Gpc. As a test of our analysis, we analyzed the NANOGrav 9 yr data set as well. This analysis found an anomolous signal, which does not appear in the 11 yr data set. This signal is not a GW, and its origin remains unknown.
Abstract Background Current literature provides conflicting data regarding seasonal variability in dietary intake. Objective Our aim was to examine seasonal variation in dietary intake in healthy ...adults from the metropolitan Washington, DC, area. Design This study utilized an observational cohort design. Participants/setting Male and female healthy volunteers (n=103) between the ages of 18 and 75 years were recruited from the metropolitan Washington, DC, area to participate in a clinical study at the National Institutes of Health Clinical Center from February 2011 to June 2014. Main outcome measures Three- to seven-day food records were collected from subjects (n=76) at three time points (12 to 15 weeks apart). Subjects were excluded from analysis (n=27) if they completed less than three time points. Food records were reviewed by nutrition staff, assigned to a season, and coded in Nutrient Data System for Research for energy, macronutrient, micronutrient, and food-group serving analysis. Statistical analyses Multivariate general linear models were run on energy, macronutrient, micronutrient, and food-group intakes, while being adjusted for age, sex, race, and body mass index (calculated as kg/m2 ). Results Subjects had a mean±standard deviation body mass index of 25±3.9 and age of 34±12.4 years. Subject demographics were 71.1% white, 9.2% black/African American, 13.2% Asian, and 6.6% unknown race, with 44.7% males and 55.3% females. Mean intake of energy across seasons was 2,214.6±623.4 kcal with 17.3%±4.1%, 33.6%±5.5%, 46.6%±8.0%, and 2.7%±3.2% of calories from protein, fat, carbohydrate, and alcohol, respectively. Intakes of energy, macronutrients, micronutrients, and food groups did not differ between seasons. Conclusions People living in the metropolitan Washington, DC, area did not exhibit seasonal variation in dietary intake. Therefore, when designing studies of nutrient intake in a metropolitan population, these findings suggest that investigators do not need to consider the season during which diet is examined.
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