Near-universal hospitalization of US emergency department patients with cancer and febrile neutropenia

IMPORTANCE: Febrile neutropenia (FN) is the most common oncologic emergency and is among the most deadly. Guidelines recommend risk stratification and outpatient management of both pediatric and adult FN patients deemed to be at low risk of complications or mortality, but our prior single-center research demonstrated that the vast majority (95%) are hospitalized. OBJECTIVE: From a nationwide perspective, to determine the proportion of cancer patients of all ages hospitalized after an emergency department (ED) visit for FN, and to analyze variability in hospitalization rates. Our a priori hypothesis was that >90% of US cancer-associated ED FN visits would end in hospitalization. DESIGN: Analysis of data from the Nationwide Emergency Department Sample, 2006-2014. SETTING: Stratified probability sample of all US ED visits. PARTICIPANTS: Inclusion criteria were: (1) Clinical Classification Software code indicating cancer, (2) diagnostic code indicating fever, and (3) diagnostic code indicating neutropenia. We excluded visits ending in transfer. EXPOSURE: The hospital at which the visit took place. MAIN OUTCOMES AND MEASURES: Our main outcome is the proportion of ED FN visits ending in hospitalization, with an a priori hypothesis of >90%. Our secondary outcomes are: (a) hospitalization rates among subsets, and (b) proportion of variability in the hospitalization rate attributable to which hospital the patient visited, as measured by the intra-class correlation coefficient (ICC). RESULTS: Of 348,868 visits selected to be representative of all US ED visits, 94% ended in hospitalization (95% Confidence Interval [CI] 93-94%). Each additional decade of age conferred 1.23x increased odds of hospitalization. Those with private (92%), self-pay (92%), and other (93%) insurance were less likely to be hospitalized than those with public insurance (95%, odds ratios [OR] 0.74-0.76). Hospitalization was least likely at non-metropolitan hospitals (84%, OR 0.15 relative to metropolitan teaching hospitals), and was also less likely at metropolitan non-teaching hospitals (94%, OR 0.64 relative to metropolitan teaching hospitals). The ICC adjusted for hospital random effects and patient and hospital characteristics was 26% (95%CI 23-29%), indicating that 26% of the variability in hospitalization rate was attributable to which hospital the patient visited. CONCLUSIONS AND RELEVANCE: Nearly all cancer-associated ED FN visits in the US end in hospitalization. Inter-hospital variation in hospitalization practices explains 26% of the limited variability in hospitalization decisions. Simple, objective tools are needed to improve risk stratification for ED FN patients

XENON1T Takes a Razor to a Dark E6E_6-Inspired Model

Motivated by the recent result of XENON1T collaboration with full exposure, 279 life days, that sets the most stringent limit on the spin-independent dark matter-nucleon scattering cross section we discuss a dark $E_6$-inspired model that features the presence of a $U(1)_{d-u}$ gauge symmetry. The dark matter candidate is a Dirac fermion that interacts with Standard Model fermions via a massive Z' that preserves the quantum number assignments of this symmetry. We compute the spin-independent scattering cross section off xenon nucleus and compare with the XENON1T limit; find the LHC bound on the Z' mass as well as the projection sensitivity of high-energy and luminosity LHC; and derive the Fermi-LAT bounds on the dark matter annihilation cross section based on the observation of gamma-rays in the direction of Dwarf Spheroidal galaxies. We exploit the complementarity between these datasets to conclude that the new bound from XENON1T severely constrain the model, which combined with the LHC upgrade sensitivity rules out this WIMP realization setup below 5 TeV.Comment: 7 pages, 3 figure

Ancient Landslide Reactivation at the Viaduct No. 1 Located on the Caraca-La-Guaira Highway in Venezuela

Reactivation of an ancient landslide detected in 1987 affected the southern side of the Viaduct No.1 located in the Caracas-La Guaira highway, which connects Caracas, capital of Venezuela, with its main seaport and the Simon Bolivar International Airport. The Viaduct was built in 1953 and covered a gorge of approximately 300 m. It consisted of three parallel double-hinged arch ribs made of plain concrete spanning over approximately 152 m and two smaller access Viaducts on either side of the arch rib span. This paper summarizes the results from geotechnical investigation, the evaluation of inclinometers readings and surface control points and the main rehabilitation measures conducted on the structure

A Two Higgs Doublet Model for Dark Matter and Neutrino Masses

Motivated by the interesting features of Two Higgs Doublet Models (2HDM) we present a 2HDM extension where the stability of dark matter, neutrino masses and the absence of flavor changing interactions are explained by promoting baryon and lepton number to gauge symmetries. Neutrino masses are addressed within the usual type I seesaw mechanism. A vector-like fermion acts as dark matter and it interacts with Standard Model particles via the kinetic and mass mixings between the neutral gauge bosons. We compute the relevant observables such as the dark matter relic density and spin-independent scattering cross section to outline the region of parameter space that obeys current and projected limits from collider and direct detection experiments via thermal and non-thermal dark matter production.Comment: 9 pages, 3 figure

Neutrino Masses in a Two Higgs Doublet Model with a U(1) Gauge Symmetry

General Two Higgs Doublet Models (2HDM) are popular Standard Model extensions but feature flavor changing interactions and lack neutrino masses. We discuss a 2HDM where neutrino masses are generated via type I seesaw and propose an extension where neutrino masses are generated via a type II seesaw mechanism with flavor changing interactions being absent via the presence of a U(1) gauge symmetry. After considering a variety of bounds such as those rising from collider and electroweak precision we show that our proposal stands as a UV complete 2HDM with a dark photon where neutrino masses and flavor changing interactions are addressed. A possible dark matter realization is also discussed.Comment: 2 figures, 44 pages. Version accepted for publication in JHE

Análisis económico de los derechos colectivos y su mecanismo de protección jurisdiccional en Colombia: El papel de los incentivos, la acción colectiva y la provisión de bienes públicos

El objetivo de este artículo es presentar una aproximación a la naturaleza de los derechos colectivos y sus mecanismos de protección jurisdiccional (las acciones populares), bajo la óptica del Análisis Económico del Derecho. Se resalta inicialmente la utilidad e importancia de considerar las reglas legales como incentivos individuales para resolver fenómenos complejos como la coordinación y cooperación colectiva en la provisión de bienes públicos; en este contexto y luego de efectuar un análisis jurídico de los derechos colectivos en el marco del ordenamiento nacional, el artículo propone una relectura de éstos derechos pero desde la perspectiva del AED; al respecto, se argumenta que los derechos colectivos pueden ser asimilados consistentemente con el concepto económico de bienes públicos, supuesto a lo cual se asocia el desarrollo de un sistema de incentivos económicos selectivos –como lo denomina Olson (1992)– que garantice la solución de los problemas propios de la acción colectiva por medio de la cual se estimule la producción de estos tipos bienes. Con todos los elementos señalados, y teniendo en cuenta la eliminación de los incentivos económicos en las acciones populares a partir de la Ley 1425 de 2010, el artículo demuestra que dicho cambio normativo propicia un escenario de desprotección de los derechos colectivos, que económicamente puede representar un costo incluso mayor que el problema que supuestamente se buscaba corregir. En razón a lo anterior, el artículo finaliza planteando un modelo teórico preliminar que puede señalar algunas alternativas regulatorias para tratar de abrir el debate en torno a la corrección de los problemas de desprotección señalados y cumpliendo con tres restricciones a saber: evitar que se afecte el erario; no propiciar la congestión judicial; y alcanzar un superior de Pareto que lleve a la protección de los derechos colectivos

Drought effects on litterfall, wood production and belowground carbon cycling in an Amazon forest: results of a throughfall reduction experiment

The Amazon Basin experiences severe droughts that may become more common in the future. Little is known of the effects of such droughts on Amazon forest productivity and carbon allocation. We tested the prediction that severe drought decreases litterfall and wood production but potentially has multiple cancelling effects on belowground production within a 7-year partial throughfall exclusion experiment. We simulated an approximately 35–41% reduction in effective rainfall from 2000 through 2004 in a 1 ha plot and compared forest response with a similar control plot. Wood production was the most sensitive component of above-ground net primary productivity (ANPP) to drought, declining by 13% the first year and up to 62% thereafter. Litterfall declined only in the third year of drought, with a maximum difference of 23% below the control plot. Soil CO2 efflux and its 14C signature showed no significant treatment response, suggesting similar amounts and sources of belowground production. ANPP was similar between plots in 2000 and declined to a low of 41% below the control plot during the subsequent treatment years, rebounding to only a 10% difference during the first post-treatment year. Live aboveground carbon declined by 32.5 Mg ha−1 through the effects of drought on ANPP and tree mortality. Results of this unreplicated, long-term, large-scale ecosystem manipulation experiment demonstrate that multi-year severe drought can substantially reduce Amazon forest carbon stocks